anands

Human Anatomy
for
Dental Students
3rd Edition
T
he book is authored by Professor Mahindra Kumar Anand, MBBS,
MS, DO, PhD, DHA Prof. Mahindra Kumar Anand is an eminent
teaching faculty with an experience of more than two decades. He
did his graduation from Maulana Azad Medical College, Delhi and his
postgraduation in Anatomy and Ophthalmology from Lady Hardinge Medical
College, Delhi. He was awarded PhD for his work in neural tube defects
from S P University, Gujarat. He has further done postgraduate diploma in
hospital administration. He has an excellent academic record with a number
of national and international publications to his credit.
He is presently Head of Department of Anatomy, Sudha Rustagi College
of Dental Sciences and Research, Faridabad. He is also visiting professor
in University of West Indies, Cave Hill Campus, Barbados. He has been
an active member of the editorial board of International Journal of Surgical
Radiologic Anatomy for many years. He has worked as an editor-in-chief
with a publication house in the past.
He has vast experience in teaching, administration and clinical knowledge.
His primary area of interest is developing models for adopting newer
teaching methods specially integrated teaching of anatomy with special
interest in medical illustrations.
anands
Human Anatomy
for
Dental Students
3rd Edition
Mahindra Kumar Anand
MBBS, MS, DO, PhD, DHA
Professor and Head
Department of Anatomy
Sudha Rustagi College of Dental Sciences and Research
Kheri More, Faridabad, Haryana, India
Visting Professor
University of West Indies, Cave Hill Campus, Barbados, West Indies
Formerly
Lady Hardinge Medical College, New Delhi
Maulana Azad Medical College, New Delhi
Pramukshwami Medical College, Karamsad, Gujarat
Manipal College of Medical Sciences, Pokhra, Nepal

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anands Human Anatomy for Dental Students

2012, Jaypee Brothers Medical Publishers

All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted
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Third Edition: 2012

ISBN 978-93-5025-503-2
Typeset at JPBMP typesetting unit
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 Preface to the Third Edition
It is my pleasure to introduce the third edition of anands Human Anatomy for Dental students. However, since the time of first
edition there have been significant changes in the understanding and perception of need based teaching methods.
The present edition of textbook is written according to the modern day need based teaching. The textbook presents with
six sections. The initial part of first section deals with general anatomy, a must for laying foundation of body structure, chapter
4 is organization of body, gives a comprehensive overview of composition of body, its various parts with essentials of
regional anatomy of limbs, thorax and abdomen.
Subsequent chapters till chapter no. 17 deals with systemic anatomy, i.e. anatomy of various systems of body with their
clinical significance.
The section of Head and Neck is extensively covered and has more illustrations. The third section is histology, it has been
modified and includes systematically written text and photographs of slides of each organ. The student will be able to understand
the text and its functional relevance. Diagrammatic pictures corresponding to each slide have been given alongside for the
students so that they can easily draw them.
The final sections include genetics, essentials of embryology and clinical radiological anatomy. General embryology has
been given in detail and explains the basis of various developmental diseases.
The additional feature of book is that after every section review viva questions have been given for quick revision. The
questions are designed to stimulate the students to correlate the subject and its clinical relevance and to help them prepare for
examinations.
I am humbled by the immense popularity of the previous two editions and have strived further to provide the best to the
students in this edition. I am open to any constructive suggestions and would welcome feedback by students for the same.

Mahindra Kumar Anand

MBBS, MS, DO, PhD, DHA

Preface to the First Edition

This book is designed as complete and comprehensive textbook of human anatomy for first year of BDS. With the advances in
technology and introduction of computer based teaching, it is essential to have a book which is need based. I have strived to
provide a comprehensive, up to date, readable and informative textbook.
Adequate text has been included in a clear and concise language with the aim to help students in preparing for examinations.
General anatomy, which is the foundation of understanding the subject is included in the beginning.
To simplify learning extensive illustrations have been included in the book.
A sound knowledge of anatomy is the basis of further clinical studies. I have provided applied anatomy in the form of
highlighted boxes at the end of each topic. This will, I hope make it more interesting and easier to understand. A special feature
of the book is inclusion of histology, embryology, osteology and neurology along with all sections of gross anatomy.
Though this book is essentially for undergraduate students is can be useful for various postgraduate entrance examinations
and as a basic knowledge guide for postgraduate students.
It gives me extreme pleasure to acknowledge the support, assistance and cooperation rendered by all those who were
closely involved in the making of this book. I hope the students will find the contents useful and enjoy reading this book as
much as I have enjoyed writing it for them.

Mahindra Kumar Anand

MBBS, MS, DO, PhD, DHA
 Contents
Section 1: General and Systemic Anatomy
1. Introduction and Anatomical Terms ...................................................................................................................3-12
2. Cell ......................................................................................................................................................................... 13-18
3. Tissues .................................................................................................................................................................. 19-26
4. Organization of Body .......................................................................................................................................... 27-66
5. Skeletal System and Joints ................................................................................................................................. 67-80
6. Muscular System ................................................................................................................................................. 81-82
7. Nervous System ................................................................................................................................................. 83-112
8. Cardiovascular System ................................................................................................................................... 113-134
9. Blood and Its Components ............................................................................................................................. 135-142
10. Lymphatic System ........................................................................................................................................... 143-154
11. Respiratory System ......................................................................................................................................... 155-166
12. Digestive System ............................................................................................................................................. 167-176
13. Urinary System ................................................................................................................................................ 177-180
14. Endocrine System ............................................................................................................................................ 181-186
15. Reproductive System ...................................................................................................................................... 187-194
16. Skin and its Appendages ............................................................................................................................... 195-198
17. Review of General and Systemic Anatomy ................................................................................................ 199-208

Section 2: Head and Neck

18. Osteology of Head and Neck ......................................................................................................................... 211-256
19. Scalp and Face .................................................................................................................................................. 257-270
20. Eye and Orbit ................................................................................................................................................... 271-300
21. Dura Mater, Intra Cranial Venous Sinuses ................................................................................................. 301-308
22. Pituitary Gland ................................................................................................................................................. 309-312
23. Temporal and Infratemporal Regions ......................................................................................................... 313-328
24. Parotid and Submandibular Regions ........................................................................................................... 329-338
25. Neck and Its Triangles ................................................................................................................................... 339-364
26. Back of Neck and The Back .......................................................................................................................... 365-370
27. Oral Cavity ........................................................................................................................................................ 371-388
28. Nose and Paranasal Sinuses .......................................................................................................................... 389-398
29. Pharynx ............................................................................................................................................................. 399-410
30. Larynx ................................................................................................................................................................ 411-422
31. Ear ...................................................................................................................................................................... 423-434
32. Cervical Viscera and Deep Muscles of Neck .............................................................................................. 435-442
 33. Lymphoid Tissue and Joints of Head and Neck ........................................................................................ 443-448
34. Surface Anatomy of Head and Neck ........................................................................................................... 449-460
35. Review of Head and Neck ............................................................................................................................. 461-482

Section 3: Histology
36. Histological Techniques ................................................................................................................................. 485-488
37. Epithelial Tissue and Glands ........................................................................................................................ 489-500
38. Connective Tissue ........................................................................................................................................... 501-504
39. Cartilage and Bone .......................................................................................................................................... 505-514
40. Muscle ............................................................................................................................................................... 515-522
41. Nervous System ............................................................................................................................................... 523-532
42. Cardiovascular System ................................................................................................................................... 533-538
43. Lymphatic System ........................................................................................................................................... 539-544
44. Respiratory System ......................................................................................................................................... 545-552
45. Digestive System ............................................................................................................................................. 553-572
46. Urinary System ................................................................................................................................................ 573-580
47. Male Reproductive System ............................................................................................................................ 581-590
48. Female Reproductive System ........................................................................................................................ 591-600
49. Endocrine System ............................................................................................................................................ 601-610
50. Review of Histology ........................................................................................................................................ 611-614

Section 4: Genetics
51. Cell Division ..................................................................................................................................................... 617-622
52. Cytogenetics, Chromosome and Chromosomal Abnormalities .............................................................. 623-630
53. Molecular Basis of Genetics .......................................................................................................................... 631-636
54. Review of Genetics ......................................................................................................................................... 637-640

Section 5: Essentials of Embryology

55. General Embryology ....................................................................................................................................... 643-676
56. Development of Musculoskeletal System .................................................................................................. 677-684
57. Development of Head and Neck .................................................................................................................. 685-698
58. Development of Nervous System ................................................................................................................. 699-708
59. Molecular Regulation of Development........................................................................................................ 709-710
60. Review of Embryology .................................................................................................................................... 711-718

Section 6: Radiological Anatomy and Anatomical Basis of Clinical Examination

61. Radiological Anatomy ..................................................................................................................................... 721-730
62. Anatomical Basis of Clinical Examination .................................................................................................. 731-742
Index ................................................................................................................................................................... 743-752

viii
 Section-1: General and Systemic Anatomy
1. Introduction and Anatomical Terms ...................... 3-12
2. Cell ............................................................................ 13-18
3. Tissues....................................................................... 19-26
4. Organization of Body ............................................. 27-66
5. Skeletal System and Joints ..................................... 67-80
6. Muscular System ..................................................... 81-82
7. Nervous System .................................................... 83-112
8. Cardiovascular System ....................................... 113-134
9. Blood and Its Components ................................ 135-142
10. Lymphatic System ............................................... 143-154
11. Respiratory System ............................................. 155-166
12. Digestive System ................................................. 167-176
13. Urinary System .................................................... 177-180
14. Endocrine System ................................................ 181-186
15. Reproductive System .......................................... 187-194
16. Skin and Its Appendages ................................... 195-198
17. Review of General and Systemic Anatomy ..... 199-208
 Chapter
1 Introduction and
Anatomical Terms
Anatomy is the oldest medical science. History of
anatomy traces its origin to early Greek civilizations
around 400 B.C. The word anatomy is derived from
Greek word anatome which means taking apart.
Anatomy is the study of various structures and their
relations in the body.
SUBDIVISIONS OF ANATOMY
Gross Anatomy or Macroscopic Anatomy
It is the study of various structures of human body
(usually carried out by dissection of cadavers or dead
bodies) usually with naked eyes. Gross anatomy can be
studied under the subdivisions of systemic anatomy and
regional anatomy.
Systemic Anatomy (Fig. 1.1)
It is the study of structure of various systems in the body.
1. Skeletal system: It consists of bones, ligaments,
cartilage and joints.
Functions of skeletal system
1. Supports body
2. Forms framework of body
3. Protects internal organs
4. Transmits body weight
2. Muscular system: It consists of muscles and
tendons.
Functions of muscular system
1. Responsible for movement of skeleton and
various hollow viscera of the body.
2. Is the site of heat production in body.
3. Nervous system: It includes brain, spinal cord,
spinal nerves, cranial nerves and sympathetic and
parasympathetic ganglia.
Functions of nervous system
1. Receives and interprets sensory information
2. Regulates voluntary and involuntary body
functions.
4. Endocrine system: It consists of endocrine glands
namely thyroid gland, suprarenal gland, pituitary
gland, ovaries, testes and pancreas, etc.
Functions of endocrine system
Regulates various body functions by secreting
hormones. It is responsible for normal growth,
development and metabolism of the body.
5. Cardiovascular system: It includes heart, arteries,
veins, blood, lymphatics and lymphoid organs.
Functions of cardiovascular system
C H A P T E R-1
1. Transports oxygen and nutrients to tissues
and removes waste products from tissues.
2. Lymphatic system
a. Carries macromolecules
b. Returns tissue fluids to blood
c. Destroys pathogens that enter the body, i.e.,
it provides the immunity.
6. Respiratory system: It consists of larynx, trachea,
bronchi, lungs.
Functions of respiratory system
Responsible for exchange of O2 and CO2 between air
and blood. O2 is taken up and CO2 is excreted out.
7. Gastrointestinal or digestive system: It includes oral
cavity, oesophagus, stomach, small intestine, large
intestine, anal canal and associated glands.
Functions of digestive system
1. Ingestion of food
2. Digestion and absorption of food: Changes food
to simple chemicals that can be absorbed and
assimilated or used by the body.
3. Detoxification and elimination of waste (by liver
and large intestine).
8. Urinary system: It includes kidney, urinary
bladder, ureters and urethra.
Functions of urinary system
1. Removes waste products from blood in the form
of urine.
2. Regulates the volume and pH of extra cellular
fluid.
S E C T I O N-1 4 Human Anatomy For Dental Students

Fig. 1.1: Different systems of the body

9. Reproductive system: It is formed by a pair of testis, 3. Prevents excessive water loss.

prostate gland, vas deferens, ejaculatory duct and 4. Is a major sense organ.
penis in male; vagina, uterus, uterine tubes and a
Regional Anatomy
pair of ovaries in female.
It is the study of the structure and organisation of a
Functions of reproductive system
definitive part of the body (Figs 1.2 and 1.3). The various
Propogation of species for survival and existence.
parts or regions of the body studied are
10. Integumentary system: It consists of skin, hair, nails 1. Head and neck
and subcutaneous tissue. 2. Thorax
Functions of integumentary system 3. Abdomen
1. Protects internal structures from physical and 4. Pelvis
chemical excesses 5. Back
2. Is a barrier to pathogens and chemicals. 6. Extremities: Upper and lower limbs

Fig. 1.2: Anterior aspect of human body showing different
regions
Functional Anatomy
Study of anatomy which provides correlation between
structure and function of various organs.
Developmental Anatomy
Study of prenatal and postnatal developmental changes
of the human body.
Histology and Cytology
Study of various body structures, organs, tissues and
cells in greater details with the help of microscope. It
includes functions of these structures also.
Surface Anatomy
Study of projection of internal body parts on the
corresponding external surface of the body. This helps
in clinical correlation with normal and abnormal
anatomy.
Radiographic Anatomy
Study of anatomy of various organs of the body with
Introduction and Anatomical Terms 5
C H A P T E R-1
Fig. 1.3: Posterior aspect of human body showing different
regions
the help of plain or contrast radiography (X-ray, CT scan,
MRI).
Physical Anthropology
Study of external features and variations in their
measurements of different races and groups of people
and their comparison with the prehistoric remains.
Clinical Anatomy
It emphasizes the structure and function of a part or the
entire body in relation to the practice of medicine and
other health related professions.
Experimental Anatomy
Study of factors, with the help of experiments, which
determine the form, structure and function of different
parts of the body.
Comparative Anatomy
Study of structural variation between other animals and
human beings. This helps to trace the sequence of events
in the structural evolution of human beings.
 6 Human Anatomy For Dental Students

TERMINOLOGY USED IN ANATOMY Other Positions of the Body

Anatomical Position
1. Supine position: Person lies straight on the back
This is the conventional position of the body according
with face directed upwards (Recumbent) (Fig. 1.5).
to which all anatomical descriptions are made.
2. Prone position: Person lies straight on the abdomen
Body is erect, the eyes face forward, arms are kept
and face is directed downwards (Fig. 1.6).
by the side with palms facing forward. The legs are
3. Lithotomy position: Person lies supine with hips
kept together with feet directed forwards (Fig. 1.4).
and knees semiflexed, thighs abducted and feet
strapped in position (Fig. 1.7). This position is useful
Importance of Anatomical Positon
in the examination of pelvic viscera of female and
All structures of our body are described in relation to is commonly practiced for delivery of a baby.
this position, irrespective to any body posture in
space.
S E C T I O N-1

Fig. 1.4: Anatomical position

 Introduction and Anatomical Terms 7

Fig. 1.5: Supine position

C H A P T E R-1
Fig. 1.6: Prone Position

Fig. 1.7: Lithotomy position

Anatomical Planes (Fig. 1.8)
Description of the various parts of the body is based on
the following four imaginary planes that divide the body
1. Midsagittal or median plane: It is a vertical plane
that passes between anterior midline and posterior
midline of the body dividing it into left and right
halves.
2. Sagittal planes: These are planes passing parallel
to the median plane on either side.
3. Coronal or frontal plane: It is a vertical plane which
is perpendicular to midsagittal plane. Mid coronal
plane divides the body into equal anterior and
posterior halves.
4. Transverse planes: These are planes that pass
perpendicular to the midsagittal and coronal
planes, dividing the body transversely.
Commonly used anatomical terms to describe the
position of a body part and structure (Figs 1.9 to 1.11).
a. Anterior: Towards the front aspect of the body.
b. Posterior: Towards the back of the body.
c. Superior: Towards the head of the body.
d. Inferior: Towards the feet of the body.
e. Central: Towards the centre of mass of body.
f. Peripheral: Away from the centre of mass of body.
S E C T I O N-1 8 Human Anatomy For Dental Students

Fig. 1.9: Anatomical terms

Fig. 1.8: Anatomical planes

g. Medial: Towards the median plane.

h. Lateral: Away from the median plane.
i. External: Close to the surface of the body.
j. Internal: Close to the centre or interior of the body.
k. Ventral: Towards the anterior aspect of the body
(in reference to belly).
l. Dorsal: Towards the posterior aspect of the body
(in reference to back of the trunk).
m. Proximal: This term is used for limbs. Proximal
structure is the one which is nearer to the trunk.
n. Distal: This term is used for limbs. Distal structure
is the one which is away from the trunk.
o. Radial border: It is the outer border of forearm.
p. Ulnar border: It is the inner border of forearm.
q. Tibial border: It is the inner border of leg.
r. Fibular border: It is the outer border of leg.
Fig. 1.10: Anterior or ventral aspect of body (Anatomical terms)

Fig. 1.11: Posterior or dorsal aspect of body (Anatomical terms)
s. Preaxial border: The outer border in the upper limb,
and the inner border in the lower limb.
t. Postaxial border: The inner border in the upper
limb, and the outer border in the lower limb.
u. Palmar or volar aspect of hand: This pertains to
the palm of hand.
v. Plantar aspect of foot: This pertains to the sole of
foot.
Introduction and Anatomical Terms 9
C H A P T E R-1
w. Superficial: Location of a structure towards the
surface of the body.
x. Deep: Location of a structure inner to the surface
of the body.
y. Ipsilateral: This term denotes any two structures
lying on the same side of the body.
z. Contralateral: This term denotes any two structures
lying on the opposite sides of the body.
 10 Human Anatomy For Dental Students

Terms Used for Various Body Movements 4. Adduction: This describes the movement towards
the median plane, moving upper limb towards the
1. Flexion: In this movement two flexor surfaces come
trunk (Fig. 1.15).
in approximation and angle of the joint is reduced
(Fig. 1.12).

Fig. 1.12: Flexion of forearm Fig. 1.15: Adduction of upper limb

2. Extension: In this movement there is approxima- 5. Medial rotation: Medial rotation denotes move-
tion of extensor surfaces whereby angle of joint ment towards median plane or inward rotation,
increases (Fig. 1.13). medial rotation of arm at shoulder joint (Fig. 1.16).
S E C T I O N-1

Fig. 1.13: Extension of forearm Fig. 1.16: Medial rotation of arm

3. Abduction: It describes the movement away from 6. Lateral rotation: Lateral rotation denotes rotation
the median plane moving away upper limb from away from the median plane or outward rotation,
trunk (Fig. 1.14). lateral rotation of arm at shoulder joint (Fig. 1.17).

Fig. 1.14: Abduction of upper limb Fig. 1.17: Lateral rotation of arm
 Introduction and Anatomical Terms 11

7. Circumduction: Combined movement of flexion, 14. Inversion of foot: It is the movement that causes
extension, adduction and abduction in a circular the plantar surface of foot to face inwards and
manner is termed as circumduction. downwards (Fig. 1.20).
8. Elevation: Raising or moving a body part towards
the cephalic (head) end is termed as elevation.
9. Depression: Lowering or moving a body part
caudally (toe) is termed as depression.
10. Protrusion: It is the forward movement of a body
part.
11. Retraction: It is the backward movement from
protrusion.
12. Pronation: It is the medial rotation of forearm so
that the palm comes to face backwards (Fig. 1.18).

Fig. 1.20: Inversion of foot

15. Eversion of foot: It is the movement that causes

the plantar surface of foot to face laterally and
downwards (Fig. 1.21).

C H A P T E R-1
Fig. 1.18: Pronation of forearm

13. Supination: It is the lateral rotation of forearm so

that the palm comes to face anteriorly (forwards)
(Fig. 1.19).
Fig. 1.21: Eversion of foot

16. Opposition: It is a combination of abduction,

medial rotation and flexion. This movement
characteristically occurs in the thumb (Fig. 1.22).

Fig. 1.19: Supination of forearm Fig. 1.22: Opposition of thumb

 Chapter
2
INTRODUCTION
Cell is the smallest independent unit of life. Cells with
similar functions and structures are grouped together
to form tissues. The cells that make the body are bathed
in extracellular fluid and are enclosed by the integument
of the body.
The study of structure and function of cells is known
as cell biology.
Structure of cell: Human body cells are eukaryotic (Fig. 2.1).
Each cell consists of three primary parts. These are:
1. Cell membrane
2. Cytoplasm
3. Nucleus
CELL MEMBRANE
It is also known as plasma membrane and it forms the
external envelope of cell. It separates the intracellular
compartment from the extracellular fluid which bathes
the cell. Thickness of the membrane is 75A. It is
semipermeable. Electron microscopy reveals that it
consists of three layers:
Fig. 2.1: Structure of cell (diagrammatic picture on electron microscopy)
Cell
1. Outer protein layer: It provides elasticity and
mechanical resistance. Its thickness is 25A.
2. Intermediate lipid layer: It is also known as the
bimolecular phospholipid layer. It is 25 to 35A thick
and consists of two rows of phopholipids. It is
permeable to those substances which are soluble in
lipid.
3. Inner protein layer: It is 25A thick.
The phospholipids are arranged in a double layer.
The hydrophobic part (water insoluble) of the
phospholipids face each other and the hydrophilic (water
C H A P T E R-2
soluble) part face extra cellular fluid on one side and
cytoplasm of cell on other. Membrane proteins are
arranged either in the periphery of membrane (known as
peripheral proteins) or may extend throughout its
thickness (these are known as integral proteins). Most
proteins are glycoproteins.
Functions of membrane proteins are as follows
Anchor cells to one another and to the basement
membrane.
Act as pumps which actively transport ions across
membrane.
 14 Human Anatomy For Dental Students
Act as carriers: Carry various molecules along their
concentration gradient that is, they provide facili-
tated transport.
Act as ion channels: Form gateway for passage of
ions and water. They may be constantly open
(example water channels) or remain closed
(example sodium channels). The closed channels
open on activation by a chemical or electrical
stimulus.
Function as receptors or recognition sites for various
hormones and other chemical messengers that
further activate intracellular reactions.
Function as enzymes: Catalyze various reactions
within the cell.
Provide immunological identity to the cell.
Functions of Plasma Membrane
1. It helps to maintain the shape of a cell.
2. It is selectively permeable: Thus, it regulates
movements of various ions and molecules in and
out of the cell. This is essential to maintain the
internal melieu of the cell for its proper functioning.
3. Various receptors are present on the cell membrane.
S E C T I O N-1
4. It aids in recognition of identical cells with the help
of cell coat which is specific to those cells. It plays
an important role in intercellular communication.
5. It helps in the process of endocytosis and exocytosis.
Glycocalyx
The outer protein layer of plasma membrane is covered
by a cell coat known as glycocalyx. It is made up of a
carbohydrate rich layer consisting of the carbohydrate
components of membrane glycoproteins and glyco-
lipids. This layer has various cell antigens including
histocompatibility antigens, blood group antigens and
adhesion molecules. It helps to maintain the integrity of
the tissues.
TRANSPORT ACROSS CELL MEMBRANE
The cell membranes are semipermeable, that is they
allow only selected substances to pass across them.
Cell membranes do not allow transport of
intracellular proteins and other organic anions to
the exterior.
Transport of various substances across cell
membrane depends on their molecular size, lipid
solubility, electronic charge, presence of transport
proteins and transmembrane channels for the
substances.
Oxygen (O2) and nitrogen (N2) have no charge, are
non polar and diffuse easily across cell membrane.
CO2 is polar with low molecular weight and it also
diffuses easily.
The lipid bilayer is permeable to water and also has
water channels that facilitate diffusion along its
concentration gradient.
Substances like glucose, aminoacids and various
ions cannot permeate cell membrane directly. Na+,
K+, Ca++, Cl and HCO3 are transported through
special channels. Amino acids, proteins, nucleic
precursors pass through channels in the membrane,
either actively or passively. Lipid soluble substances
usually pass easily through the cell membrane.
The transport across cell membrane is primarily of
two types, passive which does not require energy
and active, which is energy dependant. Energy is
mostly derived from hydrolysis of ATP.
Passive Transport
It is of the following types:
1. Passive diffusion
The transport of substances occurs down their
concentration and electrical gradient. This does
not use any energy.
Lipid soluble molecules like O2 and CO2 diffuse
rapidly across cell membrane.
Presence of transmembrane protein channels
also allows diffusion of various substances and
ions.
Some channels, like water channels are always
open and help to equalize water content on both
sides.
Most of channels for ion transport are gated, that
is, they open and close in response to various
stimuli. These are
Electrical potential changes: Voltage gated
channels. Examples are Na + channels in
muscles and nerve cells.
Binding to ligand: Ligand gated channels.
the ligand is usually an hormone or a
neurotransmitter which binds to the channel
and opens it. Example, acetylcholine binds
to and opens Na + channels in the post
synaptic neuron.
Mechanical stretch: Example mechano-
sensitive channels in muscle cell.
2. Facilitated diffusion: The transport of substances
occurs along their concentration or electrical
gradient with the help of carrier proteins present
in cell membrane. Example, transport of glucose is
facilitated by presence of glucose transporter
proteins in RBCs and muscle cells. This does not
require any energy input (Fig. 2.2).
Active Transport
Transport of substances with the help of carrier
proteins against their concentration gradient is

Fig. 2.2: Diagrammatic representation of transport across cell
membrane
active transport. This mostly involves hydrolysis of
ATP to provide energy for the process.
The most common and abundant example in our
body of active transport is Na+ K+ ATPase pump.
This transports intracellular Na+ out of the cell in
exchange for K+. Thus, intracellular concentration
of Na+ is kept low and of K+ is high.
In nerve and muscle cells excess intra-cellular K+
diffuses out of cell along its concentration gradient
into ECF via K+ channels. Thus, a positive charge
(due to Na+ and K+) is maintained on outer surface
of cell membrane with respect to the inner aspect
of cell membrane. The cell membrane is said to be
polarised. This is termed as the resting membrane
potential.
Other example of active transport is H+ K+ ATPase
pump present on basolateral surface of epithelial
cells of stomach and renal tubules.
Secondary Active Transport
It is usually secondary to the chemical gradient
created by Na+ K+ ATPase pump.
Low intracellular Na+ levels creates a gradient for
this ion. Uptake of Na+ is coupled with transport of
other substances. This is brought about by carrier
proteins in the cell membrane.
Example, transport of glucose and aminoacids
across the cell membranes in intestinal cells and
proximal convoluted tubules of kidney is dependant
on absorption of Na+ ions.
Carrier Proteins
These are proteins with specific affinity to various
substances and ions. On binding to the specific substance,
they change their configuration and allow the passage of
that substance across cell membrane. They take part in
Cell 15
both active and passive transport across cell membranes.
They are named as follows:
1. Uniporters: These transport only one substance.
Examples GLUTGlucose transporter which allows
facilitated diffusion of glucose into muscle cells, red
blood cells.
2. Symporters or co-transporters: These transport more
than one substance and both have to bind to the
protein transporter. Example, sodium (Na + )
dependant glucose transporter (SGLT) in intestinal
epithelium and renal tubules.
3. Antiporters: These transport one substance into cell
in exchange for another that is extruded out of cell.
Example is Na+ K+ ATPase pump.
Exocytosis (Fig. 2.3)
The products of cellular biosynthesis, usually
proteins, are enclosed in membrane vesicles.
These vesicles first fuse with the cell membrane
which then breaks down at the site of fusion to release
the products (proteins) outside the cell. This
mechanism is known as exocytosis.
C H A P T E R-2
Exocytosis usually requires Ca2+ and ATP for energy.
Examples: Hormone secretion by cells, secretion of
neurotransmitters at synapses.
Fig. 2.3: Diagrammatic representation of exocytosis
Endocytosis (Fig. 2.4)
It is the reverse of exocytosis. In this a substance
comes in contact with the cell membrane and at this
site the membrane invaginates to enclose the
substance. A membrane bound vesicle containing
Fig. 2.4: Diagrammatic representation of endocytosis
 16 Human Anatomy For Dental Students
the substance is pinched off from cell membrane and
enters the cell.
Phagocytosis is the process of endocytosis by which
bacteria, dead tissue or foreign particles are taken
up by cells. The cells responsible for phagocytosis
are neutrophils and lymphocytes in blood and the
tissue macrophages which are derived from blood.
The ingested vesicle or endosome is then delivered
to the lysosomes for degradation.
Pinocytosis is the process of endocytosis by which
substances in solution form are taken up as vesicles.
Endocytosis may also be receptor mediated in which
the substance binds to its receptor and the entire
complex is then ingested by the cell. Examples are
a. Iron and vitamin transport into cells.
b. Uptake of LDL-cholesterol by liver.
c. Neurotransmitter uptake by postsynaptic cells.
Filtration
Filtration is the process by which fluid, mostly water,
is forced across the cell membranes due to differences
in the hydrostatic pressure across it. It is also
dependant on the osmotic pressure difference across
S E C T I O N-1
the membrane.
Filtration is characteristically seen in the capillary
circulation. Fluid filters out at the arteriolar end due
to high pressure. The presence of various colloids,
molecules and ions in the capillary blood exert an
osmotic pressure. This pressure opposes the
filtration of water and helps to maintain the
osmolality of plasma solution. Thus, filtration is
increased in presence of high hydrostatic and low
osmotic pressure and vice versa.
CYTOPLASM
Cytoplasm or cytosol is the intracellular fluid. It
intervenes between cell membrane and the nucleus. It is
mostly (75 to 90%) made up of water and consists of two
parts:
1. Organelles: These are as follows:
a. Ribosomes
b. Mitochondria
c. Golgi apparatus
d. Endoplasmic reticulum
e. Phagosomes
f. Lysosomes
g. Peroxisomes
h. Cytoskeleton (microtubules)
i. Filaments and fibrils
2. Inclusion substances: Glycoproteins, pigments, fat
globules.
Ribosomes
Ribosomes are round to oval bodies, 15 nm in diameter
and are composed of ribosomal RNA and proteins. Each
ribosome granule consists of two subunits named, 40S
and 60S. There are millions of ribosomes within the
cytoplasm. Some of the ribosomes are free while others
are attached to the endoplasmic reticulum.
Functions of ribosomes: They are the site of protein
synthesis in the cell.
Mitochondria
Mitochondria are oval shaped vesicles, 0.5 to 2 micron,
bounded by double membrane. They are seen under
microscope with the help of acid fuchsin and supravital
stains like Janus green. Mitochondria consist of two
membranous walls separated by an intermembranous
space. Each membranous wall is made up of an unit
membrane. Outer membrane is smooth while inner
membrane shows folds or tubular invaginations known
as cristae. The interior of each mitochondrion is filled
with fluid known as the mitochondrial matrix.
Mitochondrial matrix has enzymes and contains DNA.
Thus, they have the power of division. The number of
mitochondria and cristae in a cell is determined by the
energy requirements of the cell. They are more abundant
in metabolically active cells like hepatocytes, basal part
of cells of proximal convoluted tubules of kidney and
spermatozoa.
Functions of mitochondria: Important functions are:
Synthesis of ATP from citric acid.
Steroid biosynthesis, fatty acid oxidation, nucleic
acid synthesis.
Golgi Apparatus
It is made up of vesicles and anastomosing tubules of
membranes arranged in discoid lamellae. It contains an
outer convex surface or immature face and a concave inner
surface known as the mature face.
Function of Golgi apparatus: It helps in the formation of
glycoproteins and cell coat.
Endoplasmic Reticulum
It is a system of intercommunicating membranous vesi-
cles or tubules which may extend from the nuclear
membrane to cell membrane. There are two types of
endoplasmic reticulum:
1. Smooth endoplasmic reticulum
This is arranged in a plexiform network of
tubules, vesicles or lamellae.
Its outer surface is devoid of ribosomes.
Smooth endoplasmic reticulum is involved in
lipid and steroid synthesis.
Functions: It metabolizes small molecules and
contains the cellular detoxification mechanism.
2. Rough endoplasmic reticulum
Rough endoplasmic reticulum primarily cons-
ists of a lamellar form.

Ribosome granules are attached to its outer
membrane which gives it a rough appearance.
Functions: It helps in the synthesis and storage of
proteins.
Phagosomes
When a particle or a living micro-organism enters the
cytoplasm of a cell from outside, it gets covered by the
infolding of cell membrane. Such a membranous vesicle
is known as phagosome. As the phagosome comes in
contact with the lysosome, the common wall between them
disappears and hydrolytic enzymes of the lysosome cause
lysis of the contained material. This process is known as
phagocytosis.
Lysosomes
They are thick walled membranous vesicles derived from
rough endoplasmic reticulum and golgi apparatus. They
are of two types:
a. Primary lysosomes: These have not participated in
any other metabolic event.
b. Secondary lysosomes: They are engaged in
degrading activities.
Functions of lysosomes: Lysosomes contain various
enzymes namely esterases, glycosidases, peptidases and
hydrolytic enzymes. They help in degrading old cells,
ingested foreign particles etc.
Peroxisomes
These are membrane bound spherical or oblique shaped
structures, 0.5 microns in diameter. Peroxisomes help in
detoxification of various substances. They are
predominantly found in thyroid follicles.
Cytoskeleton
It consists of interconnected filamentous proteins present
within the cell which provide shape and stability to the
cell. It is made up of microfilaments, intermediate
filaments and microtubules.
Function of cytoskeleton: It is dispersed within the cell
and gives shape to the cell. It helps in transport of various
substances and is concerned with cellular movements.
Microfilaments
These are long, solid, fibres, 4 to 6 nm in diameter and are
made up of the protein, actin. They bind with various
intercellular proteins and provides structure to the
cytoplasm and shape to the cell.
Intermediate Filaments
These are thicker, 10 to 14 nm diameter fibres of protein
which provide intracellular stability and structural
strength to the cell. They are characteristic of a particular
cell type and hence are of value in histopathology studies.
e.g., keratin in epithelial cells, vimentin in connective
Cell 17
tissue, desmin in muscle cells and neurofilaments in
neurons, etc.
Microtubules
They are made up of polymers of protein, tubulin which
is arranged in the form of long, hollow cylindrical
structres. They provide for the dynamic part of the
cytoskeleton and are constantly changing in structure.
they form centrioles, mitotic spindles, motile hair like
projections from cell surface like cilia and flagellum.
Cilia: These are numerous short, hair like projections from
surface of cell. Examples are ciliated cells in epithelium
of respiratory tract and fallopian tubes.
Flagellum: It is usually a single, long hair like structure.
The only example of a cell with flagellum in our body is
mature spermatozoa.
Centriole: Each cell possesses two centrioles within the
cytoplasm, close to the nuclear membrane. Each centriole
presents two cylindrical bodies which are placed at right
angles to each other. The wall of the cylinder consists of
nine longitudinal bundles and each bundle is composed
of three microtubules embedded in fibrillar materials.
C H A P T E R-2
Functions of centrioles: Centrioles help in synthesis of
microtubules of the achromatic spindle during cell
division.
Filaments and fibrils: These are ultra-microscopic
network of filamentous structures. They are composed of
G-actin subunits. Thicker components are known as
fibrils. They act as an internal support frame work of the
cells and enter into the central core of microvilli and
stereocilia. They form the actin and myosin filaments of
contractile muscles.
NUCLEUS
All human cells contain a nucleus, except erythrocytes.
It is a round or ellipsoid mass covered by an envelope
known as nuclear membrane and is situated with in the
cytoplasm. The location of nucleus within the cell
depends on the cell type. It may appear in the centre of
the cell (e.g., in leucocytes) or near the base (e.g., tall
columnar cells ) or near the periphery (e.g., in skeletal
muscle). Nucleus consists of:
Nuclear envelope
Chromatin threads in a resting cell or chromosomes
in a dividing cell
Nucleolus
Nuclear sap
Sex chromatin or Barr bodies
Nuclear Envelope
It is 7 to 8 nm thick, double layer of unit membrane. Outer
membrane is studded with ribosomes and is actually
derived from the rough endoplasmic reticulum of the
cytoplasm. The inner membrane is ribosome free. It gives
attachment to the ends of chromosomes and has a dense
 18 Human Anatomy For Dental Students
coating of chromatin during interphase. Several hundred
nuclear pores, 60 nm diameter, are present in the nuclear
envelope. Each pore consists of 8 subunits. Large
macromolecules, e.g., mRNA, rRNA pass from the nucleus
to cytoplasm through these pores.
Chromatin Threads and Chromosomes
In the resting phase of interphase of cell,
nucleoplasm consists of a large amount of fibrous
material called chromatin. The fibres are approx-
imately 20 nm in diameter and consist of straight
smooth areas of DNA interspersed with nucleosomes
where the DNA is tightly coiled into chromatin
fibres. One length of chromatin contains 30 lengths
of DNA.
Uncoiled segments of chromosomes are known as
euchromatin. These are the genetically active sites.
The coiled segments of chromosomes are called
heterochromatin, which is genetically inert.
During cell division, each chromosome becomes
thicker, shorter and tightly coiled along its entire
length. In human beings, the total number of
chromosomes are 46 (diploid) in all cells except in
mature germ cells where they are 23 (haploid) in
S E C T I O N-1
number.
Nucleolus
Nucleolus is a dense mass in the centre of the nucleus. It
is a highly refractile, spherical mass without a membrane.
It is made up of a compressed mass of RNA (ribosome),
granules and proteins. Nucleoli are most prominent
during interphase, disappear during metaphase and
reappear during telophase. Ribosomal RNA (rRNA)
synthesis occurs in the nucleolus. The nucleolar
organiser region contains genes that encode rRNA.
Nuclear Sap
It is the fluid containing proteins which fills up the
interspaces between the chromatin threads and the
nuclear membrane. It serves as a medium for the transport
Fig. 2.5: Cell junctions
of ribosomal RNA and messenger RNA to the nuclear
pores.
Sex Chromatin or Barr Bodies
This is the characteristic feature of cells of normal females.
During interphase, a heterochromatin, plano-convex body
is found beneath the nuclear membrane in a cell. This is
known as sex chromatin or Barr body.
Intercellular or Extracellular Matrix Junctions
The cell coat helps to maintain an intercellular distance
of 20 to 25 nm between two adjacent cells. The plasma
membrane of adjacent cells establishes contact by means
of cell adhesion molecules (Fig. 2.5). These are of the
following types
1. Macula adherens (desmosomes): They are strong
intercellular contacts bridged by filaments. They can
be circumferential or basal in location. They provide
structural integrity to the surface.
2. Zonula adherens: These junctions are found in the
apical perimeters of epithelial, endothelial and
mesothelial cells in a continuous manner. The
intercellular gap of 20 nm is filled by adhesive non-
stainable material and there are no filaments.
3. Zonula occludens (tight junction): This is an
occluding junction where the membrane of adjacent
cells come in close contact and the intercellular gap
is obliterated. These junctions are also found in the
apical perimeters of epithelial, endothelial and
mesothelial cells in a continuous manner.
4. Gap junctions: These are similar to tight junction
but have a gap of 3 nm between the cells. This
intercellular gap is traversed by numerous trans
membrane channels or connexons.
5. Fascia adherens: It is similar to zonula adherens
but its location is more limited to one side of the cell.
Example, it is present between adjacent smooth
muscle cells, intercalated discs of cardiac muscle
cells.
6. Hemidesmosomes: These are
anchoring junctions between
bases of epithelial cells and basal
lamina.
Junctional complex: It is made up of
tight junctionmacula adherens
desmosomeintercellular gap.
Microvilli
Microvilli are finger like extensions of
cell surfaces, usually 0.1 micron in
diameter and 5 microns in length.
Regularly arranged microvilli are
known as stereocilia. Example,
microvilli are present on epithelial
cells of small intestine and they
increase the surface area of absorption.
 Chapter

3
Tissues
INTRODUCTION basement membrane. They lie adjacent to each other.
Tissues are groups or aggregates of cells arranged in a This epithelium is meant for exchange of substances
definite manner having similar functions. The human which occurs across the cells.
body is made up of four basic types of tissues which can It is present at the following sites
be classified as follows based on the variations in a. Blood vessels b. Alveoli
structure and functions: c. Bowmans capsule d. Peritoneum
1. Epithelial tissue: It is also named epithelium. It is e. Pleura
made up of layer(s) of closely packed cells with 2. Simple cuboidal epithelium (Fig. 3.2): It is made up
minimal intercellular material. The cells character-
of a single layer of cubical cells on a basal lamina.
istically lie on a base lamina.

CHAPTER-3
The height and width of the cells is similar.
2. Connective tissue: It is less cellular and is made
up of cells arranged singly or in groups within an It is found at the following sites
abundant extracellular matrix. a. Ducts of various glands
3. Muscular tissue: It is made up of groups or bundles b. Thyroid
of specialized cells having contractile properties. c. Small ducts of digestive glands
4. Nervous tissue: It is made up of specialized cells, d. Germinal epithelium of ovary
neurons that initiate and conduct electrical impulses e. Retinal pigment epithelium
along with supporting cells known as neuroglia. e. Respiratory bronchiole

EPITHELIAL TISSUE
It is also known as epithelium. It consists of layer(s) of Fig. 3.2: Simple cuboidal epithelium
cells that line the body cavities and tubes and cover the
outer surface of the body (Figs 3.1 to 3.7). Epithelium 3. Columnar epithelium (Fig. 3.3): It is made up of a
can be classified on the basis of number of layers of single layer of cells which are shaped like column,
cells, shape of cells and presence of any cell surface modi- i.e., their height is more than the width. This
fications. Epithelium is classified into epithelium is present on various secretory and
1. Simple epithelium absorptive surfaces of the body. The cells often
2. Pseudostratified epithelium present with surface modifications like microvilli
3. Stratified epithelium and cilia.
It is present at the following sites
Simple Epithelium a. Uterine tube and uterus
It is made up of a single layer of cells which lie on the b. Small bronchi and bronchioles
basal lamina. It is present on the absorptive and c. Tympanic cavities
secretory surfaces of the body and at sites of exchange d. Eustasian tube
of substances which are not subjected to stress. It can be e. Epididymis
further classified into squamous, cuboidal and columnar f. Ependyma of spinal cord
epithelium based on the shape of cells: g. Gall bladder
1. Simple squamous epithelium (Fig. 3.1): It consists h. Gastro-intestinal tract
of a single layer of flat, polygonal cells lying on the

Fig. 3.1: Simple squamous epithelium Fig. 3.3: Simple columnar epithelium
 20 Human Anatomy For Dental Students
Pseudostratified Epithelium (Fig. 3.4)
It consists of a single layer of cells on the basal lamina.
The cells are tall columnar type but have variable
heights. The location of nucleus is at different levels in
the adjacent cells. This gives a false appearance of
multilayering or stratification, i.e., pseudostratification.
It is present at the following sites
1. Respiratory tract: Trachea and bronchi.
2. Male genital system, ductus deferens and male
urethra.
Fig. 3.4: Pseudostratified ciliated columnar epithelium
Stratified Epithelium
Stratified epithelium is made up of more than one layer of
cells. It is present at sites subjected to mechanical or other
SECTION-1
stress. It is further classified into the following types:
1. Stratified squamous non-keratinized epithelium
(Fig. 3.5): It is made up of 5 to 6 layers of cells. Basal
layer consists of a single layer of columnar cells on
the basal lamina. 2 to 3 layers of polygonal cells lie
over it. Superficial cells are flat, squamous. It is
protective in nature.
It is present at the following sites:
a. Oral cavity
b. Tongue
c. Tonsils
d. Pharynx
e. Esophagus
f. Vagina
g. External urethral orifice
h. Cornea
i. Conjunctiva
Fig. 3.5: Stratified squamous epithelium
2. Stratified squamous keratinized epithelium
(Fig. 3.6): It is made up of similar 5 to 6 layers of
cells. It is characterized by the presence of a layer
of keratin over the superficial cells. This epithelium
protects the exposed, dry surfaces of the body. Skin
is the primary example of stratified squamous
keratinized epithelium in the body.
Fig. 3.6: Keratinized stratified squamous epithelium
3. Stratified cuboidal epithelium: It consists of two
layers of cuboidal cells (Fig. 3.7). This epithelium
is present in large ducts at the following sites
a. Ducts of sweat glands and mammary gland
b. Seminiferous tubules
c. Ovarian follicles
Fig. 3.7: Stratified cuboidal epithelium
4. Stratified columnar epithelium (Fig. 3.8): It consists
of two layers of columnar cells. It is found at the
following sites
a. Fornix of conjunctiva
b. Anal mucous membrance
c. Urethra
Fig. 3.8: Stratified columnar epithelium
5. Transitional epithelium (Fig. 3.9): It is made up of 5
to 6 layers of cells. In this epithelium there is a
characteristic transition in shape of cells from basal
to superficial layers. Basal layer consists of a single
layer of columnar cells lying on the basal lamina.
2 to 3 layers of polygonal cells are present above it.
Superficial cells are umbrella shaped.
 Tissues 21

plasma membrane to release their contents to the

exterior, e.g., simple sweat glands.
2. Apocrine glands (Fig. 3.11): In these glands the
secretions are present as free droplets within the
cytoplasm of the cells and some of the apical
cytoplasm along with cell membrane is also extrud-
ed along with the secretions, e.g., mammary gland.
3. Holocrine glands (Fig. 3.12): Cells are filled with
secretory products and the entire cell disintegrates
to release its secretions, e.g., sebaceous glands.
Fig. 3.9: Transitional epithelium

It is present in the urinary tract at the following

sites:
a. Pelvis of kidney
b. Ureter
c. Urinary bladder
d. Urethra

GLANDS
Glands are tissues specialized for synthesis and secretion
of macromolecules. Glands are formed by the invagi-

CHAPTER-3
nation of epithelial cells into the surrounding connective Fig. 3.11: Apocrine gland Fig. 3.12: Holocrine gland
tissue.

Structural and Functional Classification

Classification of Glands
Exocrine glands are classified further as given below:
Glands can be classified in the following ways: 1. Unicellular glands (Fig. 3.13): These are made of
According to Mode of Secretion single cells, which are usually interspersed between
1. Exocrine glands: The secretions of exocrine glands a non secretory epithelial lining, e.g., goblet cells
are carried through ducts to the target surface, e.g., present in the intestinal and respiratory epithelium.
parotid gland. 2. Multicellular glands (Fig. 3.14): These glands consist
2. Endocrine glands: The secretions of endocrine of cells arranged either in sheets with a common
glands are directly poured into the circulatory secretory function, e.g., mucus lining of stomach or as
system. These are ductless glands. Secretion is clusters of cells which form invaginated structures
carried to the distant target cells by circulation, e.g., into the surrounding submucosa or connective tissue,
Pituitary gland. e.g., salivary glands.
3. Paracrine glands: These glands are similar to
endocrine glands but their secretions diffuse locally
to cellular targets in the immediate surrounding.
According to Mechanism of Secretion
1. Merocrine glands (Fig. 3.10): The cells of merocrine
glands produce secretions that are packaged into
vesicles. The vesicle membranes fuse with the

Fig. 3.13: Unicellular gland Fig. 3.14: Multicellular gland

The invaginated glands are of the two types:

a. Simple glands: These are drained by a single
duct.
b. Compound glands: These are drained by a
Fig. 3.10: Merocrine gland branched duct system.
 22 Human Anatomy For Dental Students
The secretory part of the glands can be tubular or
coiled or alveolar type. Hence, the glands are
classified as follows:
i. Simple tubular glands without ducts (Fig. 3.15):
Cells are arranged in a tubular fashion and open
on the epithelial surface without a duct.
ii. Simple tubular glands with ducts (Fig. 3.16):
Secreting cells are arranged in tubular shaped
structures with upper non-secretory parts,
which act as the ducts.
Fig. 3.15: Simple tubular Fig. 3.16: Simple tubular with
without duct duct
c. Simple branched tubular glands (Fig. 3.17):
SECTION-1
These glands have a single duct and the secretory
cells are arranged in a tubular fashion with
branches.
d. Simple coiled tubular glands (Fig. 3.18): Secre-
tory part is coiled and they have a single duct.
Fig. 3.17: Simple branched Fig. 3.18: Simple coiled
tubular gland tubular gland
e. Simple acinar or alveolar glands (Fig. 3.19):
Secretory part is flask shaped with a single
connecting duct.
Fig. 3.19: Simple alveolar gland
f. Compound glands (Figs 3.20 and 3.21): In these
glands the ducts are branched. The secretory
part of such glands may be branched tubulo-
alveolar or branched tubular or branched
alveolar type.
Fig. 3.20: Compound alveolar gland
Fig. 3.21: Compound tubular gland
According to Type of Secretion
Exocrine glands may produce mucus or serous secretions
or can be of mixed variety.
1. Mucus secreting or mucus glands: The cells of
mucus glands are filled with mucus which gives
the cytoplasm a hazy appearance. The nucleus is
flat and located at the base, e.g., sublingual salivary
glands.
2. Serous glands: These glands secrete thin serum like
secretions. The cells have a central nucleus with a
granular eosinophilic cytoplasm, e.g., Parotid
salivary gland.
CONNECTIVE TISSUE
Connective tissue provides structure, support and
protection to the various tissues, organs and ultimately
the body as a whole. Structurally, it is characterised by
the presence of abundant intercellular material known
as extracellular matrix present between the connective
tissue cells.
Functions of Connective Tissue
It connects different tissues and facilitates passage
of the neurovascular bundles into them.
It helps to give shape to an organ and protects and
supports the various organs of the body.
Special connective tissue cells (haemolymphoid
cells) are involved in various defence mechanisms
of the body.
Bone and cartilage give shape and protect the body.

Components of Connective Tissue
Connective tissue is made up of three components:
1. Cellular components
2. Matrix
3. Fibres
Cellular Components
There are two types of cells in a connective tissue.
1. Resident cells: These consist primarily of fibroblasts,
adipocytes and mesenchymal stem cells. Cartilage
also has special resident cells named chondroblasts
and chondrocytes while bone is made up of
osteoblasts, osteocytes and osteoclasts.
2. Migrant cells: These consist of cells derived from
bone marrow. They reach the connective tissue via
blood and lymphatic circulation. These are
macrophages or histocytes, plasma cells, mast cells,
pigment cells, lymphocytes and monocytes.
Fibroblasts: Fibroblasts are the most numerous resident
cells of connective tissue. They are large, spindle shaped
cells with irregular processes and a central oval nucleus.
They produce collagen and elastic fibres. Fibrocyte is
the mature form of fibroblast (Figs 3.22, 3.23 and 3.29).
Fig. 3.22: Fibroblast Fig. 3.23: Fibrocyte
Adipocytes: These cells are oval to spherical in shape
and are filled with large lipid droplets. The cytoplasm
and nucleus are present as a small rim at the periphery.
Thus, the cells look empty on routine haematoxylin and
eosin (H and E) staining. The total number of fat cells in
the body are determined at birth. In obese state, fat cells
get enlarged (Figs 3.24 and 3.30).
Fig. 3.24: Adipocytes
Mesenchymal stem cells: These cells are derived from
the embryonic mesenchyme. They are pluripotent cells
and have the capacity to differentiate into various
mature cells of connective tissue during growth and
development (Fig. 3.25).
Tissues 23
Fig. 3.25: Mesenchymal stem cell
Macrophages: They are relatively large, irregular cells with
a large nucleus. The cytoplasm contains numerous gra-
nules. They are responsible for the phagocytosis of foreign
bodies (Fig. 3.26).
Fig. 3.26: Macrophage
Plasma cells: They are large, round to oval cells with an
CHAPTER-3
eccentric nucleus that has a characteristic cart-wheel
appearance. They are responsible for production of
antibodies in the body. (Fig. 3.27).
Mast cells: They are large round to oval shaped cells with
a central large nucleus. They contain numerous
membrane bound vesicles or granules containing
heparin and histamine. They are mostly located around
blood vessels (Fig. 3.28).
Fig. 3.27: Plasma cell Fig. 3.28: Mast cell
Extracellular Matrix
Extracellular matrix is abundant in connective tissue. It
is made up of a complex network of ground substance
and insoluble fibers. The ground substance is a highly
hydrated (except in bone) medium made up of
glycosaminoglycans (dermatan sulfate, keratin sulfate,
hepararan sulfate, chondroitin sulfate, hyaluronan),
proteoglycans and glycoprotein (fibronectin, laminin,
tensascin). The matrix provides a framework for cells
and fibers provides mechanical and structural support.
It also provides a medium for diffusion of gases, nutrients,
metabolic wastes between blood vessels and cells.
Fibres
There are three types of fibres present in the matrix of
connective tissue (Fig. 3.29).
 24 Human Anatomy For Dental Students

Fig. 3.29: Loose areolar connective tissue (Stain-hematoxylin-eosin under low magnification)
SECTION-1

Fig. 3.30: Adipose tissue (Stain-hematoxylin-eosin under low magnification)

Fig. 3.31: Longitudinal section of tendon: Stain-hematoxylin-eosin under low magnification


1. Collagen fibres: Collagen fibres are made up of
collagen protein. They are secreted by fibroblasts,
chondroblasts, osteocytes and chondrocytes. They
are present as thick branched bundles of colourless
fibres.
2. Elastic fibres: They are produced by fibroblasts and
mainly contain elastin protein. These fibres are
thinner than collagen fibres. They are seen as single,
yellow fibres which show extensive branching and
cross linking with each other. The broken ends of
these fibres are seen to recoil.
3. Reticular fibres: They are fine collagen fibres which
form a supporting framework for various tissues
and organs. They are characteristically present in
lymph nodes.
The elastic and reticular fibres are not clearly seen
on routine H and E staining and require special stains
like orcein and silver stain respectively.
Classification of Connective Tissue
Connective tissue is classified into general connective
tissue which is present all over the body and specialised
connective consisting of bones, cartilages and blood and
lymph.
General connective tissue is further classified into
the following types based on relative proportion of cells,
fibres and ground substance in the connective tissue.
1. Irregular connective tissue: It is further classified as
a. Loose areolar connective tissue: It is the most
generalized form of connective tissue and is
widely distributed in the body. It consists of a
loose meshwork of thin collagen and elastic
fibres with spaces (areolae) containing ground
substance and cells.
Distribution:
Papillary layer of dermis of skin
Lamina propria (supporting tissue) of
epithelial lining of hollow organs like
gastrointestinal tract, blood vessels.
Submucosa of various hollow organs.
Serosal lining of peritoneal pleural and
pericardial cavities.
Supporting and binding tissue between
glands, muscle fibers, nerve fiber bundles,
parenchyma of glands.
b. Dense irregular connective tissue: It is found in
those regions which are subjected to considera-
ble mechanical stress. Matrix is relatively
acellular and consists of thick collagen bundles.
Distribution:
Dermis of skin
Connective tissue sheath around muscles and
nerves.
Adventitia surrounding great blood and
lymph vessels
Periosteum and perichondrium
Capsules of large organs like liver, kidneys,
testis etc.
Tissues 25
c. Adipose tissue (Fig. 3.30): It contains abundant
fat cells in a vascular loose connective tissue
network. Adipose tissue is present in certain
regions like subcutaneous tissue, bone marrow,
mammary gland, omenta and mesenteries,
surrounding kidneys and behind the eye balls.
2. Regular connective tissue (Fig. 3.31): This type of
connective tissue is characterised by presence of
abundant fibrous tissue, mostly made up of
collagen fibres with few elastic fibres. The fibres
are arranged in a regularly oriented fashion forming
sheets and bundles and they run in one direction.
This is also known as white fibrous tissue and it is
seen in tendons, ligaments and aponeurosis.
Elastic tissue: It is compose of numerous bundles of elastic
fibers. They are arranged parallel to each other with few
collagen fibers and flat fibroblasts in between. It possesses
more elasticity and is present in areas where there is
constant stretching and relaxing.
Distribution: Vocal ligaments (cords), ligamentum
nuchae, elastic arteries, superficial fascia of anterior
abdominal wall.
CHAPTER-3
Reticular tissue: It is a loose connective made up of
predominantly reticular fibers which form a meshwork
of fine interconnecting fibres surrounding small
sinusoid like spaces. Specialized fibroblasts known as
reticular cells are present scattered along the fibres. The
tissue provides structural framework for the organs like
lymph nodes, spleen, bone marrow and surround the
parenchyma (cellular component) of organ like liver,
endocrine glands. The trabecular meshwork of reticular
fibres of haemolymphoid organs allows for flow of cells
(mainly mononuclear phagocytic cells) and fluids across
the organ.
Mucoid tissue: It is fetal or embryonic type of connective
tissue which consists of mesenchymal fibroblasts and
loose areolar connective tissue with mucoid matrix. It is
present in Whartons jelly, vitreous body of the eye,
nucleus pulposus of intervertebral disc and pulp of
developing tooth.
Functions of General Connective Tissue
1. Binds together various structures.
2. Facilitates passage of neurovascular bundle.
3. In the form of deep fascia, connective tissue keeps
the muscles and tendons in position, gives origin
to muscles and forms different functional
compartment of muscles.
4. In the form of ligaments, binds the bones.
5. Attaches muscle to the bone with the help of
tendons and facilitates a concentrated pull.
6. Facilitates venous return in lower limb with the help
of deep fascia.
7. Helps in wound repair due to the presence of
fibroblasts.
8. Aponeurosis is a regular dense connective tissue
associated with the attachment of muscles. It is
made up of densely arranged collagen fibres.
 26 Human Anatomy For Dental Students
Bursa
It is a sac of synovial membrane supported by dense
irregular connective tissue. It reduces the friction. Hence,
it is found at those places where two structures which
move relative to each other are in tight apposition.
Bursae present at different places are (Fig. 3.32):
a. Subcutaneous bursa: between skin and bone.
b. Submuscular bursa: between muscle and bone.
c. Subfascial bursa: between fascia and bone.
d. Interligamentous bursa: the bursa between two
ligaments.
Adventitious Bursa
It develops over bony parts which are subjected to much
friction or pressure. It develops due to physiological
reasons and is not present normally. e.g., Tailors ankle,
Porters shoulder, Weavers bottom.
SECTION-1
Fig. 3.32: Different type of bursae around knee joint
SUPPORTING TISSUES
Mucosa
It is also known as the mucous membrane and is made
up of the following:
1. Epithelium lying on basement membrane.
2. Epithelial invaginations that form glands.
3. Lamina propria: It is a loose connective tissue layer
present below the epithelium.
4. Smooth muscle layer: A thin layer of smooth muscle
fibers lies outer to the lamina propria.
Mucosa is the innermost lining of various hollow
organs of the body like, stomach and intestines, parts of
respiratory, urinary and genital tracts.
A layer of loose connective tissue with fine, terminal
branches of vessels and nerves is present below the
mucosa. It is known as submucosa. It also contains
glandular tissue, lymphoid follicles at places and few
smooth muscle fibers.
Serosa
It is also known as serosal membrane and is made up of
a single layer of flattened, squamous type cells present
over a loose connective tissue layer containing a fine
network of blood vessels and lymphatic vessels. Serosa
lines the pleural, pericardial and peritoneal cavities and
forms the external covering of the various viscera present
in these cavities.
Fascia
It is a type of connective tissue consisting of interwoven
bundles of collagen fibers. They are not as regularly
arranged as in tendons and ligaments.
There are two types of fascia:
1. Superficial fascia: It consists of a loose connective
tissue layer which is present below the skin all over
body. Hence, it is also known as subcutaneous tissue
and it consists of variable amounts of adipose tissue
which provides insulation to the body. It provides
passage for the blood vessels and nerve endings to
reach the skin.
It is of variable thickness in various parts of the body
according to its adipose tissue content. It is well
demarcated in lower part of anterior abdominal
wall, limbs and perineum. It is dense over scalp,
palm and soles. It is thin and insignificant over the
dorsal aspect of hands and feet, side of neck, face,
penis and scrotum.
2. Deep fascia: It lies below the superficial fascia and
is made up of more dense form of connective tissue
with bundles of collagen fibers. It provides support
to the skin and musculature of body. It provides
passage to the neurovascular supply to the under-
lying muscles. It is well developed functionally in
the region of neck and limbs. It is condensed to form
specialized binding structures at certain area
especially in limbs, forming intermuscular sheaths
and retinaculae. The various modifications of deep
fascia are described in the respective chapters.
BONE AND CARTILAGE
Bone and cartilage are a form of specialised connective
tissue. They are described in skeletal system chapter no. 5.
BLOOD AND LYMPH
This is a form of specialised connective tissue. Blood is
described in chapter no. 9 (see page no. 135). Lymph is
described in lymphatic system (see page no. 143).
MUSCULAR TISSUE
The muscular tissue is organised to form the musculature
of the body. It helps in the movements of various parts of
the body. It is described in muscular system (chapter no.
6, see page no. 82).
NERVOUS TISSUE
It is responsible for the maintenance of internal
homeostasis by controling the responsiveness of various
organs and tissues of the body. It is described in nervous
system (chapter no. 7, see page no. 83).
 Chapter
4
Organization of Body
INTRODUCTION
Anatomy deals with study of structure of body. The
primary aim of any living organism is survival and
existence and it includes basic life processes like
1. Metabolism: This includes all chemical processes
occurring in the body which facilitate survival and
existence.
2. Homeostasis: This is the ability of an organism to
respond to the external environment and regulate
its own internal environment.
3. Movement: It includes movement of cells inside the
body and of the organism as a whole.
4. Growth: It involves increase in size and number of
cells, replacement of cells and removal of older cells.
5. Differentiation: This is the basic fundamental of
formation of various organs of an organism. An
unspecialized cell gets converted into a specialized
cell during growth and development.
6. Reproduction: It includes new cell formation for
growth, repair or production of a new individual.
The structural and functional unit of a human body
is the cell. A number of cells with similar embryonic origin
and function form a tissue (see chapter 3). A number of
tissues are organised to form an organ that performs a
specific function, e.g., stomach, heart etc.
The various organs and tissues of body are arranged
in a systematic manner in order to perform different
functions of the body, e.g., gastrointestinal tract, nervous
system, etc. These systems perform specific function for
survival and maintenance of human body. Each system
has an independent function but is interdependent on
other systems for its proper functioning.
Composition of Body
In average adults, 60% of total body weight is water, 18%
is protein and related substances, 15% is fat and 7% is
minerals.
The body water is divided into two parts:
1. Intracellular fluid (ICF): It is the fluid contained
within the cells. It forms 2/3rd of total body water
and 40% total body weight.
2. Extracellular fluid (ECF): It forms 1/3rd of total body
water and 20% of total body weight. It is further
divided into two components:
a. Circulating plasma: It is 25% of ECF and forms
5% of total body weight. Plasma along with
various cellular elements forms blood which
circulates in the vascular system.
b. Interstitial fluid: It is 75% of ECF and forms 15%
of total body weight. This fluid lies outside the
C H A P T E R-4
blood vessels and bathes the cells.
The normal cell function depends on the composition
of interstitial fluid. Thus the internal environment of the
body is kept constant by multiple regulatory factors. This
is called homeostasis. This is a dynamic process that
regulates volume, composition, pH, temperature and
contents of fluid within physiological limits.
The human body is a well organised unit and it can
be studied systematically by dividing it into study of
various regions of the body. The various regions are:
1. Head and neck
2. Thorax
3. Abdomen and pelvis
4. Upper limb
5. Lower limb
This chapter describes the general organisation of
various regions of the body. The specific skeleto-muscular
framework, nerve supply and vascular supply of various
regions and the anatomical and functional organisation
of various systems of the body are described in subsequent
chapters.
HEAD AND NECK (Figs 4.1 to 4.4)
Head consists of skull and face. Upper part of skull
known as calvaria.
The cavity present inside the skull is known as
cranial cavity. Cranial cavity lodges the brain, its
coverings known as meninges, cerebrospinal fluid
and the vascular supply of brain.
 28 Human Anatomy For Dental Students
Fig. 4.1: Head, neck and face
The anterior part of skull provides the skeletal
framework for the face. Face has openings of
proximal ends of respiratory tract (nostrils) and
digestive tract (oral cavity) that communicate with
exterior for intake of air (oxygen) and food. The face
and skull also have sockets for eyeballs and organ
of hearing (ears) which facilitate the communication
S E C T I O N-1
with external environment.
Neck connects head to the upper part of trunk. It
gives passage to trachea, esophagus, and spinal
cord, spinal nerves with sympathetic nerve trunk
and carries the vascular supply (carotid and
Fig. 4.2: Skeleton of head and neck
vertebral vessels with their branches, internal jugular
veins) to and from the various structures of head
and neck and brain. It is cylindrical in shape and is
covered by skin, superficial fascia and deep cervical
fascia. Neck is studied in two parts namely, side of
neck and back of neck. Side of neck encompasses the
anterior and lateral surfaces of the neck. It is
rectangular in shape and is divided into anterior
and posterior triangles by sternocleidomastoid
muscle. Back of the neck is primarily muscular. It is
divided into two halves by a median fibrous sheath
attached to the spines of cervical vertebrae, the
ligamentum nuchae. Each half consists of muscles
which lie between deep cervical fascia and posterior
surface of cervical vertebra.
Skeleton of neck is formed by 7 cervical vertebrae.
Skeletomuscular framework of neck helps in
movement of head over trunk. This helps in search
and intake of food, facilitates function of sight and
hearing and aids in defense.
The skin, fascia and external musculature of neck
enclose the following structures.
In midline (From before backwards)
1. Thyroid and parathyroid glands.
2. Larynx and trachea.
3. Pharynx and esophagus.

Fig. 4.3: Muscles related to orifices of face, of facial expression, scalp and neck (Diagrammatic representation)
On each side
4. Neurovascular bundle consisting of common
carotid (internal carotid) artery, internal jugular
vein and vagus nerve. These are present on each
side.
5. Cervical sympathetic chain.
6. Origin of cervical and brachial plexuses.
7. Pre and para-vertebral muscles.
Scalp: The soft tissue covering the vault of skull is
termed as scalp. Skin of scalp is richly supplied by
hairs, sweat glands and sebaceous glands (Figs 4.3
and 4.4).
Face: Face is the anterior aspect of head (Figs 4.3
and 4.4). It extents from hairline of scalp to chin and
base of mandible. Laterally, it extends upto tragus of
ear on both sides. Features present on face are shown
in (Fig. 4.4).
Fig. 4.4: Scalp and face
Organization of Body 29
C H A P T E R-4
THORAX (Figs 4.5 to 4.7)
Thorax is the part of trunk which extends from the
thoracic inlet or root of neck upto the abdomen.
It presents with the thoracic cavity that contains
heart and lungs bounded by the thoracic cage.
Thoracic inlet is reniform in shape and continues
above with the neck. The plane of thoracic inlet slopes
downwards and forwards and forms an angle of
45 with the floor. The posterior end is about 4 cm.
higher than the anterior end. The thoracic inlet is
separated from the root of neck by a suprapleural
membrane. It is a triangular shaped membrane
present on either side of inlet with a gap in the centre.
Thoracic outlet is wider than the inlet and continues
below with the abdomen. It is separated from the
abdomen by a diaphragm which forms the floor of
thoracic cavity.
Thoracic cage consists of an osseo-cartilaginous
framework made up of thoracic vertebrae, ribs with
costal cartilages and sternum. This osseocartilagi-
nous cage with its muscular attachments is
responsible for the movements of respiration. It
protects the vital organs namely, lungs, heart, great
vessels, trachea and esophagus.
THORACIC CAGE
It consists of an osseo-cartilaginous framework which
encloses the thoracic cavity. It is formed by twelve pairs
of ribs with costal cartilages, twelve thoracic vertebrae
and sternum (Fig. 4.5).
 30 Human Anatomy For Dental Students

Fig. 4.5: Thoracic cage

2. Body of sternum: It lies opposite the level of bodies

S E C T I O N-1

STERNUM
It is a flat bone which lies in the median part of the anterior of T5 to T9 thoracic vertebrae. It is twice as long as the
thoracic wall (Fig. 4.6). manubrium and is made up of four sternal segments
(sternebrae). It is widest at the level of the 5th costal
Anatomical Features cartilage.
3. Xiphoid process: It is also known as xiphisternum.
It has three parts
It is the small tapering part of the sternum which
1. Manubrium: It is the upper part of sternum and is
lies in the epigastric fossa. It is triangular in shape
roughly quadrangular in shape. It lies at the level
with its apex downwards. It may also be broad and
opposite to the T3 and T4 vertebrae.
flat, bifid or perforated.

RIBS
Ribs are flat bones and represent the costal elements of
thoracic vertebrae. They form the largest part of the
thoracic cage. There are a total of 12 pairs of ribs. These
elongated, flat bones articulate posteriorly with the
corresponding thoracic vertebrae. They extend up to the
sternum anteriorly, (except the 11th and 12th ribs) (Figs
4.7 to 4.11). The corresponding ribs of two sides with
sternum and the thoracic vertebra form an oval shaped
cavity.

Classification of Ribs
1. True ribs: They are also called vertebrosternal ribs.
These ribs articulate both with the vertebral column
and the sternum. Upper seven pairs constitute true
ribs.
2. False ribs: These ribs articulate indirectly with
sternum or do not articulate with it at all. Lower five
pair of ribs are false ribs. False ribs are further divided
Fig. 4.6: Sternum (anterior aspect) into:

a. Vertebrochondral ribs: 8th, 9th and 10th ribs
articulate posteriorly with vertebrae, while
anteriorly their costal cartilages fuse together and
then fuse with the 7th costal cartilage which joins
with the sternum.
b. Floating ribs: Their anterior ends do not
articulate with sternum or with any costal
cartilage. They lie free in abdominal wall. The
11th and 12th ribs belong to this category.
3. Typical ribs: They bear common features and
individual identification is not possible. 3rd to 9th
ribs are typical.
4. Atypical ribs: They have individual distinguishing
features. 1st, 2nd, 10th, 11th and 12th ribs are atypical
ribs.
Anatomical Features of a Typical Rib
Each typical rib presents the following three parts
(Fig. 4.7):
1. Anterior end or the sternal end: It presents a cup
shaped oval depression for articulation with the
costal cartilage. This end lies at a lower level than
the vertebral end.
2. Shaft: The shaft of a rib is thin and flat. It curves
backwards and laterally from the anterior end and
then turns backwards and medially. It has an upper
and a lower border with an inner and an outer
surface. Upper border is thick and lower border is
thin. Inner surface is concave, smooth and is related
to the pleura. The lower part of inner surface has a
groove known as the costal groove which lodges the
following, from above downwards:
Fig. 4.7: Typical rib of left side (seen from inner aspect)
Organization of Body 31
a. Posterior intercostal vein
b. Posterior intercostal artery
c. Intercostal nerve
The shaft is curved at an angle about 5 cm in front of
tubercle of rib which is known as angle of rib.
3. Posterior end or the vertebral end: It has the
following three parts:
a. Head: It consists of two facets separated by a
crest.
b. Neck: It extends from the head to the tubercle.
c. Tubercle: It is a small elevation present post-
eriorly at the junction of neck with shaft. It has a
medial articular facet which forms the costo-
transverse joint with the transverse process of
corresponding vertebra. The lateral part is non
articular.
First Rib
It has the following peculiarities (Fig. 4.8).
a. It is the shortest and the strongest of true ribs.
b. It is broad and flat with upper and lower surfaces
and inner and outer borders.
C H A P T E R-4
c. The vertebral end has a small head with a single
facet and an elongated round neck.
Second Rib
Peculiarities of 2nd rib (Fig. 4.9).
a. It is twice as long as the 1st rib and is thinner. It is
shaped more like a typical rib.
b. Posterior angle of rib is present close to the tubercle
c. Head presents with two facets.
d. Costal groove, present on inner surface is short.
 32 Human Anatomy For Dental Students
Fig. 4.8: 1st rib of left side
S E C T I O N-1
Fig. 4.10: 11th rib of left side
10th Rib
It has one single facet on its head. The rest of the features
are similar to a typical rib.
11th Rib
1. Anterior end: It is pointed and ends midway.
2. Posterior end: The head has a single large facet. It
does not have neck and tubercle.
3. Shaft: It has a gentle curve with a slight angle. A
shallow costal groove is present on its inner surface
(Fig. 4.10).
Fig. 4.9: 2nd rib of left side
Fig. 4.11: 12th rib of left side
12th Rib
It is a short floating rib attached posteriorly to T12 vertebra
but ends anteriorly midway within the musculature
(Fig. 4.11).
Costal Cartilages (Fig. 4.5)
These are hyaline cartilages extending from the
anterior ends of the ribs.
These cartilages represent the unossified anterior
parts of the embryonic cartilaginous ribs.
Upper seven costal cartilages articulate with the
sternum forming costosternal joints which are of the
synovial variety.
8th to 10th costal cartilages join with each other and
further join the 7th costal cartilage.

The floating anterior ends of the 11th and 12th ribs
are also capped by cartilage.
Function: The costal cartilages provide elasticity and
mobility to the thoracic column.
THORACIC VERTEBRAE
There are twelve thoracic vertebrae. They are divided into
two types (Fig. 4.12).
1. Typical thoracic vertebrae: These have similar
characteristics. Vertebrae T2 to T8 are of the typical
type.
2. Atypical thoracic vertebrae: Their basic structure is
that of thoracic vertebrae but they have peculiar
Fig. 4.12: Typical thoracic vertebra (superior view)
Fig. 4.13: Thoracic cage with intercostal muscles
Organization of Body 33
characteristics of their own. T1 and T9 to T12 vertebrae
belong to this group.
Identification of thoracic vertebrae: Thoracic vertebrae
are identified with the help of following features
1. Heart shaped bodies.
2. Presence of costal facets on the sides of the bodies.
3. Presence of costal facets on the transverse processes,
except in the 11 and 12th thoracic vertebrae.
Features of Thoracic Vertebra (Fig. 4.12)
1. Body is heart shaped.
2. Vertebral foramen is small and circular.
3. Pedicles are short and present with two notches.
4. Transverse processes are large and project laterally
and backwards from the junction of the pedicles and
the laminae.
5. Laminae are short, thick and broad.
6. Spinous processes are long and slope downwards.
INTERCOSTAL MUSCLES (Fig. 4.13)
C H A P T E R-4
Following muscles are attached to bony thoracic cage.
1. External intercostal
2. Internal intercostal
3. Inner intercostal
4. Transversus thoracic
 34 Human Anatomy For Dental Students

THORACIC CAVITY j. Trachea with lymph nodes

k. Esophagus
Thoracic cavity is the cavity enclosed by the thoracic cage.
l. Left recurrent laryngeal nerve
It communicates above with the neck at the thoracic inlet
m. Thoracic duct, left to esophagus
and is separated from the abdominal cavity by the
Inferior mediastinum lies between posterior surface
diaphragm. It contains right and left pleural sacs which
of body of sternum and lower thoracic vertebrae with
enclose right and left lungs respectively. The soft tissue
their intervertebral discs. The most important content
space between the two sacs is known as mediastinum
is heart and pericardium which is placed centrally
(Fig. 4.14).
and divides it into anterior, middle and posterior
mediastinum (Figs 4.14 and 4.15).
Mediastinum
Contents
For the purpose of description mediastinum is
1. Ascending aorta
divided into superior and inferior mediastinum with
2. Pulmonary trunk
the help of an imaginary line extending from the
3. Four pulmonary veins
sternal angle to lower border of T4 vertebra.
4. Lower part of superior vena cava
Superior mediastinum lies between manubrium
5. Arch of azygos vein
sterni and upper four thoracic vertebrae with their
6. Bifurcation of trachea
inter-vertebral discs and anterior longitudinal
7. Deep cardiac plexus
ligament (Figs 4.14 and 4.15).
8. Inferior tracheo-bronchial lymph nodes
Contents: Antero-posteriorly.
9. Phrenic nerve and pericardiophrenic vessels
a. Origin of sternohyoid muscle and sternothyroid
10. Esophagus
muscle.
11. Descending aorta
S E C T I O N-1

b. Thymus gland
12. Azygos and hemiazygos veins
c. Right and left brachiocephalic veins
13. Thoracic duct
d. Upper part of superior vena cava
14. Vagus nerves
e. Left superior intercostal vein
15. Splanchnic nerves
f. Arch of aorta with its three large branches
16. Posterior mediastinal lymph nodes
g. Phrenic nerve
17. Posterior intercostal arteries
h. Vagus nerve
18. Some of posterior intercostal veins
i. Cardiac nerves

Fig. 4.14: Thoracic cavity showing mediastinum Fig. 4.15: Visceral contents of mediastinum
 Organization of Body 35

ABDOMEN (Figs 4.16 to 4.26)

Abdomen is the part of trunk which lies below the
thoraco-abdominal diaphragm. It has anterior wall,
posterior wall, roof and floor (Fig. 4.16). Anterior wall
is musculoaponeurotic and is formed by three flat
muscles namely external and internal oblique and
transversus abdominis with their aponeurosis. In
the mid line it is strengthened by rectus abdominis
and pyramidalis muscles (Fig. 4.17).
Posterior wall is osseomusculofascial. It is formed
by lumbar vertebrae in mid line and the pre and para
vertebral muscles on both sides. Principal nerves and
vessels of abdomen lie in relation to the posterior
wall.
Roof is formed by the undersurface of thoraco-
abdominal diaphragm.
Floor is formed by the pelvic diaphragm posteriorly
and the urogenital diaphragm in anterior part.
Abdomen contains the organs of digestive system
with its associated glands, urinary system and
Fig. 4.16: Boundaries of abdomen

C H A P T E R-4
reproductive system.

Fig. 4.17: Muscles of anterior abdominal wall

 36 Human Anatomy For Dental Students
Fig. 4.18: Lumbar vertebra (superior aspect)
LUMBAR VERTEBRAE
There are five lumbar vertebrae. The size of bodies of
S E C T I O N-1
lumbar vertebrae increases from above downward. Upper
four lumbar vertebrae are typical (Fig. 4.18).
Features of Typical Lumbar Vertebra
1. Massive reniform (kidney shaped) body.
2. Conspicuous vertebral notches are present on
pedicles.
3. Transverse processes project laterally from the
junction of pedicle and lamina. Accessory tubercles
are present on the posteroinferior part of the roots of
transverse processes.
4. Superior articular facets are concave facing
backward and medially. They lie further apart from
inferior articular facet.
5. A mamillary tubercle is present at the posterior
margin of each superior articular facet.
6. Spine is quadrangular and horizontal.
5th lumbar vertebra is atypical and presents the
following features
1. Body of L5 is the largest
2. Anterior surface of 5th lumbar vertebra is more
extensive than posterior surface.
3. Distance between superior and inferior articular
facets is identical.
4. Transverse processes encroach on the sides of the
body. They are short and large.
5. Vertebral canal is triangular.
SACRUM
It is a large, flattened, triangular bone formed by fusion of
5 sacral vertebrae. The upper part of sacrum is broad and
stout as it supports the body weight. The lower part is
narrow and tapers downwards. The sacrum articulates
with the two hip bones on either side in its upper part.
Weight transmission of the body occurs from sacrum
through each of the sacro-iliac joints to the hip and thence
to the lower limb (Figs 4.19 and 4.20).
Sacrum is divided into a base, an apex and four
surfaces.
Base of sacrum: It is formed by the upper surface of 1st
sacral vertebra. The first sacral vertebra is similar to the
lumbar vertebra. The anterior border of base is prominent
and projects anteriorly. It is known as the sacral
promontory. Vertebral foramen is present behind the body
and leads to the sacral canal below. It is triangular in
shape. Transverse processes are modified to form ala of
sacrum on either side. Each ala is formed by fusion of
transverse process and the corresponding costal element.
Apex: It is formed by inferior surface of 5th sacral vertebra
and articulates with coccyx.
Pelvic/ventral surface: It is concave and directed down-
wards and forwards.
Dorsal surface: It is a rough, convex and irregular surface.
It is directed backwards and upwards. A bony ridge is
present in median plane called the median sacral crest.

Fig. 4.19: Sacrum (pelvic surface)
This bears 3 to 4 tubercles which represent the fused spines
of upper 4 sacral vertebrae.
Below the 4th tubercle is an inverted V-shaped gap
called the sacral hiatus. The haitus is formed because the
laminae of the 5th sacral vertebra fail to meet posteriorly.
Four dorsal/posterior sacral foramina are present on each
side of fused articular processes. These transmit the dorsal
rami of upper four sacral nerves.
Lateral surfaces: Each lateral surface is formed by the
fused transverse processes and costal elements of sacral
vertebrae. The upper part is wider and bears an L-shaped
articular surface anteriorly. It articulates with the
auricular surface of hip bone and forms the sacro-iliac
joint.
Sacral canal: It is formed by the central foramen of fused
sacral vertebrae. It contains the cauda equina, filum
terminale and spinal meninges. Subdural and
subarachnoid spaces end at the level of 2nd sacral
vertebra.
COCCYX
It is formed by fusion of four rudimentary coccygeal
vertebrae. It is a small triangular bone with the wider
part above and an apex below.
It consists of
1. Base: It is formed by the upper surface of body of first
coccygeal vertebra. This articulates with the apex of
sacrum. The 2nd, 3rd and 4th coccygeal vertebrae
are merely bony nodules which progressively
diminish in size
2. Pelvic surface: Ganglion impar is present over it.
3. Dorsal surface
4. Lateral margins
5. Apex
Organization of Body 37
Fig. 4.20: Sacrum (Dorsal aspect)
BONY PELVIS
Pelvis means basin (Fig. 4.21). It is formed by two hip
bones sacrum and coccyx. The two hip bones are placed
laterally and meet anteriorly at pubic symphysis.
Posteriorly, the pelvis is completed by articulation of the
two hip bones with sacrum and articulation of sacrum
C H A P T E R-4
with coccyx. Pelvis is divided into two parts by the pelvic
brim. The pelvic brim is formed by sacral promontory,
anterior border of ala of sacrum, lower of medial
border of ilium, pecten pubis, pubic crest and upper
border of symphysis pubis. The two parts of pelvis are
false pelvis and true pelvis.
False or greater pelvis: It is the part of pelvis lying above
the pelvic brim. It consists of lumbar vertebrae posteriorly,
iliac fossae laterally and anterior abdominal wall
anteriorly. The only function is to support the viscera.
True or lesser pelvis: It is the part of pelvis below the
pelvic brim. In the females it is adapted for childbearing
The baby has to negotiate this bony passage during labour
and delivery. It is further divided into three parts.
1. Pelvic inlet or pelvic brim: The plane of pelvic inlet
makes an angle of about 55 to 60 degrees with the
horizontal. Axis of inlet is a line passing through
umbilicus above and the tip of coccyx below. It meets
the centre of plane of inlet at right angles.
2. Pelvic cavity: It is a J-shaped canal curving down-
wards and forwards. It is bounded by pubic
symphysis and body of pubis in front. On each side
is ischiopubic ramus and behind there is sacrum
and coccyx.
3. Pelvic outlet: It is a diamond shaped inferior aperture
of the pelvis. It is bounded anteriorly by subpubic
arch, laterally by inferior border of ischiopubic rami
and ischial tuberosities, poster.
 38 Human Anatomy For Dental Students

Fig. 4.21: Bony Pelvis

S E C T I O N-1

Fig. 4.22: Vertical disposition of peritoneum in male

ABDOMINAL CAVITY Peritoneum (Fig. 4.22)

Abdominal cavity is the cavity enclosed within the
abdominal wall. It is lined by peritoneum which consists
of a single layer of epithelial cells known as mesothelium
with a thin connective tissue layer. It is separated from
the thorax superiorly, by diaphragm but continues below
with the pelvic cavity.
It is a large serous sac which lines the inner surface of the
abdomino-pelvic wall and is invaginated by viscera from
different sides. These invaginations throw the peritoneal
sac into folds and forms parietal and visceral layers of
peritoneum.

Structures that are suspended by the peritoneal folds,
also known as mesenteries, are intraperitoneal in location.
The structures which are not suspended by peritoneal
folds lie between the peritoneum and posterior abdominal
wall. They are retroperotoneal in location. Intraperitoneal
structures include stomach, small intestine and part of
large intestine. Retroperitoneal structures include
kidneys, ureters and part of large intestine. The
retroperitoneal area provides passage to vessels
lymphatics and nerves.
Functions of the Peritoneum
The neurovascular bundle is carried along the
peritoneal folds to the organs.
It facilitates movement of viscera by reducing friction.
It prevents spread of infection. The greater omentum
wraps around an inflamed organ to contain the
infection. Greater omentum is known as the
policeman of abdomen.
Phagocytes and lymphocytes that are present in the
tissue provide local cellular and humoral immunity
against infection.
It aids the transfer of oocyte shed from ovary into the
uterine tubes
It has great absorbtive power and can be used to
treat local cancers by injecting drugs.
Peritoneal dialysis is helpful in patients with kidney
failure to remove urea.
Peritoneal Cavity
It is the potential space between the parietal and visceral
peritoneum. Peritoneal cavity is a closed sac in males. In
Fig. 4.23: Sagittal section of female abdomen and pelvis showing different viscera
Organization of Body 39
females however, the cavity communicates to the exterior
via the ostia of uterine tubes. It contains minimal serous
fluid made up of water electrolytes, proteins, few epithelial
cells and phagocytes. Normally there is no gas in the
cavity. Peritoneal cavity is primarily made up of two
intercommunicating sacs
1. Greater sac : It is the larger sac and extends from the
diaphragm to the pelvic floor.
2. Lesser sac (omental bursa): It is the smaller sac
present behind stomach and liver and opens into
the greater sac via the omental foramen.
PELVIS
Pelvis is the region2 which lies below the abdomen and
consists of structures enclosed within the two hip bones
and sacrum (Figs 4.23 to 4.24).
Pelvic cavity is a bowl shaped cavity enclosed within
the hip bones and sacrum. It continues above with the
abdominal cavity at the pelvic inlet. Pelvic inlet is formed
by sacral promontory, ala of sacrum ileopectineal line
C H A P T E R-4
and pubic symphysis on each side. It is separated from
the perineum below by the pelvic diaphragm. It contains
the bladder, rectum and anal canal and reproductive
tracts of male or female.
Pelvic diaphragm: It is a gutter shaped thin sheet of
muscular partition that separates the pelvic cavity from
perineum. This forms floor of pelvic cavity. It is formed by
two muscles namely levator ani and coccygeus and the
fasciae covering them (Fig. 4.25)
 40 Human Anatomy For Dental Students

Fig. 4.24: Sagittal section of male abdomen and pelvis showing different viscera
S E C T I O N-1

Fig. 4.25: Pelvic diaphragm

PERINEUM tissue forming the superior and inferior fascia of

It is a diamond shaped space between the upper part of urogenital diaphragm.
two thighs, lying below the pelvic diaphragm. It fills the It is pierced by urethra in male and urethra and vagina
pelvic outlet (Fig. 4.26). in female.
It is bounded anteriorly by lower border of symphysis
pubis and arcuate pubic ligament, anterolaterally on each
side by ischiopubic rami and ischial tuberosity,
posterolaterally on each side by sacrotuberous ligament
and posteriorly by tip of coccyx.
Perineum is divided into anal triangle posteriorly and
urogenital triangle anteriorly by an imaginary line
passing through the two ischial tuberosities.
Urogenital diaphragm (Fig. 4.16): It is a musculo fascial
partition which separates the pelvic cavity from anterior
part of outlet. It is made up of a sheet of muscles namely,
sphincter urethrae and a pair of deep transverse perinei.
This sheet is covered by condensations of pelvic connective Fig. 4.26: Perineum

Functions of Urogenital Diaphragm
1. It supports the prostate or bladder.
2. Sphincter urethrae exerts voluntary control of
micturation, and expels the last drop of urine after
the bladder stops contraction.
3. It constricts the vagina in female.
4. It fixes the perineal body.
UPPER LIMB
Upper limb is also known as upper extremity. Adapting
to the upright posture of human beings, upper limb
Fig. 4.27: Parts and bones of upper limb
Organization of Body 41
became the prehensile organ used to manipulate the
environment for survival and existance by its primary
function of grasping mechanism brought about with the
help of hand. Arm and forearm increase the range of move-
ment of hand to manipulate the external environment
aided by the shoulder and elbow joints (Fig. 4.27).
Functions of Upper Limb
1. Grasping
2. Defence
3. Tactile apparatus: It helps in feeling and holding
objects.
C H A P T E R-4
 42 Human Anatomy For Dental Students

Parts of Upper Limb 7. Lunate 8. Triquetral

9. Pisiform 10. Trapezium
Upper limb can be studied as follows:
11. Trapezoid 12. Capitate
1. Attached part of upper limb: It is the region in
13. Hamate 14. Five metacarpals
relation to shoulder girdle with the help of which
15. Fourteen phalanges
upper limb proper is attached to the trunk. It consists
of the following parts: Clavicle
a. Shoulder region: Region in relation to shoulder It is also known as collar bone. It connects the sternum
girdle. with scapula (Figs 4.28 and 4.29). The clavicle has a shaft
b. Pectoral region: It lies on the front of the chest. and two ends.
c. Scapular region: Part around shoulder joint and 1. The medial or sternal end is rounded and articulates
over the scapula on the back of the body is the with manubrium sterni forming the sternoclavicular
scapular region. joint. A small inferior part articulates with the first
d. Axilla or arm pit: Pyramidal space between costal cartilage.
pectoral region and scapular region is known as 2. The lateral end is also known as acromial end. It is
axilla or arm pit. flattened and articulates with the acromian process
2. Upper limb proper: This part of the limb is free and of scapula forming acromioclavicular joint.
is attached to the trunk with the help of shoulder 3. The shaft is divided into a medial part (2/3rd) which
region. It consists of the following parts: is convex in front and a lateral part (1/3rd) which is
a. Arm: It extends from shoulder joint to elbow joint. concave in front.
b. Forearm: It extends from elbow joint to wrist joint.
c. Hand: It is further divided into two parts: Characteristics of Clavicle
S E C T I O N-1

i. Wrist: It is the region in relation to carpal 1. It is the first bone to be ossified in the body.
bones. Ossification occurs in the 5th and 6th week of
ii. Hand proper: It is the region in relation to intrauterine life from two primary centres.
metacarpals, and phalanges. 2. Clavicle is subcutaneous throughout.
3. It is a long bone. However, it differs from a typical
long bone because of following features:
BONES OF THE UPPER LIMB (Figs 4.28 to 4.36) a. It has no medullary cavity.
1. Clavicle 2. Scapula b. Ossification of clavicle is membranous except at
3. Humerus 4. Radius the two ends.
5. Ulna 6. Scaphoid c. It is placed in a horizontal position in the body.

Fig. 4.28: Superior aspect of right clavicle

Fig. 4.29: Inferior aspect of right clavicle


Humerus
It is the bone of the arm (Figs 4.30 and 4.31). It is a long
bone divided into two ends (Upper and Lower) and one
shaft.
Upper end of humerus: It consists of the following parts:
1. Head of humerus: It is rounded and forms about
1/3rd of a sphere. It articulates with the glenoid
cavity of scapula to form shoulder joint and is
covered by articular cartilage.
2. Neck of humerus
a. Anatomical neck: Is the part which surrounds
the margin of head. It connects the head to the
upper end of humerus.
b. Morphological neck: It is the line of fusion
between the epiphysis and diaphysis. It corres-
ponds to a line passing through the lower part of
greater and lesser tubercles.
c. Surgical neck: Is the junction of upper end of
humerus with the shaft. It is seen as a slightly
Fig. 4.30: Left humerus (anterior aspect)
Organization of Body 43
constricted portion below the epiphyseal line. It
is the narrowest upper part of shaft of humerus
which is most likely to be fractured in case of
injury to upper part of humerus.
3. Tubercles of humerus
a. Lesser tubercle
b. Greater tubercle
4. Inter tubercular sulcus (Bicipital groove): It is the
groove present between the greater and lesser
tubercles on the anterior surface of humerus below
the head. It contains the following structures
a. Tendon of long head of biceps
b. Synovial sheath of the tendon
c. Ascending branch of anterior circumflex
humeral artery.
Shaft of humerus: It is rounded in upper half and
triangular in lower half. It presents three borders namely:
anterior, medial and lateral and has three surfaces
namely: anterolateral surface, anteromedial surface and
posterior surface.
C H A P T E R-4
Fig. 4.31: Left humerus (posterior aspect)
 44 Human Anatomy For Dental Students
Lower end of humerus: It is expanded from side to side
to form the condyle and is divided into articular and
nonarticular portions.
1. Articular part consists of
a. Capitulum: It articulates with head of radius.
b. Trochlea: It articulates with trochlear notch on
ulna.
2. Non articular parts consists of two epicondyles
medial epicondyle and lateral epicondyle which are
felt as subcutaneous projections.
Scapula
It is also known as shoulder blade (Figs 4.32 and 4.33).
The clavicle and scapula together form shoulder girdle. It
is homologous to the ilium of hip bone. It is a large, flat
triangular bone situated on each side of upper part of
posterolateral aspect of thorax. It extends from 2nd to 7th
ribs and consists of a body and three processes.
Body of scapula: It presents a costal or ventral surface
and a dorsal surface. It has three borders namely: superior
S E C T I O N-1
border, medial or vertebral border and lateral border. The
borders meet at angles and form superior angle, inferior
angle and lateral angle.
The lateral angle presents a glenoid fossa which
articulates with the head of humerus to form the shoulder
joint.
Fig. 4.32: Right scapula (anterior aspect)
Processes of scapula: Scapula bears three processes
namely:
a. Spinous process: It is a large process on the dorsal
surface of the scapula. Its posterior border is
subcutaneous.
b. Acromion process: It is a anterior projection from
the lateral most end of spinous process. It articulates
with lateral end of clavicle to form acromio-
clavicular joint.
c. Coracoid process: It is a short process from upper
part of glenoid cavity. It is directed anteriorly.
Radius
It is the long bone of forearm situated laterally. It is
homologous with the tibia of lower limb (Figs 4.34 and
4.35). It is divided into two ends and a shaft.
Upper end of radius: This includes the following:
1. Head: It is disc shaped. The superior surface
articulates with the capitulum of humerus to form
elbow joint. Medial side of head articulates with ulna
to form superior Radio-ulnar joint.
2. Neck: It is a small constricted part below the head.
3. Radial tuberosity
Shaft of radius: It has three borders anterior border,
medial or interosseous border and posterior border. It
presents three surfaces anterior surface, posterior surface
and lateral surface.
Fig. 4.33: Right scapula (posterior aspect)

Fig. 4.34: Anterior aspect of left radius and ulna
Lower end of radius: It is the widest part of bone and has
five surfaces. Medial surface articulates with head of ulna
to form inferior Radio-ulnar joint. Inferior surface
articulates with scaphoid laterally and lunate medially
to form wrist joint.
Ulna
It is the bone of forearm placed medially and is homo-
logous to the fibula of lower limb (Figs 4.34 and 4.35). It
has two ends and a shaft.
Upper end of ulna: It has two processes and two articular
surfaces known as notches
1. Olecranon process: It is an upward, hook like
projection and its tip fits into the olecranon fossa of
humerus when forearm is extended. Posterior
surface is a smooth triangular subcutaneous area
separated from skin by a bursa. This surface in its
upper part forms the point of elbow, most prominent
when the elbow is flexed.
Organization of Body 45
C H A P T E R-4
Fig. 4.35: Posterior aspect of left radius and ulna
2. Coronoid process: It is a bracket like forward
projection from the area just below olecrenon.
3. Trochlear notch: It articulates with the trochlea of
the humerus to form elbow joint.
4. Radial notch: It is situated on the lateral surface and
it articulates with medial aspect of head of radius
forming superior radio-ulnar joint.
Shaft of ulna: It has three borders anterior border, lateral
or interosseous border and posterior border. Posterior
border is subcutaneous and can be felt on the lateral aspect
of forearm, dorsally. It presents with three surfaces anterior
surface, medial surface and posterior surface.
Lower end of ulna: It consists of the following two parts
1. Head of ulna: It is subcutaneous posteriorly.
Laterally it presents a facet for articulation with
ulnar notch of radius to form inferior radio-ulnar
part.
2. Styloid process: It projects down from the
posteromedial side of lower end of ulna.
S E C T I O N-1 46 Human Anatomy For Dental Students

Fig. 4.36: Skeleton of hand

Bones of the Hand Sesamoid Bones of Upper Limb

Hand has twenty seven bones. These include eight 1. Pisiform: It is ossified in the tendon of flexor carpi
carpals, five metacarpals and fourteen phalanges ulnaris.
(Fig. 4.36). 2. Two sesamoid bones are present on the palmar aspect
1. Carpal bones: They are 8 short bones arranged in of 1st metacarpal bone.
two rows. Proximal row consists of (from lateral to
medial) scaphoid, lunate, triquetral and pisiform.
Distal row consists of (from lateral to medial) JOINTS OF UPPER LIMB
trapezium, trapezoid, capitate and hamate. 1. Sterno-clavicular joint
A neumonic has been designed with first letter of
2. Acromio-clavicular joint
each bone to remember the names of the boneShe
looks too pretty, try to catch her. 3. Gleno-humeral joint or shoulder joint
2. Metacarpals: These are five in number and 4. Elbow joint
numbered from lateral to medial side (Fig. 4.36). The 5. Superior radio-ulnar joint
thumb is the first metacarpal and little finger the 6. Middle radio-ulnar joint
fifth metacarpal. 7. Inferior radio-ulnar joint
Each metacarpal is a miniature long bone and is
8. Wrist joint
divided into three parts namely, distal end which is
rounded and called the head, proximal end which 9. Inter carpal joints
is expanded from side to side and named the base 10. Carpo metacarpal joints
and shaft. 11. Inter metacarpal joints
3. Phalanges: They are fourteen phalanges in each hand 12. Metacarpo-phalangeal joints
(Fig. 4.36). Two phalanges are present in thumb and
13. Proximal interphalangeal joints
rest of four fingers have three phalanges each. Each
phalanx consists of proximal end or base, distal end 14. Distal interphalangeal joints
or head and intermediate portion which is the shaft.
 Organization of Body 47

MUSCLES OF UPPER LIMB Muscles of Shoulder and Scapular Region (Figs 4.38
to 4.40)
Muscles of Pectoral Region (Fig. 4.37)
Muscles Action
Muscle Action
1. Deltoid 1. Abduction acts at
1. Pectoralis major
Nerve supply:
It acts on shoulder joint causing
1. Adduction
Nerve supply:
Axillary nerve (C5, 6)
2. Flexion
3. Extension
} shoulder
joint
Medial (C8, T1) and 2. Medial rotation
Flexion and extension are
lateral(C5, C6, C7) 3. Flexion of extended arm by
caused by anterior and
pectoral nerves swinging it forwards
posterior fibres
4. Accessory muscle of
respectively
inspiration
5. Helps in climbing when 2. Supraspinatus 1. Initiates abduction of
humeral attachment is fixed Nerve supply: shoulder joint up to 15
2. Pectoralis minor 1. Draws the scapula Suprascapular nerve (C5) 2. Helps in stability of
Nerve supply: forwards with serratus shoulder joint.
Medial pectoral anterior 3. Infraspinatus 1. Lateral rotation of arm
nerve (C8, T1) 2. Helps in forced inspiration Nerve supply: 2. Stabilization of shoulder
when scapula is fixed Suprascapular nerve (C5) joint
3. Subclavius 1. Depresses clavicle
Nerve Supply: 2. Steadies clavicle during 4. Teres minor 1. Lateral rotation of arm
Nerve to subclavius movements of shoulder Nerve supply: 2. Stabilization of shoulder
(C5,C6) Axillary nerve (C5,6) joint

4. Serratus anterior 1. Protracts scapula along 5. Teres major 1. Medial rotation of arm

C H A P T E R-4
Nerve supply: with pectoralis minor Nerve supply:
Long thoracic nerve 2. Helps in forced inspiration Lower subscapular nerve
(C5,C 6,C 7) (C 6,7)
6. Subscapularis 1. Medial rotation of arm
Nerve supply: 2. Stabilization of shoulder
Upper and lower joint
subscapular nerves (C5,6,7)

Fig. 4.37: Clavipectoral fascia, Pectoralis major muscle, Pectoralis minor muscle
 48 Human Anatomy For Dental Students
Muscles of Upper BackRelated To Upper Limb
(Figs 4.41 to 4.43)
Muscle
1. Trapezius
Nerve supply:
a. Spinal part of
XI cranial nerve
b. C2 C3 proprioceptive
fibres
2. Latissimus dorsi
Nerve supply:
Thoraco dorsal nerve
(C6,7,8)
Fig. 4.38: Attachments of deltoid muscle
S E C T I O N-1
3 Levator scapulae
Nerve supply:
It receives branches from
dorsal scapular nerve (C5)
and C3 + C4 spinal nerves
4. Rhomboideus major
Nerve supply:
Dorsal scapular nerve (C5)
5. Rhomboideus minor
Nerve supply:
Dorsal scapular nerve (C5)
Fig. 4.39: Attachments of subcapularis muscle
Fig. 4.41: Attachments of trapezius and latissimus dorsi
Fig. 4.40: Posterior scapular region muscles muscles
Action
1. Over head abduction
by facilitating rotaion
of scapula
2. Elevation of scapula
3. Retraction of scapula
It acts on shoulder joint
and causes
1. Adduction of arm
2. Medial rotation of
arm
3. Extension of arm
4. Helps in climbing by
elevating trunk when
arm is raised and
fixed hence it is
also known as
climbing muscle
1. Elevation of scapula
2. Steadies the scapula
along with
rhomboideus
during movement of
upper limb.
1. Retraction of scapula
along with
rhomboideus minor
2. Also steadies scapula
Same as above

Fig. 4.43: Superficial muscles of the back and muscles of extensor compartment of arm and forearm
Muscles of Arm (Figs 4.43 and 4.44)
Muscle
1. Coracobrachialis
Nerve supply: It is pierced
and supplied by Musculocu-
taneous nerve (C5,6,7)
2. Biceps brachii
Nerve supply:
Musculocutaneous nerve
(C5,6,7)
Fig. 4.42: Superficial muscles of the back
Action
Weak flexor of arm, acts at
shoulder joint
1. Supination in semi
flexed forearm
2. Flexor of elbow joint
3. Helps in screwing
movement
4. Short head causes flexion
of shoulder joint
5. Long head helps in
stabilisation of shoulder
joint
Organization of Body 49
C H A P T E R-4
Muscle Action
3. Brachialis Flexion of elbow joint.
Nerve supply: It is the main flexor of
Musculocutaneous (C5,6,7) forearm
and Radial nerve
4. Triceps brachii Extension of forearm, acts
Nerve supply: at elbow joint
Radial nerve (C5,6,7,8 T1)
Important: Branch to
long head is given out in
axilla by radial nerve.
S E C T I O N-1 50 Human Anatomy For Dental Students

Fig. 4.44: Muscles of pectoral region, arm and forearm

Muscles of Flexor Compartment of Forearm

(Figs 4.44 to 4.46)
Muscles are arranged in three layers namely: superficial,
intermediate and deep.
Superficial group: All are supplied by median nerve
except flexro carpi ulnaris (Figs 4.44 and 4.45). They are
tabulated below:

Muscles Action
1. Pronator teres 1. Pronation
Nerve supply: 2. Weak flexor of elbow joint
Median nerve, it
lies between the
origin of two
heads

2. Flexor carpi 1. Flexor of wrist

radialis 2. Abduction of wrist along
Nerve supply: with extensor carpi radialis
Median nerve longus and brevis

3. Palmaris longus Weak flexor of wrist

Nerve supply:
Median nerve
4. Flexor carpi 1. Flexion of wrist
ulnaris 2. Adduction of wrist with
Nerve supply: flexor and extensor carpi
Ulnar nerve ulnaris Fig. 4.45: Superficial muscles of flexor compartment of forearm
 Organization of Body 51

Muscles of Extensor Compartment of Forearm

(Fig. 4.47)
The Muscles arranged in superficial and deep layers.

Superficial Group (Fig. 4.47)

They are tabulated below:

Muscles Action
1. Brachioradialis Flexion of elbow joint (acts
Nerve supply: as shunt muscle)
Radial nerve
2. Extensor carpi radialis 1. Abduction of wrist
longus 2. Extention of wrist
Nerve supply: Radial
nerve
3. Extensor carpi radialis 1. Extension of wrist
brevis 2. Abduction of wrist
Nerve supply: Posterior
interosseous nerve
4. Extensor digitorum Extension at metacarpo-
Nerve supply: Posterior phalangeal joint and flexion
at interphalangeal joints

C H A P T E R-4
interosseous nerve
Fig. 4.46: Deep muscles of flexor compartment of forearm 5. Extensor digiti minimi Extension of little finger
Nerve supply: Posterior
Intermediate Group (Figs 4.44 and 4.45) interosseous nerve
6. Extensor carpi ulnaris
Muscles Action 1. Extension of wrist
Nerve supply: Posterior
Flexor digitorum 1. Flexion at proximal 2. Adduction of wrist
interosseous nerve
superficialis interphalangeal joints
7. Anconeus
Nerve supply: 2. Secondary flexor of 1. Extension of elbow
Nerve supply: Radial
Median nerve metacarpophalangeal 2. Abduction of ulna during
nerve
and wrist joint pronation

Deep group (Figs 4.44 and 4.46)

Deep group (Fig. 4.47)
Muscles Action
1. Flexor pollicis Flexor of thumb
longus Muscles Action
Nerve supply: 1. Supinator Supination of forearm, in
Median nerve Nerve supply: Posterior extension.
(anterior interosseous nerve
interosseous nerve) 2. Abductor pollicis longus 1. Abduction of thumb.
Nerve supply: Posterior
2. Flexor digitorum 1. Flexion of distal interosseous nerve 2. Extension of thumb.
profundus interphalangeal joints
Nerve supply: 2. Secondary flexors of 3. Extensor pollicis brevis Extension of proximal
a. Medial part by metacarpo-phalangeal Nerve supply: Posterior phalanx of thumb.
ulnar nerve and carpal joints interosseous nerve
b. Lateral part by 4. Extensor pollicis
Median nerve longus
(anterior Nerve supply: Posterior Extension of distal phalanx
interosseous interosseous nerve of thumb.
nerve) 5. Extensor indicis
3. Pronator quadratus Principal pronator of Nerve supply: Posterior Extension of index finger.
Nerve supply: forearm interosseous nerve
Median nerve
 52 Human Anatomy For Dental Students

Thenar and Hypothenar Muscles (Figs 4.48 and 4.49)

Muscles Action
1. Abductor pollicis 1. Abduction of thumb
brevis (Fig. 7.55) 2. Medial rotation of
Nerve supply: thumb
Recurrent branch of
median nerve
2. Flexor pollicis brevis Flexion of proximal phalanx
Nerve supply: of thumb
Recurrent branch of
median nerve
3. Opponens pollicis Opposition of thumb
Nerve supply:
Recurrent branch of
median nerve
4. Adductor pollicis Adduction of thumb
Nerve supply: Deep
branch of ulnar nerve

5. Abductor digiti minimi The hypothenar muscles act

Nerve supply: Deep as a group to deeper the
branch of ulnar nerve cup of the palm for a firm
Fig. 4.47: Muscles of extensor compartment of forearm grip on a large object
S E C T I O N-1

6. Flexor digiti minimi The hypothenar muscles act

Nerve supply: Deep
branch of ulnar nerve
MUSCLES OF HAND
They consist of tendons of long flexors and extensors of 7. Opponens digiti
minimi
forearm (described above), and intrinsic muscles of hand.
Nerve supply: Deep
The intrinsic muscles of hand are arranged in three branch of ulnar nerve
groups namely: thenar muscles, hypothenar muscles and 8. Palmaris brevis
deep muscles. Nerve supply: Superficial
branch of ulnar nerve
as a group to deeper the
cup of the palm for a firm
grip on a large object
The hypothenar muscles act
as a group to deeper the
cup of the palm for a firm
grip on a large object
Protects underlying ulnar
vessels and nerves

Fig. 4.49: Thenar muscles of hand

Fig. 4.48: Thenar and hypothenar muscles of hand
 Organization of Body 53

Fig. 4.50: Attachment of lumbricals

Fig. 4.51: Attachment of lumbricals

Deep Muscles of Hand (Figs 4.50 and 4.51) Functions of Lower Limb
These consists of lumbricals and interossei muscles which 1. Locomotion.
act on fingers.

C H A P T E R-4
2. It provides support to the body.
Lumbricals: They are four in number (Fig. 4.51) . 3. It helps in transmitting body weight.
1 and 2 are unipennate and arise from radial side of
profundus tendon for index and middle finger. 3 and 4
are bipennate and arise from adjacent sides of Parts of Lower Limb
profundus tendons of middle and little fingers. Lower limb consists of hip and bottock, thigh, leg, foot
They insert into the dorsal digital expansion and toes.
Nerve supply: 1st and 2nd lumbricals are supplied by 1. Hip and buttock: It is also called as gluteal region. It
median nerve while 3rd and 4th lumbricals are supplied
extends from small of the back of waist superiorly,
by ulnar nerve.
to the gluteal fold inferiorly and the hollow on lateral
Palmar Interossei: They are four in number and are
supplied by deep branch of ulnar nerve. side of thigh.
Dorsal Interossei: They are four in number and are Hip : It is the upper part.
supplied by deep branch of ulnar nerve. Buttock : It is the rounded bulge behind and
below.
Action of Dorsal Digital Expension 2. Thigh : Extends from the hip to knee.
1. Tendon of extensor digitorum: Prime mover for Proximally extends upto
extension at metacarpo-phalangeal and inter-
Anteriorly : Groove of groin
phalangeal joints.
Posteriorly : Gluteal fold
2. Lumbricals: Flexion at metacarpo-phalangeal joint
and extension at interphalangeal joints. Medially : Perineum
3. Dorsal intersossei: Less powerful flexor at Laterally : Hollow on the side of the hip.
metacarpo-phalangeal Joint, abductor of digits. Distally
4. Palmar intersossei: Less powerful flexor at Anteriorly : Extends upto knee joint
metacarpo-phalangeal Joint, adductor of digits. Posteriorly : Popliteal fossa
3. Leg: Extends from knee joint to ankle joint. The fleshy
LOWER LIMB part of back of leg is known as calf.
4. Foot: Extends from the point of heel to the roots of
Lower limb is also known as inferior extremity. Lower the toes. Superior surface is called dorsum of the
limb is that part of the body which extends from the region
foot. Inferior surface is sole or plantar surface.
of hips and buttocks on each side to the toes. Lower limb
5. Toes: Five toes are present extending from foot.
is attached to the trunk by the sacro-iliac joint (Fig. 4.52).
S E C T I O N-1 54 Human Anatomy For Dental Students

Fig. 4.52: Parts and bones of lower limb

BONES OF THE LOWER LIMB 31+2 IN NUMBER 7. 5 Metatarsals: Bones of foot

(Fig. 4.52) 8. 14 Phalanges: Bones of toes
9. 2 Sesamoid bones in relation to 1st metatarsal
1. Hip bone
2. Femur: Bone of thigh
3. Patella Hip Bone (Figs 4.53 and 4.54)
4. Tibia: Bone of leg Hip bone is a large, irregular bone made up of three parts
5. Fibula: Bone of leg namely, ilium, pubis and ischium.The three parts are
6. Tarsal bones: Bones of foot fused at a depressed area called the acetabulum. There
a. Calcaneum are two hip bones in our body which meet anteriorly to
b. Talus
form pubic symphysis. Posteriorly they articulate with
c. Navicular
sacrum to form sacroiliac joint on either side. Together
d. Cuboid
they form the hip girdle (Figs 4.53 and 4.54).
e. Cuneiform: Three in number
 Organization of Body 55

C H A P T E R-4
Fig. 4.53: Right hip bone (external aspect)

Fig. 4.54: Right hip bone (internal aspect)

 56 Human Anatomy For Dental Students
The three parts of hip bone are described below:
Ilium
It forms the upper, expanded, plate like part of the hip
bone. It forms 2/5th of the acetabulum in its lower part.
Ilium consists of upper and lower ends, three borders
and three surfaces which are described below.
Iliac crest: The upper end of the expanded plate of ilium
is in the form of a long broad ridge. It is called iliac crest.
The anterior end is known as anterior superior iliac spine
while the posterior end is known as posterior superior
iliac spine.
Morphologically iliac crest is divided into two parts:
a. Ventral segment: This forms just more than
anterior 2/3rd of the iliac crest. It has an outer lip
and an inner lip with an intermediate area in
between. A small elevation is present 5 cm behind
the anterior superior iliac spine on the outer lip. This
is called the tubercle of iliac crest.
b. Dorsal segment: It is smaller and forms about
S E C T I O N-1
posterior 1/3rd of the crest. It is broadened and
consists of a lateral slope and a medial slope divided
by a ridge.
Lower end: The lower end of ilium is small. This fuses
with the pubis and ischium at the acetabulum. It forms
2/5th of the acetabulum.
Three borders: It has anterior border, posterior border
and medial border.
Three surfaces: These are
a. Gluteal surface: It is the posterior surface and is
divided into four areas by three gluteal lines namely,
posterior gluteal line, anterior gluteal line and
inferior gluteal line.
b. Iliac surface or iliac fossa: It is the anterior concave
surface.
c. Sacropelvic surface: It is the medial surface which
articulates with sacrum. It is divided into three areas
iliac tuberosity, auricular surface and pelvic surface.
Pubis
It forms the anterior and inferior part of hip bone. Anterior
1/5th of acetabulum is formed by pubis. Pubis consists
of a body and two rami.
Body of pubis: It is flattened from before backwards. The
upper border is known as the pubic crest. The medial
surface articulates with the opposite side pubis bone
forming the symphysis pubis.
Superior ramus of pubis: It extends from the body of pubis
to the acetabulum and lies above obturator foramen. It
has three borders and three surfaces. It contributes to
1/5th of acetabulum.
Inferior ramus of pubis: It extends from the body of pubis
downwards and backwards to meet the ischial ramus
forming the ischiopubic ramus. Upper border forms the
lower margin of obturator foramen. Lower border forms
the pubic arch.
Ischium
It forms the posterior and inferior part of hip bone and
the adjoining 2/5th of the acetabulum. Ischium has a
body and a ramus.
Body of ischium: It is thick and short and lies below and
behind the acetabulum. Upper end forms the
posteroinferior 2/5th of acetabulum. Lower end forms
the ischial tuberosity.
Ramus of ischium: It forms the ischiopubic ramus along
with inferior ramus of pubis as described above.
Acetabulum
It is a deep cup-shaped hemispherical cavity formed
by all three elements of hip bone namely ilium (upper
2/5), pubis (anterior 1/5), ischium (posterior 2/5).
A fibrocartilaginous acetabular labrum is attached
to the margins forming a rim. This helps to deepen
the acetabular cavity.
The margin of acetabulum is deficient inferiorly and
forms the acetabular notch.
The cavity can be divided into two parts.
a. Nonarticular part or the acetabular fossa.
b. Articular part: It is a horseshoe shaped area
occupying the anterior, superior and posterior
parts of acetabulum. Acetabulum articulates
with head of femur.
Obturator Foramen
This is a large gap situated inferior and anterior to the
acetabulum between the pubis and ischium
Femur (Figs 4.55 and 4.56)
Femur is the longest and strongest bone of the body. It is
the bone of the thigh (Figs 4.55 and 4.56). It is a long bone
and can be divided into a shaft and two ends.
Upper end of femur: This includes the head, neck and
two trochanters.

1. Head of femur: It is globular and forms more than
half of a sphere. It articulates with the acetabulum to
form hip joint. A pit known as fovea is situated just
below and behind the centre of the head.
2. Neck of femur: It connects the head to the shaft and
is about 5 cm long. The neck is so inclined that it
makes an angle of 165 degree with the shaft in
children. This is reduced to 125 degree in adults.
The angle is more acute in females due to wider
pelvis. This helps to facilitate movement at hip joint
and allows the lower limb to swing clear of the pelvis.
3. Greater trochanter: It is a large quadrangular
prominence from the upper part of junction of shaft
and neck.
4. Lesser trochanter: It is a conical projection in the
posteroinferior part of junction of neck and shaft and
is directed medially
Fig. 4.55: Right femur (Anterior aspect)
Organization of Body 57
Intertrochanteric line: It is a prominent ridge. It extends
from anterosuperior angle of greater trochanter to the
spiral line in front of lesser trochanter.
Intertrochanteric crest: It is a smooth and rounded ridge
which extends from posterosuperior angle of greater
trochanter to the posterior aspect of lesser trochanter. A
rounded elevation known as quadrate tubercle is present
a little above its middle.
Shaft of femur: It is cylindrical in shape being narrowest
in middle with expanded upper and lower parts. The
shaft of femur can be divided into three parts namely,
upper 1/3rd, middle 1/3rd and lower 1/3rd.
The middle 1/3rd has 3 borders which divides the
shaft into 3 surfaces. The lateral and medial borders
are indistinct and extend both above and below.
C H A P T E R-4
Fig. 4.56: Right femur (Posterior aspect)
 58 Human Anatomy For Dental Students

However the posterior border is prominent and forms Patella

a ridge known as linea aspera.
The linea aspera has two lips and a central area.
The two lips diverge from the upper and lower end
of middle third of shaft to divide the shaft into four
surfaces in the upper and lower third.
The upward continuation of medial lip of linea
aspera forms a rough line extending to the lower
end of intertrochanteric line. This is the spiral line.
The lateral lip continues upwards as a broad ridge
posteriorly known as gluteal tuberosity.
The medial and lateral lips diverge downwards to
form medial and lateral supracondylar lines.
The medial supracondylar line ends in the adductor
tubercle.
Lower end of femur: It is widely expanded and consists
of two large condyles, medial and lateral. The two are
united anteriorly and separated by a deep gap posteriorly,
the intercondylar fossa. The two condyles are in line with
shaft anteriorly but project posteriorly much beyond the
plane of popliteal surface.
S E C T I O N-1
It is the largest sesamoid bone of body. It develops in the
tendon of quadriceps femoris. It is situated in front of
knee joint (Fig. 4.57). Patella is irregular in shape and is
flattened anteroposteriorly. It has an apex, three borders
and two surfaces namely anterior and posterior surfaces.
Posterior surface articulates with the lower end of
femur.
Tibia
It is the long bone of the leg, situated medially. It is larger
and stronger than fibula (Figs 4.58 and 4.59). Tibia is a
long bone with two ends and one shaft.
Upper end of tibia: It is markedly expanded and consists
of the following:
1. Medial and lateral condyle: These can be palpated
by the sides of patellar tendon. Lateral surface of
lateral condyle bears a facet that articulates with
fibula.
2. Intercondylar area: It is a roughened, non articular

part between the superior surfaces of the two

Articular Surfaces of Lower End of Femur condyles.
It covers both the condyles and is divided into two 3. Tuberosity of tibia.
1. Patellar surface: It articulates with patella.
2. Tibial surface: It articulates with upper end of tibia.

Fig. 4.57: Left patella (anterior aspect)


Shaft of tibia: The shaft of tibia is prismoid in shape and
has three borders namely anterior border, interosseous
or lateral border and medial border and three surfaces
namely, medial surface, lateral surface and posterior
surface.
Lower end of tibia: It is slightly expanded and
quadrangular. It has five surfaces namely anterior surface,
medial surface, lateral surface, inferior surface and
posterior surface.The medial surface presents a short and
strong bony projection extending downwards known as
medial malleolus. The medial surface is largest and
subcutaneous and forms prominence on medial side of
ankle. The lateral surface articulates with talus.
Fibula
It is the long bone of leg situated laterally. It is very slender
and does not play any role in weight transmission
(Figs 4.58 and 4.59). It has two ends and one shaft.
Fig. 4.58: Right tibia and fibula (anterior aspect)
Organization of Body 59
Upper end of fibula: Is divided into
1. Head of fibula: It has a circular facet an anteromedial
side for articulation with fibular facet of lateral
condyle of tibia. Styloid process is a projection from
the posterolateral aspect of head.
2. Neck of fibula: The head narrows down to the neck
which connects it to the shaft.
Shaft of fibula: It has three borders namely, anterior
border, medial or interosseous border and posterior border
and three surfaces medial or extensor surface, lateral or
peroneal surface and posterior or flexor surface
Lower end of fibula: It is also known as lateral malleolus.
It has four surfaces anterior surface, posterior surface,
lateral surface and medial surface. Lateral surface is
subcutaneous. Medial surface articulates with talus. An
elongated triangular area is situated above the lateral
surface of lateral malleolus and is subcutaneous.
C H A P T E R-4
Fig. 4.59: Right tibia and fibula (posterior aspect)
 60 Human Anatomy For Dental Students

Fig. 4.60: Skeleton of foot (dorsal aspect) Fig. 4.61: Skeleton of foot (plantar aspect)

Bones of the Foot 5. Subtalar joint

6. Joints of the foot
They can be divided into three groups (Figs 4.60 and 6.61).
S E C T I O N-1

7. Inter metatarsal joints

1. Tarsal bones: Tarsal bones are cubical in shape with 8. Metatarso-phalangeal joints
six surfaces. These are seven in number and are 9. Proximal interphalangeal joints
arranged in two rows. 10. Distal interphalangeal joints
Proximal row consists of talus above and calcaneum
below. Distal row consists of four bones which lie MUSCLES OF LOWER LIMB
side by side. From lateral to medial they are cuboid,
lateral cuneiform, intermediate cuneiform and Muscles of Front of Thigh (Fig. 4.62)
medial cuneiform. The navicular bone lies between Muscle Action
the two rows.
2. Metatarsals: These consist of 5 bones numbered from 1. Sartorius 1. Flexion of thigh and leg
medial to lateral. Each metatarsal is a miniature long (Sartor means 2. Abduction and lateral
bone divided into a head or distal end, shaft and a tailor) rotation of thigh
base or proximal end. 2. Iliacus 1. Flexion of hip
3. Phalanges: There are fourteen phalanges in each foot 2. Medial rotation of femur
3. Psoas major 1. Acting from above is
with two for great toe and three each for rest of the
the chief flexor of hip
toes. They are smaller than the phalanges of the hand. 2. Acting from below
in recumbent position
Sesamoid Bones of Lower Limb Raising trunk
4. Pectineus 1. Flexor of hip
1. PatellaLargest sesamoid bone in the body Supplied by femoral 2. Adductor of hip
2. Tendon of peroneus longus has one sesamoid bone and obturator nerves
which articulates with cuboid 5. Rectus femoris
3. There are two small sesamoid bones in tendons of Straight head Extensor of leg
flexor hallucis brevis. Reflected head
4. Sometimes there may be sesamoid bones in tendons 6. Vastus lateralis Extensor of leg
of tibialis anterior, tibialis posterior, lateral head of 7. Vastus medialis Extensor of leg
gastrocnemius, gluteus maximus and psoas major. 8. Vastus intermedius Extensor of leg
9. Articular genu It keeps the suprapatellar
bursa in position by
MAIN JOINTS OF THE LOWER LIMB pulling upwards the apex
of synovial fold
1. Sacroiliac joint
2. Hip joint 10. Tensor fascia lata Through ilio tibial tract
3. Knee joint 1. Extension of knee
2. Abduction and medial
4. Ankle joint
rotation of thigh
 Organization of Body 61

Muscles of Medial Compartment of Thigh (Fig. 4.62)

Muscle Action
1. Gracilis (Fig. 7.66) 1. Adduction of hip
Nerve supply: 2. Flexion of knee
Anterior division of 3. Stabilizes pelvis
Obturator nerve on tibia
2. Adductor longus 1. Adduction of thigh
(Fig. 7.66) 2. Medial rotation of
Nerve supply: thigh
Anterior division of
Obturator nerve
3. Adductor brevis Adduction of hip
Nerve supply:
Anterior division of
Obturator nerve
4. Adductor mangus 1. Addiction of thigh
(Fig. 7.67) 2. Medial rotation of hip
Nerve supply:
a. Adductor part
Posterior division of
obturator nerve
b. Hamstring part
Tibial component of
sciatic nerve
5. Obtutator externus 1. Lateral rotation of hip
Nerve supply: 2. Stabilizes the hip joint

C H A P T E R-4
Posterior division of
Obturator nerve

Fig. 4.63: Muscles of gluteal region and back of thigh

Muscles of Gluteal Region (Fig. 4.63)
Muscle Action
1. Gluteus maximus 1. Chief extyensor of hip joint in
Nerve supply: running and while standing
Inferior gluteal from sitting position
(L5, S1, S2) 2. Lateral rotator of hip joint,
3. Upper fibres cause abduction
of hip joint
4. Maintains the extended
position of knee joint.
2. Gluteus medius 1. Abductor of hip joint along
Nerve supply: with gluteus minimus.
Superior gluteal 2. stabilises the pelvis when
nerve (L4, L5, S1) opposite foot is off the ground.
3. Medial rotator of hip
3. Gluteus minimus 1. Abduction of thigh.
Nerve supply: 2. Medial rotation and flexion of
Superior gluteal thigh.
nerve
4. Piriformis 1. Lateral rotation of thigh.
Nerve supply: 2. Abduction of thigh when
Fig. 4.62: Muscle of front and medial side of thigh Ventral rami S1, S2 thigh is flexed.
 62 Human Anatomy For Dental Students

Muscle Action Nerve Supply to Hamstring Muscles

1. Long head of biceps femoris, semitendinosus,
5. Obturator internus 1. Lateral rotation of thigh.
Nerve supply: 2. Abduction of thigh when
semimembranosus and ischial head of adductor
Nerve to obturator thigh is flexed. magnus are supplied by tibial component of sciatic
internus (L5, S1) nerve.
6. Superior gemellus Lateral rotation of thigh 2. Short head of biceps is supplied by common
Nerve supply: peroneal component of sciatic nerve.
Nerve to obturator
internus Action of Hamstring Muscles
7. Inferior gemellus Lateral rotation of thigh. 1. Flexion of knee joint
Nerve supply: 2. Extension of hip joint especially on standing and
Nerve to quadratus walking
femorus (L5, S1). 3. In semiflexed knee semimembranous and semiten-
8. Quadratus femoris Lateral rotation and dinosus act as medial rotators and biceps femoris
Nerve supply: abduction of thigh.
acts as a lateral rotator.
Nerve to quadratus
femorus.
Muscles of Anterior Compartment of Leg and
Muscles of Back of Thigh Dorsum of Foot
They consists of hemistring muscles and short head of Nerve supply: All the muscles are supplied by deep
biceps femoris muscle. peroneal nerve (Fig. 4.64).
Hamstring Muscles Muscle Action
They are four in number (Fig. 4.63). 1. Extensor digitorum 1. Extension of toes
S E C T I O N-1

1. Semimembranosus: A true hamstring muscle. longus 2. Dorsiflexion of foot

2. Semitendinosus: A true hamstring muscle. 2. Tibialis anterior 1. Dorsiflexion of foot
3. Long head of biceps femoris muscle. 2. Inversion of foot
4. Ischial head of adductor magnus muscle. 3. Helps to maintain
arches of foot
Characteristics of hamstring muscles 3. Peroneus tertius 1. Dorsiflexion of foot
1. All arise from the ischial tuberosity. 2. Eversion of foot
2. All are inserted beyond the knee joint to either tibia 4. Extensor hallucis 1. Dorsiflexion of foot
or fibula or both. Hence, they cross both hip joint longus 2. Extension of
and knee joint. phalaynx of great toe
3. All are supplied by tibial components of sciatic 5. Extensor digitorum Dorsiflexes medial four
nerve. brevis toes in dorsiflexed ankle
4. They act as flexors of knee and extensors of hip joint.

Fig. 4.64: Muscles of anterior and posterior compartments of leg

 Organization of Body 63

Muscles of Lateral Compartment of Leg (Fig. 4.65)

Nerve supply: The muscles are supplied by superficial
peroneal nerve.
1. Peroneus Longus : It is bipennate in upper part
Action
1. Eversion of foot
2. Steadies the leg in standing, maintaining
longitudinal and transverse arches of foot.
2. Peroneus Brevis
Action
1. Eversion of foot
2. Helps to steady the leg

C H A P T E R-4
Fig. 4.66: Muscles of posterior compartment of leg

Fig. 4.65: Muscles of lateral and posterior compartment of leg

Muscles of Posterior Compartment of Leg

The muscles of posterior compartment are supplied by
tibial nerve (Figs 4.66 to 4.67).
Muscle Actions
1. Gastrocnemius Plantar flexion of ankle joint
2. Soleus Plantar flexion of ankle joint
3. Popliteus Unlocking muscle of knee joint,
flexion of knee joint
4. Tibialis posterior 1. Inversion and adduction of foot
2. Maintenance of medial
longitudinal arch
3. Plantar flexion
5. Flexor hallucis 1. Plantar flexion of great toe.
longus 2. Secondary plantar flexion of
ankle joint.
3. Maintains medial longitudinal
arch of foot.
6. Flexor digitorum 1. Plantar flexion of lateral
longus four toes.
2. Maintains medial longitudinal
arch of foot.
7. Plantaris It is primarily a vestigeal muscle
in human beings. It continues as Fig. 4.67: Deep muscles of posterior compartment of leg
the plantar aponeurosis in the foot.
 64 Human Anatomy For Dental Students

Tendocalcaneus: It is also known as Achilles tendon. It

is the strongest tendon of the body measuring about
15 cm. it is formed by gastrocnemius and soleus muscle.
Action of tendocalcaneus: Plantar flexion of ankle joint
Action of gastrocnemius: It increases the range of
movement and produces flexion of knee joint also.
Action of soleus: It is multipennate hence, increases the
power of contraction. It also acts as peripheral heart. The
tonic contraction of gastrocnemius and soleus prevents
the anterior slipping of tibia over talus.

Figs 4.68 and 4.69: Muscles of 1st and 3rd layer of sole
Layers of the Sole
Sole is divided into six layers. They are as follows
(Figs 4.68 to 4.72)
1. 1st layer: It lies beneath the plantar aponeurosis. It
has three short muscles, all are intrinsic muscles of
the foot. These muscles are
a. Abductor hallucis
S E C T I O N-1

b. Flexor digitorum brevis

c. Abductor digit minimi
2. 2nd layer: It contains medial and lateral plantar
nerves and vessels.
3. 3rd layer: It has two extrinsic tendons and two
intrinsic muscles.
Fig. 4.70: Muscles of 4th layer of sole
Extrinsic muscles are
a. Tendon of flexor hallucis longus
b. Tendon of flexor digitorum longus
Intrinsic muscles are
a. Flexor digitorum accessorius
b. Lumbricals are four in number
4. 4th layer: It contains three intrinsic muscles of foot
which are limited to region of metatarsals.
These muscles are
a. Flexor hallucis brevis
b. Adductor hallucis
c. Flexor digiti minimi brevis
Figs 4.71 and 4.72: Muscles of 6th layer of sole
5. 5th layer: It contains deep part of lateral plantar
artery and nerve.
6. 6th layer: It has seven intrinsic muscles and two VERTEBRAL COLUMN
extrinsic tendons. Vertebral column is made up of 33 vertebrae
Intrinsic muscles are four dorsal interossei and three articularted with each other in a vertical line (Figs
plantar interossei. 4.73 to 4.75). These are:
Extrinsic muscles are tendons of peroneus longus 1. 7 cervical vertebrae
and tibialis posterior. 2. 12 thoracic vertebrae
3. 5 lumbar vertebrae

4. 5 sacral vertebrae
5. 4 coccygeal vertebrae
The column encloses a vertebral canal formed by
joining of the vertebral foramen of the 33 vertebrae.
The vertebral canal contains spinal cord with its
meninges, nerve roots and blood vessels.
Length of vertebral column in adult male is 70 cm
and in adult female is 60 cm.
The adjacent vertebrae are join together by
intervertebral disc between the vertebral bodies and
by synovial joints between the facets on the pedicle
of vertebrae (except in sacral vertebrae which are
fused to form a single sacrum).
On each side a gap is present between two adjacent
vertebrae known as the intervertebral foramen which
transmits spinal nerves and vessels.
Vertebral column is not linear. It presents with two
primary and two secondary curvatures, in the sagittal
plane.
Fig. 4.73: Vertebral column (ventral aspect) Fig. 4.74: Vertebral column (lateral
aspect)
Organization of Body 65
Primary curvatures: The vertebral column is curved
with concavity facing anteriorly in the thoracic and
pelvic (sacral) regions. These are primary curvatures
of the column whcih correspond to the flexed attitude
of the fetus.
Secondary curvatures: The vertebral column
presents with convex curvature anteriorly at the
cervical and lumbar regions. These are the secondary
curvatures of the vertebral column which help adapt
to the upright posture and walking on two legs
(bipedal gait).
There may be a slight lateral curvature seen in the
thoracic region which is convex to right side, in right-
handed person and left in left-handed person.
The line of centre of gravity of vertebral column, in
erect posture, extends through the process of dens to
just anterior to body of T2 vertebra. It then passes
down through the center of T12 vertebra to the
C H A P T E R-4
Fig. 4.75: Vertebral column (dorsal
aspect)
 66 Human Anatomy For Dental Students
Fig. 4.76: Parts of a vertebra
posterior part of body of L5 vertebra. Further it lies
S E C T I O N-1
anterior to sacrum.
A diurnal variation seen in the height of vertebral
column from recumbencey to the upright posture.
The overall height loss with in 3 hours after rising
up in the morning has been found to be upto 16 mm.
Movements of Vertebral Column
Following movements occur at the vertebral column
a. Flexion
b. Extension
c. Lateral flexion
d. Rotation
e. Circumduction
These movements are restricted by limited deformation
of the intervertebral discs and shape of articular facets in
different regions of vertebral column.
Anatomical Features of a Vertebra (Fig. 4.76)
Vertebra is made up of a ventral body and a dorsal
vertebral or neural arch that encloses the vertebral
foramen.
The body of vertebra is like a small cylinder which
varies in size and shape in the various regions. The
size of body increases from cervical to lumbar
regions. This is associated with an increase in load
of weight on lower vertebra.
Vertebral arch is made up of a pedicle and a lamina
on each side.
Each pedicle is a short and thick projection from
superior part of body projecting dorsally. The
superior and inferior borders of the pedicle are
notched and when two adjacent vertebrae are joined
they are converted to intervertebral foramen.
Lamina is a broad, vertically flattened part which is
dorsal to pedicle and continues medially to meet the
lamina of other side.
A spinous process or vertebral spine projects from
dorsal surface of junction of laminae posteriorly.
The junction of pedicle and lamina bears superior
and inferior articular facets on each side.
Two small bony processes known transverse
processes extend laterally on each side from junction
of pedicle and lamina.
 Chapter

5
Skeletal System and Joints
Skeletal system is composed of skeleton. Appendicular Skeleton (Fig. 5.1)
Bones Forming Upper Limb Skeleton
SKELETON (Fig. 5.1)
Human skeleton is endoskeleton. It forms the structural Clavicle
frame work of the body. Skeleton includes bones, Scapula
cartilage and joints. It is bilaterally symmetrical. It can Humerus
be studied in two parts: Radius
1. Axial skeleton: It includes bones which lie in the Ulna
sagittal plane of body and consist of head (skull), 8 Carpal bones: Scaphoid, lunate, triquetral, pisiform,
vertebral column, ribs and sternum. Hyoid bone is trapezium, trapezoid, capitate, hamate

C H A P T E R-5
also the part of axial skeleton. 5 Metacarpals
2. Appendicular skeleton: It consists of bones of 14 Phalanges
extremities, i.e., upper limb and lower limb.
Bones Forming Lower Limb Skeleton
Axial Skeleton (Fig. 5.1)

}
It consists of skull, vertebral column, thoracic cage and Ilium
hyoid bone. Ischium form hip bone
Pubis
Skull Femur
It is made up of 22 bones and 6 ear ossicles: Patella
Tibia
Paired bones Unpaired bones Fibula
Temporal Frontal 8 Tarsal bones: Talus, calcaneum, navicular, cuboid and
Parietal Occipital
three cuneiform bones
Maxilla Sphenoid
Lacrimal Ethmoid 5 Metatarsals
Palatine Vomer 14 Phalanges
Zygomatic Mandible
Nasal Functions of the Skeleton (Fig. 5.1)
Inferior concha 1. Skeleton forms the structural framework of the
Bones of middle ear cavity body.
Incus 2. It supports the body.
Malleus 3. It transmits the weight of the body.
Stapes 4. Bones and joints act as a biochemical levers on
Vertebral Column which muscles act to produce motion.
5. Skeleton of head and vertebral column protect the
It is made up of 33 vertebrae, namely, 7 cervical, 12
thoracic, 5 lumbar, 5 sacral and 4 coccygeal vertebrae. vital organs namely brain and spinal cord.
6. Skeletal frame work of thoracic cage (ribs and
Thoracic Cage sternum) provides for the respiratory movements
It consists of 12 thoracic vertebrae, 12 pairs of ribs with and protects the heart and lungs.
their costal cartilages, sternum and xiphoid process. 7. Bones serve as a reservoir of ions (Ca++, PO4, CO3)
in the mineral homeostasis of the body.
Hyoid Bone 8. Bone marrow in adults is the source of red blood
It lies in the mid line. cells, granular white blood cells and platelets.
S E C T I O N-1 68 Human Anatomy For Dental Students

Fig. 5.1: Human skeleton

9. Cartilage is a precursor for bone formation. Most BONES

of the bones are laid down on cartilage. It also Bones are specialized, highly vascular, constantly
provides structural support in areas like ear, larynx changing, mineralized connective tissue. They are hard,
and trachea where rigidity is not require. resilient and have enormous regenerative capacity. They
 Skeletal System and Joints 69

are made up of cells and inter cellular matrix. Cellular
component is 2% of bone mass. Matrix is made up of
40% organic substance consisting mainly of collagen and
60% inorganic substance made up of, inorganic salts of
calcium and phosphate.
Cellular Components
These consist of the following cells:
1. Osteoblasts: These are large, basophilic cells with
a round, and slightly eccentrically placed nucleus.
They originate from osteogenic stem cells from bone
marrow.
Functions:
a. They are responsible for the synthesis of organic
matrix, i.e., collagen and other glycoprotein
molecules, which is called osteoid.
b. Osteoblasts also play a significant role in
mineralization of the osteoid.
c. They have a role in bone remodelling.
2. Osteocytes: They form the majority of the cellular
component. They are mature bone cells derived
of hydroxyapatite crystals of calcium and
phosphate. These crystals are closely packed and
arranged along the collagen fibers.
Gross Anatomy of Bone
Externally bones appear white to off-white in colour and
are of two types:
1. Compact bones: These are dense bones. 70 to 75%
of bones in body are compact bones (Fig. 5.2).
Compact bone form the external cylinder of all the
bones in the body.
2. Trabecular bone or spongy or cancellous bones:
They are less dense and present with large cavities
in between plates of bones giving them a honey-
comb appearance (Fig. 5.2). This type of bone is
present inner to the compact bone and supports the
bone marrow.

C H A P T E R-5
from osteoblats which do not produce matrix and
have lost their ability to divide. They form the
cellular architecture of bone. The cells lie singly,
embedded in the matrix and are surrounded by a
lacuna. They are large cells with numerous dend-
ritic processes that branch and are interconnected
to the processes of adjacent cells. The dendrites are
surrounded by extensions of lacunae forming
canaliculi which serve the function of providing
channels for diffusion of nutrients, gases and waste
products.
Functions: Osteocytes play significant role in Fig. 5.2: Compact and cancellous bones
maintainance of bone.
3. Osteoclasts: These are large multinucleated cells
with eosinophilic cytoplasm. They arise from mono- Classification of Bones
cytes in bone marrow.
Functions: They help in resorption and remodeling Bones can be classified into the following according to
of bones. shape (Figs 5.3 to 5.8).
1. Long bone
Matrix 2. Short bone
3. Flat bone
It is the extracellular component of bone which is made
4. Irregular bone
up of
5. Pneumatic bone
1. Organic component: This is mostly made up of
collagen with small amount of proteoglycans and
Long Bones
glycoproteins. Collagen fibres are arranged in
bundles. In woven, immature bones they form an Long bones are those bones in which the length
interwoven meshwork. In mature bones, they have exceeds the breadth (Fig. 5.3).
lamellar arrangement which is in the form of Each long bone presents a tubular shaft and two
regular parallel laminae. ends. Shaft is made up of compact bone which
2. Inorganic component: The mineral component of encloses a large cavity in centre known as
bone gives it the hardness and rigidity. It consists medullary cavity. It is filled with bone marrow. The
 70 Human Anatomy For Dental Students
ends are expanded and modified according to the
type of articular surface. The ends are composed of
cancellous bone.
Long bones ossify in cartilage.
Functions:
They act as levers for muscles.
All long bones are weight bearing.
Example: Humerus, femur, radius, ulna, tibia, fibula.
S E C T I O N-1
Fig. 5.3: Humerus-long bone
Short Bones (Fig. 5.4)
Short bones are cubical in shape and present with
six surfaces, out of which four surfaces are articular
and the remaining two surfaces give attachment to
various muscles, ligaments and are pierced by
blood vessels.
Short bones have a central marrow cavity which is
surrounded by trabecular bone with a plate of
compact bone externally.
All short bones ossify after birth in cartilage, except
talus, calcaneus and cuboid bones which start
ossification in intrauterine life.
Example: Carpal bones, Tarsal bones.
Fig. 5.4: Short and long bones
Flat Bones
Flat bones consist of two plates of compact bone with
intervening spongy bone and marrow. The intervening
spongy tissue in the bones of the vault of skull is known
as the diploe which contain numerous veins. Flat bones
form boundaries of some bony cavities and appear in
those areas where protection of essential organs is of
paramount importance (Fig. 5.5).
Example: Parietal bones , Frontal bone, Ribs, Sternum,
Scapula.
Fig. 5.5: Rib-Flat bone
Irregular Bones
These bones are irregular in shape. They consist mostly
of spongy bone and marrow and have an outer thin
covering of compact bone (Fig. 5.6).
Example: Vertebra, Hip bone, Sphenoid, Maxilla.
Fig. 5.6: Vertebra-Irregular bone
Pneumatic Bones
These are similar to irregular bones and have air filled
cavities in them (Fig. 5.7).
Example: Maxilla, Sphenoid, Ethmoid.
Fig. 5.7: Maxilla-Pneumatic bone

Sesamoid Bones
These bones develop in the tendon of a muscle. They
help share the load of the tendon and they may also be
responsible in changing the direction of pull of the
tendon. Sesamoid bones are not covered with
periosteum (Fig. 5.8).
Example: Patella, Pisiform, Fabella.
Fig. 5.8: Patella-Sesamoid bone
Parts of a Young Long Bone (Fig. 5.9)
A young long bone presents with the following four
regions:
1. Diaphysis
2. Epiphysis
3. Epiphyseal cartilage
4. Metaphysis.
1. Diaphysis: It is the part of bone which ossifies from
the primary centre and forms the shaft of bone.
It is composed of a thick collar of dense compact
bone, beneath which is a thin layer of spongy
trabecular bone enclosing the marrow cavity.
2. Epiphysis: It is the part of bone which ossifies from
the secondary centres. Epiphyses are functionally
of three basic types:
a. Pressure epiphysis: It helps to transmit the
weight of body and protects the epiphyseal
cartilage, e.g., Head of femur, head of humerus.
Fig. 5.9: Parts of young long bone
Skeletal System and Joints 71
b. Traction epiphysis: It is produced due to the
pull of muscles., e.g., Trochanters of femur,
tubercles of humerus.
c. Atavistic epiphysis: It is phylogenetically an
independent bone which gets attached to the
host bone secondarily, to receive nutrition, e.g.,
coracoid process of scapula, posterior tubercle
of talus or trigonum.
3. Epiphyseal cartilage: It is a plate of cartilage which
intervenes between the epiphysis and diaphysis of
a growing bone. Epiphyseal cartilage persists till
the bone is growing. When the full length of bone
is achieved, epiphyseal cartilage is replaced by bone
and further growth stops.
4. Metaphysis: The end of diaphysis facing towards
the epiphyseal cartilage is known as metaphysis.
Characteristics of metaphysis
a. It is the most actively growing area of long bone
b. Metaphysis has a rich blood supply derived
from nutrient, periosteal and juxtra-epiphyseal
arteries. Nutrient arteries form pin head like
capillary loops in the metaphysis. Hence, any
circulating microorganisms can settle in these
C H A P T E R-5
loops. Thus, infections of long bones primarily
affect the metaphysis.
BLOOD SUPPLY OF BONES
Nutrition of bones differs according to the type of bones
Blood Supply of a Typical Long Bone (Fig. 5.10)
A long bone is supplied by 4 sets of blood vessels
1. Nutrient artery: Some bones have several nutrient
arteries where as, others have only one. Nutrient
artery grows in the periosteal bud and enters the
middle of the shaft of the bone. It divides into two
branches known as nutritiae, one for each end. Each
branch further subdivides into a number of smaller,
parallel arteries which enter the metaphysis and
form hair pin like loops. Hair pin loops anastomose
with periosteal, juxta-epiphyseal and epiphyseal
arteries.
Nutrient artery supplies the bone marrow and
inner 2/3rd of cortex. Nutrient artery enters the
Volkmans canal and Haversian system. Each
Haversian system is one fifth of millimeter in
diameter so that, no osteocyte would lie more than
1/10th of a millimeter from the artery of the central
canal.
2. Metaphyseal arteries: They are also known as
juxta-epiphyseal arteries. They arise from the
anastomosis around the joint and pierce the
metaphysis along the attachment of the joint
capsule.
3. Epiphyseal arteries: These are derived from
periarticular vascular arcades (anastomosis) found
on the non-articular bony surface.
 72 Human Anatomy For Dental Students

Arterial Supply of Flat Bones

1. Periosteal arteries Supply major part of the bone.
2. Nutrient arteries Pierce the compact part of bone
and subdivide into smaller branches.
Arterial Supply of Irregular Bones
Different arteries supply body and processes.
Venous Drainage of Bones
Veins retrace of the path of arteries.
Nerve Supply of Bones: Nerves supplying a bone
accompany the blood vessels. Most of them are
sympathetic and vasomotor in function. Sensory supply
is distributed to the periosteum and articular ends of
the bones, vertebra and large flat bones.
Microscopic Structure of Bone
Histologically bones are of two types namely:
1. Compact bone
2. Trabecular or spongy bone
Compact Bone
It is characterized by presence of Haversian systems
Fig. 5.10: Blood supply of a long bone or osteons (Fig. 5.11).
Each Haversian system consists of concentrically
4. Periosteal arteries: Are numerous and lie beneath
S E C T I O N-1

arranged lamellae around a central Haversian

the muscular and ligamentous attachments. They
ramify beneath the periosteum and supply the
Haversian system in outer 1/3rd of the cortex.
Arterial Supply of Short Long Bone
Periosteal artery is the main artery.
1. Nutrient artery: It enters the middle of the shaft
and divides into a plexus. This explains why
infection begins in middle of the shaft of a short
long bone in childhood
2. Epiphyseal and Juxtaepiphyseal arteries: Supply
epiphyseal end of bones.
3. Periosteal arteries: Periosteal arteries supply the
major part of the bone and replace the nutrient
artery in these bones.
canal.
Haversian canal contains capillaries and axons of
nerves (Neurovascular channel).
Lamellae are made up of bundles of collagen within
a sheet of mineralized matrix.
In between lamellae are present osteocytes with
their canaliculi.
The Haversian system are arranged adjacent and
parallel to each other. Vascular channels known as
Volkmanns channels are present obliquely or
horizontally, perpendicular to the Haversian
systems that connect adjacent Haversian systems
to each other and connect the Haversian system to
marrow cavity.

Fig. 5.11: Transverse section of compact bone (Dried sectionunder high magnification)

Fig. 5.12: Transverse section of cancellous bone (Stainhematoxylin-eosin under high magnification)
The outer most covering of bone is fibrous layer of
dense collagen tissue called periosteum. It has an
inner cellular layer of osteoblasts, osteoprogenitor
cells and osteoclasts. Inner layer covering the
marrow cavity is known as endosteum. Periosteum
is absent on articular surfaces of bone where it is
replaced by hyaline cartilage and at sites of insertion
of muscles or tendons.
Functions of Periosteum
1. Receives attachment of muscles and maintains
the shape of the bone.
2. Provides nutrition to outer 1/3rd of cortex of
compact bone by periosteal blood vessels.
3. Helps in formation of subperiosteal deposits,
increasing the width of the bone.
4. Protects the bone.
5. Periosteum is sensitive to pain.
6. It is important in the healing of bone injuries or
fractures.
Trabecular Bone
These consists of plates of bones of varying width
and length known as trabeculae (Fig. 5.12).
These trabeculae are curved and branched enclose
a number of marrow cavities in between.
Each trabecula is lined by endosteum.
The arrangement of ground substance of matrix,
collagen fibres and cells is lamellar, in regular
parallel fashion. No definite Haversian system is
seen.
Ossification of Bone
Ossification literally means deposition of the proteo-
osseous substance or the process of bone formation. It
involves the differentiation of osteoblasts which secrete
organic intercellular substance or matrix and deposition
of Ca2+ crystals and salts. Ossification is of two types:
Skeletal System and Joints 73
1. Intramembranous or membranous ossification: It
is the formation of bone from primitive mesench-
yme. The mesenchymal cells differentiate to
osteogenic progenitor cells and then osteoblasts
C H A P T E R-5
around a branch of the capillary network of
mesenchyme. The osteoblasts proliferate and lay
down lamellae of collagen and ground substance
molecules. Calcification of matrix occurs and
continuous deposition of matrix and calcification
with proliferation of osteoblasts results in formation
of trabecular bone. This gradually thickens to form
compact bone.
Example: Bones of the vault of skull.
2. Endochondral or cartilaginous ossification (Fig.
5.13): The basic principle of endochondral
ossification is that bone formation occurs over
templates of hyaline cartilage. It means that
cartilage dies and bone forms. Most bones ossify in
cartilage. At the site of future bone formation
mesenchymal cells get collected. These mesen-
chymal cells becomes chondroblasts and form
hyaline cartilage. Mesenchymal cells on the surface
of cartilage forms perichondrium. Cells mature and
secrete matrix. Hypertrophic cells secrete alkaline
phosphatase. Alkaline phosphatase helps in
deposition of calcium salts. Due to calcium salt
deposition there is no diffusion of nutrition in
cartilage, leading to death of cells. This leaves spaces
around them known as primary areola. Inner layer
of perichondrium (now periosteum) give rise to
osteoprogenitor cells. These cells enter along with
nutrient artery inside the cartilaginous matrix and
proliferate to form the periosteal bud. These
osteoprogenitor cells eat away the wall of primary
areola and these cavities become larger and now
called as secondary areola. Osteoprogenitor cells
S E C T I O N-1 74 Human Anatomy For Dental Students
Fig. 5.13: Endochondral ossification
get converted into osteoblasts and lines the walls
of these cavities. Osteoblasts lay down the ground
substance and collagen fibres to form osteoids.
These osteoids become calcified and called as
lamellae of new bone.
Growth of Bones
The long bones increase in length by interstitial growth
of cells of the epiphyseal cartilage. Width of the long
bone increases by subperiosteal deposition of bone
formation. Short bones increase in size by the interstitial
growth of the articular cartilage.
Factors Affecting Bone Growth
1. Vitamin A: Vitamin A controls the activity,
distribution and co-ordination of osteoblasts and
osteoclasts. High vitamin A concentration leads to
resorption of bone. Deficiency of vitamin A causes
slow destruction of bone. This reduces the size of
spinal and cranial foramina that leads to
compression of nerve roots and cranial nerves.
2. Vitamin C: Vitamin C helps in formation of
intercellular matrix. Deficiency of vitamin C leads
to decrease production of trabeculae on the
diaphyseal side of epiphyseal cartilage. This, can
cause separation of epiphyseal plate.
3. Vitamin D: It is essential for the absorption of
calcium and phosphorus from intestine. In
deficiency of vitamin D, calcification of osteoid
matrix is interfered. This leads to osteomalacia and
rickets.
4. Hormonal factors
a. Growth hormone: Hypersecretion of growth
hormone from pituitary gland before puberty
leads to persistent growth at epiphyseal
cartilages with consequent gigantism, hyper-
secretion of growth hormone after puberty
causes acromegaly. Hypopituitarism of infant
causes failure of normal growth of bones with
dwarfism.
b. Parathormone: It increases resorption of Ca2+
from bones.
c. Calcitonin: It is secreted by thyroid gland and
helps in deposition of Ca2+ in bones.
d. Sex hormones: Testosterone and estrogens lead
to early fusion of epiphysis. Bone growth is
decreased if their level increases before puberty.
5. Mechanical factors: Tensile forces help in bone
formation. Compression force favours bone
resorption. Local osteoporosis occurs when a limb
is paralysed or immobile.

CARTILAGE
Cartilage is a specialized connective tissue which has
the capacity to bear mechanical stress, is resilient and is
highly resistant to compression and tension. It provides
support to soft tissues and allows for the smooth
movements of bones over each other acting as a shock
absorber. It also provides template for endochondral
ossification and hence is essential for growth and
development of bone.
Structure of Cartilage
Cartilage is composed of cells and fibres embedded in a
firm, gel like matrix which is rich in mucopoly-
saccharides. The consistency of matrix is responsible for
the firm and resilient nature with elasticity and shock
absorbing capacity of cartilage. It consists of the
following components.
1. Cells: Cartilage has two types of specialised cells:
a. Chondroblasts: These are young cells which
have the ability to divide.
b. Chondrocytes: These are larger mature cells
derived from chondroblasts. They cannot divide
but are very active in producing and secreting
proteins.
On microscopy, the cells are seen to be arranged
singly or in groups of 2 to 3 surrounded by a thin
cavity in matrix known as lacuna .
2. Intercellular substance: Matrix forms about 90%
of cartilage content. It is made up of mucopoly
sacharides and consists of collagen fibres.
3. Fibres: Cartilage is predominantly made up of
collagen type II fibres and elastic fibres in the matrix.
Characteristic Features of Cartilage
1. Cartilage is surrounded by a thin, dense fibrous
layer known as perichondrium. Perichondrium is
absent at the junction of cartilage with bone and
over the synovial surfaces. Fibrocartilage does not
have perichondrium.
Fig. 5.14: Transverse section of hyaline cartilage (Stain-hematoxylin-eosin under high magnification)
Skeletal System and Joints 75
2. Cartilage is avascular: It receives its nutrition
through diffusion from the nearest perichondrial
capillaries. Many cartilage masses are traversed by
cartilage canals which convey blood vessels. These
cartilage canals provide nutrition to the deepest core
of cartilaginous mass.
3. Cartilage has no nerves. Hence it is insensitive
4. Cartilage grows by appositional as well as
interstitial method of growth.
5. When cartilage calcifies, chondrocytes die because
they are deprived of nutrition as diffusion caeses.
6. Cartilage has low antigenicity because it lacks
lymphatics. Hence, homologus transplantation of
cartilage is possible without much risk of graft
rejection.
7. It has poor regenerative capacity except fibro-
cartilage which has some capacity to regenerate.
Types of Cartilage
1. Hyaline cartilage (Fig. 5.14): It is the most abundant
form of cartilage in the body. It appears as a bluish,
opalescent, tissue. Hyaline cartilage is surrounded
by perichondrium. Cartilage cells are arranged in
groups of two or more which occupy small lacunae
C H A P T E R-5
in the matrix. The matrix appears homogeneous
and basophilic. Fibres are not seen on routine
staining because the refractive index of fibres and
ground substance is similar.
Distribution: It is widely distributed in the body
and is present at the epiphyseal ends of the bone in
children. It is also present in articular cartilage,
thyroid cartilage, cricoid cartilage, lower part of
arytenoid cartilage, tracheal rings, costal cartilages,
bronchial cartilages, nasal cartilage.
2. Elastic cartilage (Fig. 5.15): In elastic cartilage the
matrix is traversed by yellow elastic fibres which
anastomose and branch in all directions. Extra-
cellular matrix is metachromatic due to high
 76 Human Anatomy For Dental Students
Fig. 5.15: Transverse section of elastic cartilage (Stain-hematoxylin-eosin under high magnification)
S E C T I O N-1
Fig. 5.16: Transverse section Fibrocartilage (Stain-hematoxylin-eosin under high magnification)
concentration of glycosaminoglycans. Cells are
present in ground substance in groups of 2 to 3.
Outer most covering is the perichondrium.
Distribution: Pinna of external ear, epiglottis,
corniculate cartilage, cuneiform cartilage, apex of
arytenoid cartilage, auditory tube, external auditory
meatus.
3. White fibro-cartilage (Fig. 5.16): Fibrocartilage is a
dense opaque fibrous tissue. It consists of regularly
arranged collagen fibres, in the form of fascicles. It
is less cellular than hyaline cartilage and
chondrocytes are scattered in the matrix. It also
consists of fibroblasts. It does not have any
perichondrium.
Distribution: Intervertebral disc, interpubic disc,
menisci of knee joint, articular discs of tempora-
omandibular, sternoclavicular and inferior radio-
ulnar joints, labra of glenoid and acetabular cavities.
JOINTS
Joint is a junction between two or more bones and is
responsible for movement, growth or transmission of
forces.
Classification
Depends upon the function of the joint. They are of two
types:
1. Synarthroses: These are solid joints without any
cavity. No movement or only slight movement is
possible. Synarthroses are further subdivided into
a. Fibrous joints
b. Cartilaginous joints
 Skeletal System and Joints 77

2. Diarthroses: They are c avitated joints and form

the synovial joints in which the joint cavity is filled
with synovial fluid. These joints permit free
movements.

Fibrous Joints
Types of fibrous joints:
1. Sutures (Fig. 5.17): Sutural joints appear between
those bones which ossify in membranes. The sutural Fig. 5.17: Sutural joint
membrane between the edges of two growing bones Function: They provide growth and bind together
consist of osteogenic and fibrous layers. Sutural the apposed margins of bones.
membrane connects the periosteum covering the Example: Joints of skull are sutural joints.
outer and inner surfaces of bones.

Different Types of Sutures

Type Appearance Example

1. Plane Borders are plane and united by Palatine processes of the two maxilla
sutural ligaments

2. Serrate Edges of bones present a Sagittal suture

C H A P T E R-5
saw-tooth appearance

3. Denticulate Margins present teeth, with the Lambdoid suture

tips being broader than the roots

4. Squamous Edges of bones are united by Between parietal bone and

overlapping squamous part of temporal bone

5. Schindylesis Edge of one bone fits in the Rostrum of sphenoid and upper
(wedge and groove) groove of other bone margin of vomer.

2. Syndesmosis (Fig. 5.18): Where the surfaces of Function: Slight amount of movement is possible
bones are united with an interosseous membrane at these joints.
or a ligament. The two bones lie some distance Example: Middle radio-ulnar joint, inferior tibio-
apart. fibular joint.
3. Gomphosis (Peg and socket joint) (Fig. 5.19): Root
of teeth fit in the socket of jaw and are united by
fibrous tissue.

Fig. 5.18: Syndesmosis Fig. 5.19: Gomphosis

 78 Human Anatomy For Dental Students
Car tilaginous Joints
Cartilaginous joints are of two types:
1. Primary cartilaginous joint (Fig. 5.20): It is formed
when two bones are connected with the help of
hyaline cartilage. This joint ultimately gets ossified.
Example: Joint between epiphysis and diaphysis
of a bone.
Fig. 5.20: Primary cartilaginous joint
2. Secondary cartilaginous joint (Fig. 5.21): All
midline joints are secondary cartilaginous joints.
The two bones are united with the help of fibro
cartilage in the centre which is surrounded by
hyaline cartilage on both the sides. Generally it
doesnt get ossified.
S E C T I O N-1
Example: Manubriosternal joint, symphysis pubis,
intervertebral disc.
Fig. 5.21: Secondary cartilaginous joint
Fig. 5.22: Intervertebral disc
Fig. 5.23: Formation of intervertebral disc
Formation of Intervertebral Disc
It is secondary cartilaginous joint present between body
of two adjacent vertebrae. It is formed by nucleus
pulposus in the centre surrounded by fibro-annulosus.
Fibro-annulosus is covered by fibro cartilage which is
lined by hyaline cartilage on both the sides. Inter-
vertebral disc facilitates movement and acts as shock
absorber (Figs 5.22 and 5.23).
Synovial Joint
Synovial joint permits free movement. The characteristic
feature of a synovial joint is the presence of a joint cavity
filled with synovial fluid and lined by the synovial
membrane which is enveloped by articular capsule
(Fig. 5.24).
Fig. 5.24: Synovial joint
Components of a Synovial Joint and their Function
1. Articular surfaces: These consist of corresponding
ends of articulating bones.
2. Articular cartilage: Articular cartilage covers the
articular surfaces of the articulating bones. It is
made up of hyaline cartilage at most of the places
except where the articular surfaces are ossified in
membrane. In these cases articular cartilage is made
up of fibrocartilage. Articular cartilage has no
perichondrium and hence no regenerative power.
 Skeletal System and Joints 79

Once it is damaged, replacement is by fibrous tissue. Functions:

Function: The co-efficient of friction of articular
cartilage is equal to ice on ice. Therefore it provides
a smooth gliding surface and reduces the forces of
compression during weight bearing. Aricular
cartilage is porous and absorbs fluid in resting
condition. When joint is compressed, the fluid is
squeezed out of the cartilage.
3. Synovial fluid: It is a clear or pale yellow, viscous
slightly alkaline fluid. It is the dialysate of blood
plasma with added hyaluronic acid, sulphate free
glycosaminoglycans.
Functions:
a. It maintains the nutrition of articular cartilage.
b. It provides lubrication to the joint cavity and
helps to prevent wear and tear.
4. Synovial membrane: It is a pink, smooth and shiny,
cellular connective tissue membrane of mesench-
ymal origin. It lines the fibrous capsule from inside.
Articular cartilage and menisci are not lined by
synovial membrane. Synovial membrane is made
up of two layer. Outer layer is subintima and inner
a. Secretes synovial fluid
b. Liberates hyaluronic acid
c. Removes particulate matter from the synovial
fluid.
5. Joint cavity: Formed by one of the articular surfaces.
It accommodates the articular surfaces, articular
cartilage, synovial fluid and synovial membrane.
6. Articular capsule: Consists of a fibrous capsule
lined by synovial membrane on the inside. Capsule
is formed by bundles of collagen fibres arranged in
irregular spirals and is sensitive to changes of
position of joint (Fig. 5.24).
Function: It binds the articulating bones together.
7. Articular disc or meniscus: It is made up of
fibrocartilage and divides the joint into two
incomplete or complete joint cavities.
Function: It helps to increase the range of
movement.
8. Labrum, if present: It is made up of fibrocartilage.
It increases the depth of cavity as well as provides

C H A P T E R-5
layer is intima. Intima consists of type A and type stability to the joint.
B cells. Type A cells are phagocytic, type B cells 9. Ligaments: True and accessory. They maintain the
secrete hylauronic acid. stability of the joint.

Types of Synovial Joints

Type Movement Example
1. Plane joint Gliding movement is possible Intercarpal, acromio-clavicular and intertarsal
joint. Joint between 1st rib and sternum

2. Uniaxial joint: Movement

is possible in one axis
a. Hinge joint Movement around transverse axis. Elbow, ankle and interphalangeal joints
It allows flexion and extension.
b. Pivot joint Movement occurs on a vertical axis. Superior radioulnar, inferior radioulnar and
The bone acts as a pivot which is median atlanto axial joints.
encircled by an osseo ligamentous ring.
c. Condylar joint Movement occurs mainly on transverse Knee joint, temporomandibular joint.
Also known as axis and partly on vertical axis.
modified hinge joint.

3. Biaxial joint: Movement

occurs in two axes
a. Ellipsoid joint Movement occurs around transverse
and antero-posterior axes. It allows
flexion, extension, adduction and
abduction
b. Saddle joint Movement occurs around transverse
and antero-posterior axes. Conjunct
rotation is also possible.
Wrist joint, metacarpophalageal,
metatarsophalangeal and
atlanto-occipital joints.
Ist carpometacarpal joint
Sternoclavicular joint
Calcaneo-cuboid joint

4. Polyaxial joints: They have

three degrees of freedom
Ball and socket Movement occurs around antero-post- Hip joint
(spheroidal) joint erior, transverse and vertical axes. It Shoulder joint
allows flexion extension. adduction, Talo-calcaneo-navicular joint
abduction, rotation and cicumduction Incudo-stapedial joint.
 80 Human Anatomy For Dental Students
Movements and Mechanism of Synovial Joints
There are four following types of movements taking
place in synovial joints namely.
1. Gliding: Movement take place in plane joints where
one bone slips over the other in a particular
direction.
2. Angular movements: May be of two types:
a. Flexion and extension: In flexion two ventral
surfaces approximate with each other while in
extension it is the opposite.
b. Adduction and abduction: In adduction the
body part moves towards the median plane or
median axis. In abduction the body part moves
away from the median plane or median axis.
3. Circumduction: It is a combination of flexion,
extension, adduction and abduction in a successive
order.
4. Rotation: Movement occurs around vertical axis.
Blood Supply of Joints
The articular and epiphyseal branches given off by the
neighboring arteries form a periarticular arterial plexus.
Numerous vessels from this plexus pierce the fibrous
S E C T I O N-1
capsule and form a rich vascular plexus in the deeper
part of synovial membrane. The blood vessels of synovial
membrane terminate around the articular margin in the
form of a capillary plexus. This is known as circulus
vasculosus. It supplies the capsule, synovial membrane
and epiphysis.
Lymphatic Drainage of Joints
Lymphatics form a plexus in the subintima of synovial
membrane and drain into lymphatics present along the
blood vessels to the corresponding regional deep nodes.
Nerve Supply of Joints
Nerve supply of a joint lies in its capsule, ligaments and
synovial membrane. The capsule and ligaments have a
rich nerve supply and are sensitive to pain. Articular
cartilage is non sensitive because it has no nerve supply.
Articular nerves contain sensory and autonomic
fibres. Some of the sensory fibres are proprioceptive.
Autonomic fibres are vasomotor or vasosensory. Joint
pain is often diffuse and may be associated with nausea,
vomiting, slowing of pulse and fall in blood pressure.
Pain commonly causes reflex contraction of muscles
which fix the joint in a position of comfort. Joint pain
may also referred to another uninvolved joint.
Hiltons law: Hiltons law states that, nerve supplying
a joint also supplies the muscles acting on the joint and
the skin over the joint.
Gardners modification: The part of the joint capsule
which is rendered taut by the contraction of a group of
muscles, is supplied by a nerve which innervates the
antagonist muscles.
CLINICAL AND APPLIED ANATOMY
Imaging bones and joints in the body:
A. Standard radiography (X-ray imaging): It
provides a detailed appearance of compact and
cancellous bones. Their shape and extent are
clearly recorded with spatial resolution of 0.1
to 0.2 mm.
B. Arthrography: It involves introduction of iodine
based contrast media or air or CO2 into a joint
cavity to assist in visualization and / or
differentiating between soft tissue, particularly
to study joint spaces, bursae, synovial
membrane, the size of menisci, intra articular
ligament and articular cartilage.
C. Computerized tomography: It is more useful
in the study of complex joints e.g. sacroiliac joint,
ossicles with in the middle ear. Spatial
resolution is 0.4 mm much less than plain
radiography.
D. Ultrasonography: Mainly useful in assessment
of thickness of synovial membrane, bursae,
synovial sheath of the hand.
E. Magnetic resonance imaging: Is useful in
detecting joint structures, especially vertebral
joints.
F. Soft tissue radiography: Allows the study of
details of soft tissue, tendons, sheaths,
ligaments, joint capsules, cartilages with the
help of a low kilovolt X-ray unit.
G. Magnification radiography: This technique
provides the greatest details of the structural
organization of bone.
H. Stereo-radiography: It provides a three
dimensional evaluation of structures.
I. Radionuclide imaging: It helps in identifying
sites of bone growth and remodelling.
Anthropometry is the study of variations in dimen-
sions and bodily proportions of various bones in
different races and with age and sex in a single race.
Symphysis menti is not a true secondary cartilag-
inous joint because the fusion of two halves of the
mandible takes place at the age of 3 years. Therefore
it behaves like a primary cartilaginous joint.
Wolfs law states that osteogenesis is directly
proportional to the stress and strain on a bone.
Law of union of epiphysis states that the epiphy-
seal centre which appears first unites last while the
epiphyseal centre which appears last unites first.
Articular disc performs the following functions:
a. It divides the joint cavity into two, this increases
the range of movement.
b. It acts as a shock absorber.
c. It increases the depth of the joint cavity.
Neve supply of a joint lies in the capsule of the joint
and its ligaments. Articular cartilage however, is
insensitive.
 Chapter
6
Muscular System
INTRODUCTION
Muscle is a contractile tissue and is primarily designed
for movements. The word muscle is derived from the latin
word musculus which means mouse. Certain muscles
resemble a mouse with their tendon representing the
mouse tail.
All muscles of the body are developed from
mesoderm, except the arrector pilorum, muscles of iris
and myo-epithelial cells of salivary, sweat and lacrimal
glands which are derived from ectoderm.
Muscle are divided into three types based on their
location in relation to various body parts and on the
differences in microscopic structure.
1. Skeletal muscle 2. Smooth muscle
3. Cardiac muscle
SKELETAL OR STRIATED MUSCLE
Skeletal muscles are also called voluntary muscles as they
are mostly under the conscious control of central nervous
system (CNS). The muscle fibres are attached to the skeletal
framework of the body and help in movement of joints
and bones.
Skeletal muscles are supplied by spinal and cranial
nerves and are usually under voluntary control. Muscles
of pharynx and diaphragm are striated but not entirely
under voluntary control.
Parts of striated muscles: Each muscle presents with the
following two parts:
1. Fleshy part: It is the contractile, highly vascular part
and has a higher metabolic rate.
2. Fibrous part: May be tendinous or aponeurotic, is
non elastic, less vascular and resistant to friction.
Attachment of Skeletal Muscles
The skeletal muscles are attached to the bones and
originate from one site and attached to the another site on
a different bone usually crossing the corresponding joint.
Origin of a muscle: The end of a muscle which is fixed
during contraction is known as origin of the muscle.
Insertion of the muscle: Movable end of a muscle is
known as insertion of muscle. In limbs the distal end
generally corresponds to insertions. However, in some
muscles it is known that both the ends move in different
conditions. Therefore, the term attachments of the
muscle is more appropriate.
The attachment of skeletal muscles is via tendons,
apponeurosis and fasciae. These are varieties of regular
connective tissue which contain dense arrangement of
collagen fibres and are continuous with the muscle fibres
near the site of attachment. They help attach the muscle
to the periosteum of the corresponding bone. They provide
strength to attachment, are responsible for change in
direction of pull of muscle and help resist forces of stress.
Classification of Striated Muscles
Grossly striated muscles are classified according to the
direction of muscle fibres, colour of muscles and force of
C H A P T E R-6
action.
Classification According to Direction of Muscle Fibres
1. Parallel muscle: Muscle fibres are parallel to the line
of pull. The fibres are long, but their numbers are
relatively few.
Example:
a. Strap muscles: Sartorius, rectus abdominus,
sternohyoid.
b. Quadrate muscle (Fig. 6.1): Quadratus lumborum.
c. Fusiform muscle: Biceps brachii, digastric
(Fig. 6.2).
Functional characteristics: These muscles provide
more range of movement but total force of contrac-
tion is less.
2. Pennate muscles or oblique muscles: Fleshy part
of fibres are arranged obliquely to the line of pull.
The fibres are short and a greater number of them can
be accommodated. They are of the following types
a. Unipennate muscle: All fleshy fibres slope into
one side of the tendon which is formed along
one margin of the muscle. This gives a half feather
appearance (Fig. 6.3).
Example: Flexor pollicis longus, extensor
digitorum, peroneus tertius
b. Bipennate muscle: Tendon is formed in the
central axis of the muscle and the muscle fibres
slope from the two sides into the central tendon,
like a feather (Fig. 6.4).
Example: Dorsal interossei of foot and hand,
rectus femoris
c. Multipennate muscle: A series of bipennate
fibres lie side by side in one plane (Fig. 6.5).
Example: Acrominal fibres of deltoid
Fucntional characteristics: It provides for a wide
range of movements.
d. Circumpennatemuscle : Muscle is cylindrical
with a central tendon. Oblique muscle fibres
 82 Human Anatomy For Dental Students

Fig. 6.1: Strap Fig. 6.2: Fusiform Fig. 6.3: Unipennate
converge into the central tendon from all sides.
Example: Tibialis anterior.
Functional characteristics: Total force of
contraction is increased though the range of
movement is less.
3. Spiral muscle: This type of muscle has a twisted
arrangement close to its insertion (Fig. 6.6).
Example: Pectoralis major, supinator.
Functional characteristics: Spiral course imparts
rotational movement.
4. Cruciate muscle: Muscle fibres are arranged from
the superficial to deep planes in a criss cross X-
S E C T I O N-1
Fig. 6.4: Bipennate Fig. 6.5: Multipennate Fig. 6.6: Spiral
the wall of hollow viscera, tubular and saccular viscera,
ducts of exocrine glands, blood vessels, stroma of solid
organs and the tracheo-bronchial tree.
They are known as involuntary muscles and are under
control of autonomic nervous system. The muscles also
respond to harmones and mechanical stretch (e.g., smooth
muscle of intestine). Hence, their movements are not under
conscious control.
They do not have any tendinous or apponeurotic
attachments.
Arrangement of Smooth Muscles

shaped pattern. In blood vessels, smooth muscles are predominan-

Example: Masseter, sternocleidomastoid. tly arranged in a circular fashion. They help in the
Functional characteristic: This arrangement increa- movement of blood and regulate blood flow locally
ses the range of movement. by contracting and relaxing.
In the gastrointestinal tract smooth muscles are
Classification According to Force of Action arranged in inner circular and outer longitudinal
1. Shunt muscles: These muscles tend to draw the bone layers. The muscles are responsible for forward
along the line of shaft towards the joint and compress propulsion, mixing and expulsion of contents of GIT.
the articular surfaces. Example: Brachioradialis In urinary bladder, uterus and stomach smooth
2. Spurt muscles: A swing component tends to produce muscles are arranged in three layers, namely circular,
angular movement of the joint. When the swing longitudinal and oblique. The muscles stretch to help
component is more powerful, the muscle is known in storage and contract for expulsion of contents in
as spurt. Example: Brachialis a proper manner.
Classification According to Colour Smooth muscles are supplied by parasympathetic
and sympathetic nervous system. Parasympathetic
Colour of muscle fibres depends upon the capillary stimulation usually causes contraction while sympa-
density and amount of myohaemoglobin in the sarco- thetic stimulation causes relaxation of the smooth
plasm of muscle cells. There are of two types of muscle muscle.
fibres namely red muscle fibres and white muscle fibres.
CARDIAC MUSCLE
SMOOTH OR NON-STRIATED MUSCLE
Cardiac muscles are present in the heart and at the
Non striated or smooth muscles are widely distributed in beginning of great vessels.
Characteristic features of skeletal, smooth and cardiac muscles.
Skeletal muscles Smooth muscles Cardiac muscles
1. Most abundant muscles in the body, Surround the various viscera It is the specialised muscle of heart
are attached to the skeleton. It is also of the body. It is under involuntary which is under involuntary control.
called voluntary muscle as it is mostly control and mostly forms part of
under conscious control by CNS. visceral structures in the body.
2. Supplied by spinal nerves (somatic) Supplied by autonomic nervous Supplied by autonomic nervous
nerves. Are under voluntary control system. Are mainly under system, are under involuntary con-
except pharynx and diaphragm. involuntary control. trol. Autorhythmical activity seen.
3. Respond quickly to stimuli, undergo Respond slowly to stimuli, do not Automatic and rhythmic sustained
rapid contractions, get fatigued easily. fatigue easily. contractions occur, do not fatigue easily.
4. Help in adjusting the individual Help in regulating internal Help to pump blood into circulation
his external environment. environment. at regular intervals.
5. Highest control is at the cerebral cortex. Less dependent on neuronal control. Nervous control maintains the rhythm.
 Chapter

7
Nervous System

INTRODUCTION
Nervous system is the system which responds to the
internal and external environments in order to maintain
the internal environment and manipulate the external
environment for survival and existence. Nervous system
regulates all functions of the body.

Parts of Nervous System (Fig. 7.1)

C H A P T E R-7
1. Central nervous system (CNS): It consists of brain
and spinal cord (Fig. 7.1).
Brain: It is also known as encephalon. It lies in the
cranial cavity and continues as the spinal cord. It
consists of following parts (Figs 7.2 to 7.4):
a. Prosencephalon or forebrain: It is further
subdivided into telencephalon (cerebral hemis-
pheres) and diencephalon (thalamus proper and
its related neuronal masses).
b. Mesencephalon or midbrain: It is made up of
cerebral peduncles.
c. Rhombencephalon or hind brain: Hind brain
is made up of pons and medulla oblongata,
ventrally and cerebellum, dorsally.
Spinal cord: It is also known as spinal medulla. It
is the caudal, elongated part of central nervous
system which occupies the upper 2/3rd of the
vertebral canal.
Functions of CNS: Perception, integration and
analysis of all types of sensory input and initiation
of motor activity.
2. Peripheral nervous system (PNS): It includes those
parts of nervous system which lie outside the central
nervous system. It consists of twelve pairs of cranial
nerves, thirty one pairs of spinal nerves, somatic
and special sense receptors and the autonomic
nervous system.
Cranial nerves (Fig. 7.4): All are attached to the
ventral surface of the brain except 4th cranial nerve
(trochlear nerve) which arises from its dorsal
surface.
Spinal nerves (Figs 7.1, 7.11 and 7.12): Each pair of
spinal nerves are attached to the sides of the spinal Fig. 7.1: Parts of brain with spinal cord
cord by two roots.
 84 Human Anatomy For Dental Students

Fig. 7.2: Parts of brain in lateral view

S E C T I O N-1

Fig. 7.3: Parts of brain ventral surface

Autonomic nervous system: It has two components
namely:
a. Sympathetic nervous system
b. Parasympathetic nervous system
Functions of PNS: It carries impulses from periphe-
ral sensory receptors and sense organs to the central
nervous system and back from the central nervous
system to the effector organs, e.g., muscles and
glands.
Functional Subdivision of Nervous System
Nervous system is classified into the following two types
according to the functional differences:
1. Somatic nervous system: This deals with the
changes in the external environment and has
both afferent and efferent components. It has
connections with both central and peripheral
nervous systems.
 Nervous System 85

Fig. 7.4: Parts of brain and cranial nerves (base of brain)

C H A P T E R-7
Function: Soma or Cell Body (Perikaryon)
a. Afferent component or somatosensory system: Cell body is surrounded by a plasma membrane. The
It is concerned with carrying and processing plasma membrane contains various integral, membrane
conscious and unconscious sensory impulses. proteins which act as Na+, K+, Ca++, Cl ion channels. It
It is made up of sense organs and sensory also has receptor proteins.
nerves. It carries the impulses of touch, pain,
temperature and proprioception.
b. Efferent component or somatomotor system:
It is concerned with the voluntary control of
muscles. It is made up of somatic motor nerve
fibres which carry impulss from CNS to the
skeletal muscles.
2. Visceral or autonomic nervous system: It responds
to the various changes in the internal environment
of the body. It also has both sensory (afferent) and
motor (efferent) components. It is derived from the
central as well as the peripheral nervous system.
It is further divided into:
1. Sympathetic nervous system
2. Parasympathetic nervous system
Function: It is concerned with the regulation of
visceral functions that maintain the internal home-
ostasis and works mostly at the unconscious level.

NEURON
Neuron is the structural and functional unit of the
nervous system (Figs 7.5 to 7.8). Each neuron consists of
1. Soma or cell body
2. Neurites or processes: They are, axons and dendrites. Fig. 7.5: Multipolar neuron
 86 Human Anatomy For Dental Students
Fig. 7.6: Unipolar neuron
S E C T I O N-1
Fig. 7.7: Bipolar neuron
The shape of cell body can vary from stellate,
fusiform, basket shape, flask or pyramidal shape. Soma
is made up of the following two components:
1. Cytoplasm: It contains numerous organelles and
inclusion bodies. Cytoplasm is surrounded by the
plasma membrane.
2. Nucleus: It is large, vesicular and contains a
prominent nucleolus.
Cytoplasmic Organelles and Inclusions
1. Nissl bodies: These are made up of rough
endoplasmic reticulum with ribosomes. They are
basophilic in nature. Nissl bodies are present in cell
body and dendrites. They are absent in axons. These
bodies disappear, when the neuron is injured and
this phenomenon is known as chromatolysis.
Functions: Synthesis of new proteins and enzymes.
2. Smooth endoplasmic reticulum
Functions: It helps in transmission of neuro-
chemical substances by forming synaptic vesicles.
3. Golgi apparatus: It is present close to the nucleus
and is absent in axon and dendrites.
Functions: Is responsible for the packaging of
neurosecretions.
4. Mitochondria: These are rod like structure with
double membrane, present in soma, dendrites and
axons.
Functions: Mitochondria are the site of production
of energy molecules for the cell.
5. Lysosomes: They are thick walled membranous
vesicles containing hydrolytic enzymes.
Functions: Phagocytosis, hydrolysis of Nissl bodies.
6. Neurofilaments and Microtubules: These are agg-
regated at the axon hillock. They form the cyto-
skeleton of the neuron.
Functions: Are responsible for the shape and
mobility of the neuron. Microtubules provide
contractility to the neuron.
7. Centrioles: These are present in soma.
Functions: They help in regeneration of the cyto-
plasmic microtubules.
8. Pigments and mineral containing granules:
Old age pigments: Lipofuscin, Lipochrome.
Neuromelanin: Present in substantia nigra.
Functions: Synthesis of dopamine.
Zn (zinc): Present in hippocampus.
Fe (Iron): Present in oculomotor nucleus.
Cu (copper): Present in locus ceruleus.
Axons and Dendrites (Fig. 7.5 and 7.8)
These are processes which arise from the cell body.
1. Dendrites: These are 5 to 7 small processes which
branch repeatedly and end in terminal arborization.
The ends form dendritic spines. They contain Nissl
bodies, mitochondria and neuro filaments. They
receive and transmit impulses towards the cell
body.
2. Axons: These are generally single and they
terminate away from the cell body. Collateral
branches may be present at right angles. Nissl
bodies are absent. Spines are absent. They carry
impulses away from the cell body. The terminal
portion of axons usually branch and end in dilated
ends called as synaptic knobs.
Axons are surrounded by myelin sheath (Fig. 7.8).
Myelin sheath consists of a proteinlipid complex
which is produced by Schwann cells. Schwann cells
surround the axons and are present along the length
of the axons. The myelin sheath is deficient at
regular intervals of around 1 mm. These points are
known as nodes of Ranvier.
 Nervous System 87

tissue named endoneurium is pesent between two

adjacent nerve fibers.
Nerve trunk: It is made up of a number of bundles of
nerve fibres. Nerve fibres are arranged in fascicles which
are surrounded by a thin layer of connective tissue
known as perineurium. A number of fascicles together
form a nerve trunk. The outer most covering of nerve
trunk is a connective tissue layer named epineurium
(Fig. 7.9).

C H A P T E R-7
Fig. 7.8: Diagrammatic representation of myelinated neuron
Fig. 7.9: Peripheral nerve trunk

FUNCTIONS OF NERVE CELL Type of Nerve Fibers and their Functions

Functions of Each Part of Neuron (Fig. 7.8) General facts about nerve fibres and conduction:
1. Cell body: It houses the various cell organelles that 1. Myelinated nerves conduct impulses faster than
help in protein synthesis and maintain the function unmyelinated nerves.
of metabolism of neurons. 2. Nerves with larger diameter have greater speed of
2. Dendrites: These receive impulses and transmit conduction of impulses.
them to cell body. 3. Large nerve axons usually respond to touch,
3. Axon: It generates and transmits nerve impulses, pressure and proprioception while smaller nerves
as action potentials, away from cell body. usually respond to temperature, pain and auto-
4. Myelin sheath: It helps in insulating the nerve nomic functions.
impulses from surrounding cells. Hence, it facili- Nerve fibers are classified as A, B and C according
tates transmission of impulses. to the diameter of the fibers. The diameter and speed of
5. Synaptic knobs: These contain vesicles which store conduction of impulses in A fibers is higest and lowest
various neurotransmitters. The neurotransmitters in C group. A-group is further divided into .
are chemical molecules that released in response The fiber size decreases from to . The functions of
to action potential changes reaching the synaptic
each one is given below:
knobs (Fig. 7.10).
Type of nerve fibers Function
NERVE A- Proprioception, somatic
motor
Structure of Nerve Fiber and Nerve Trunk A- Touch, pressure
A- Motor to muscle spindles
Nerve fiber: It is primarily made up of axon of a neuron
A- Pain, temperature
(occasionally dendrites also) which is covered by B Preganglionic autonomic
neurilemma. Neurilemma is made up of Schwann cells. nerve fibers
Schwann cells lay down the myelin sheath around the C-Dorsal root ganglion fiber Pain, touch, reflex response
axon under the neurilemma. A thin layer of connective C-Sympathetic component Postganglionic sympathetic
nerve fibers
 88 Human Anatomy For Dental Students
B fibers are most susceptible to hypoxia while A are
most susceptible to pressure and C to action of local
anaesthetics.
SYNAPSES
Synapses are specialized junctions between two or more
neurons. The axon of one neuron divides into terminal
buttons known as synaptic knobs which come in contact
with soma or dendrites of another neuron (Fig. 7.10).
Components of a Synapse
1. Presynaptic membrane: It is the axolemma of the
presynaptic neuron.
2. Postsynaptic membrane: It is the cell membrane
of the postsynaptic neuron.
3. Synaptic cleft: A 20 to 30 nm wide cleft is present
between the two membranes.
Types of Synapses
1. Axo-dendritic: Synapse between axon of one
neuron with the dendrite of other neuron.
NEUROMUSCULAR JUNCTION
2. Axo-somatic: Synapse between axon of one neuron
S E C T I O N-1
with the soma of other neuron.
3. Axo-axonic: Synapse between axon of one neuron
with the axon of other neuron.
4. Dendo-dendritic: When dendrites of two different
neurons make a synapse.
General Features of a Synapse
The terminal portion of axons usually branch and
end in terminal dilated ends named synaptic knobs.
Fig. 7.10: Diagrammatic representation of a synapse
These knobs contain neurotransmitters bound in
vesicles. These synaptic knobs form synapses with
dendritic spines, proximal part of dendrites, cell
bodies or end on axons of post synaptic neurons.
The presynaptic terminal is seperated by a synaptic
cleft from the postsynaptic neuron. It contains extra
cellular fluid.
The action potential on reaching the terminal end
of an axon stimulates release of the neurotrans-
mitter.
Neurotransmitters are chemical mediators that bind
to receptors present on the postsynaptic membrane.
This interaction leads to opening or closing of ion
channels. This means it can lead to excitation or
inhibition of the postsynaptic neuron.
Postsynaptic neurons receive inputs from axonal
endings of a number of neurons. This is known as
convergence. Also, axons may divide into branches
and end on various post synaptic neurons. This is
known as divergence.
It is the junction between the terminal part of axon
of a neuron and the skeletal muscle fiber supplied
by it.
The terminal part of axon is unmyelinated and
divides into terminal synaptic button like endings.
This is the presynaptic membrane.
The part of muscle fiber coming in contact with
axon is thickened and the sarcolemma is thrown
into number of folds. This forms the postsynaptic
membrane also named motor-end plate.

The action potential at nerve endings increases Ca2+
influx which stimulates release of acetylcholine.
Acetylcholine is the neurotransmitter at neuro-
muscular junctions.
Skeletal muscle membrane has N-receptors
(nicotinic receptors) for acetylcholine. Activation of
these receptors results in opening of Na+ channels.
The influx of Na+ leads to depolarization of muscle
fibers. The endplate potentials thus developed lead
to formation of action potentials.
GLIAL CELLS
These consist of supporting cells present along the nerves
in the nervous system. They are numerous in central
nervous system (CNS) where they can be classified into
four types:
1. Microglia: They are phagocytic cells similar to
tissue macrophages and are derived from blood
vessels.
2. Oligodendrogliocytes: These are rounded cells
arranged in clusters. They synthesize and maintain
myelin around axons of nerve fibers in CNS.
3. Astrocytes: They are relatively larger, star shaped
cells which have membranous processes extending
from the cell body called foot processes. They act
as supporting cells and provide for neurotropins
the growth factors to the nerve. They also form the
blood brain barrier with capillary endothelium.
They help in providing nutrition to the neurons.
4. Ependymal cells: Ependymal cells form blood CSF
barrier and secrete CSF. These cells are present in
ventricles of brain and central canal of spinal cord.
In the peripheral nervous system, Schwann cells
are considered as glial cells.
GANGLIA
These are collections of nerve cells enclosed within a
connective tissue capsule. They are present in the dorsal
root of spinal nerves, along sensory roots of trigeminal,
facial, glossopharyngeal and vagus nerves. They also are
a part of autonomic nervous system.
GREY AND WHITE MATTER
The nervous tissue is made up of neurons, nerve fibers
and the supporting neuroglial cells. Arrangement of
nervous tissue in central nervous system is of two types:
1. Grey matter: These are areas primarily made up of
neuronal cell bodies with dendrites and mostly
unmyelinated axons with neuroglial cells. For
example, various nuclei in the brain.
Nervous System 89
2. White matter: These are areas which consist
primarily of nerve fibres or axons. The myelinated
nerve fibres predominate in these areas which gives
it a relatively pale or white colour.
CLINICAL AND APPLIED ANATOMY
Nerve injury: Injury to nerve can be caused by
trauma, ischemia, toxic substances or high temp-
erature > 104F. The changes after any injury occur
in the following sequence:
Retrograde degeneration: Changes begin in the
cell body of the damaged nerve fiber. There is
disintegration of Nissls granules along with
disruption of golgi apparatus, mitochondria
and neurofibrils. Cells allow entry of fluid and
become round and nucleus is pushed to one
side.
Antegrade degeneration: The changes in the
segment distal to the site of injury are termed
as Wallerian degeneration. Cylinder of axon
distal to injury breaks up and disappears. The
C H A P T E R-7
myelin sheath also gradually disintegrates.
Schwann cells start multiplying and form cords
to fill the endoneural tubes.
Degeneration at site of injury: Schwann cells
elongate to fill the gap at site of injury. If gap is >
3 cm then the space cannot be filled completely.
Regenerative changes: They start by 3rd week
or 20 days. Nissls granules and organelles
reappear. The axon from the proximal stump
grows fibrils which are guided by Schwann
cells towards the distal end. One of the fibrils
enlarges and bridges the gap to complete the
axon tube while the rest degenerate. If gap is >
3 cm regenerating fibrils intermingle and form
a collection of fibers called neuroma. This
appears as a lump and may be painful.
Gliosis: It is the proliferation of astrocytes leading
to formation of local fibrosis which acts as a space
occupying lesion in the brain.
In demyelinating conditions like multiple sclerosis,
oligodendroglia, cells responsible for laying down
myelin sheath of neurons of CNS, are destroyed
by presence of autoimmune antibodies.
Myasthenia gravis: It is an autoimmune disease
which results in formation of antibodies to
N-acetylcholine receptors at the neuromuscular
junction. The distruction of these receptors results
in weakness and fatigue of muscles. It mainly
affects eye muscles, facial muscles and muscle for
chewing and swallowing.
 90 Human Anatomy For Dental Students
SPINAL NERVES (Fig. 7.11)
Each spinal nerve is formed by a ventral root and a dorsal
root attached to the spinal cord. These two roots unite
in the intervertebral foramina to form spinal nerve.
Ventral root: It contains the axons of neurons in anterior
and lateral spinal grey column. Thus, it is made up of
motor nerve fibres.
Dorsal root: It contains central and peripheral processes
of neurons situated in the dorsal root ganglion (spinal
ganglion). Thus, it is made up of sensory nerve fibres.
Spinal ganglion (Dorsal root ganglion): It is the
collection of neurons enclosed in a fibrous tissue capsule
with satellite cells. Spinal ganglion is present on the
dorsal root of each spinal nerve. It contains unipolar
neurons which divide into peripheral and central
processes. 1st cervical ganglion may be absent.
Each spinal nerve contains motor and sensory fibres
and divides into a ventral ramus and a dorsal ramus.
Dorsal rami of spinal nerves divide into medial and
lateral branches which supply the muscles and skin of
the back. Each ventral ramus of spinal nerves divides
into divisions which join to form plexuses that further
S E C T I O N-1
give branches to supply skin and muscles of upper limb,
lower limb and body wall.
There are 31 pairs of spinal nerves. These are:
8 Cervical spinal nerves
12 Thoracic spinal nerves
5 Lumbar spinal nerves
5 Sacral spinal nerves
1 Coccygeal spinal nerve
Functional Components of a Spinal Nerve
There are two functional components of a spinal nerve:
Fig. 7.11: Transverse section of spinal cord showing rootlets, roots and rami of spinal nerve
1. Somatic component: It contains both efferent (motor)
and afferent (sensory) fibres.
2. Visceral component: It constitutes the autonomic
nervous system. There are again efferent and
afferent components of this nervous system.
Typical Spinal Nerve (Figs 7.11 and 7.12)
Typical spinal nerves in general do not form any plexus.
Thoracic spinal nerves are the example of a typical spinal
nerve and are limited to supplying the thoracic wall.
The dorsal rami of thoracic spinal nerves give branches
to supply the skin and muscles of the back of the
corresponding region. The ventral rami supply the
antero-lateral surfaces of lower part of neck, thorax and
abdomen.
Branches: Following are the branches of a typical
thoracic spinal nerve:
1. Dorsal ramus: It divides into medial and lateral
branches. Medial branch supplies muscles of the
back and lateral branch after giving muscular
branches becomes the posterior cutaneous branch.
2. Ventral ramus: It is also known as the intercostal
nerve. It supplies the muscles of the ventral thoracic
wall. It gives rise to the lateral cutaneous branch
posterior to midaxillary line and ends anteriorly as
the anterior cutaneous branch.
3. Meningeal branch: It supplies the duramater of
spinal cord.
4. White rami communicans: These are preganglionic
sympathetic fibres from T1 to L2 spinal segments
which pass through the respective ventral root of
spinal nerve and leave the nerve as white rami
 Nervous System 91

C H A P T E R-7
Fig. 7.12: Typical thoracic spinal nerve

communicans. They further relay in the sympathetic
ganglion. Post ganglionic fibres from the sympathetic
ganglion join the same spinal nerve as the grey rami
communicans. These are distributed via the branches
of the spinal nerve.
supplies the lower limb and anterior abdominal
wall.
4. Sacral and coccygeal plexus: It is formed by
interconnection of L4, L5 and S1 to S4 spinal nerves.
It supplies pelvis and lower limb.

PERIPHERAL NERVES CRANIAL NERVES (Fig. 7.4)

There are twelve pairs of cranial nerves that carry
Interconnection of ventral rami of two or more spinal
information to and fro from head and neck region of
nerves gives rise to a plexus. The plexus further gives
body and various viscera (vagus nerve) to brain.
rise to nerves which supply skin and muscles of body
1. Olfactory nerve
wall and limbs. These nerves are known as peripheral
2. Optic nerve
nerves.
3. Oculomotor nerve
The various plexuses that supply different regions
4. Trochlear nerve
of the body are:
5. Trigeminal nerve
1. Cervical plexus: It is formed by interconnection of
6. Abducent nerve
ventral primary rami of C1 to C4 spinal nerves. It
7. Facial nerve
supplies muscles and skin of head and neck region,
8. Vestibulocochlear nerve
upper part of trunk and shoulder region. It also
9. Glossopharyngeal nerve
supplies diaphragm through phrenic nerve.
10. Vagus nerve
2. Brachial plexus: It is formed by interconnection of
11. Accessory Nerve
ventral primary rami of C5 to C8 and T1 spinal
12. Hypoglossal nerve
nerves. It supplies the upper limb and muscles of
There are seven functional components of the cranial
neck.
nerves based on their position and the embryological
3. Lumbar Plexus: It is formed by interconnection of
origin of tissues which they supply. These are tabulated
ventral primary rami of L1 to L4 spinal nerves. It
below:
 92 Human Anatomy For Dental Students

Functional component Tissue supplied Basis of classification

Somatic efferent
General visceral efferent
Special visceral efferent
General somatic afferent
Special somatic afferent
General visceral afferent
Special visceral afferent
Striated muscle of limbs and body
wall, extrinsic muscles of the eye ball
and muscles of tongue
Smooth muscles, glands, heart muscles
Muscles of face, mastication, larynx
and pharynx
Skin, tendon, muscle joints
Eye (retina), ear and nose
Viscera
Tongue (Taste buds)
These tissues are derived from
somites and mesoderm of body wall.
They form viscera of the body.
These are muscles derived from
the branchial arches.
Convey sense of touch, pain and
temperature from skin and sense
of proprioception from the joints.
Ectodermal origin of sense organs
of vision, hearing and olfaction.
Transmits pain from viscera.
Endodermal in origin, an organ
of special sense.

SENSORY RECEPTORS (Fig. 7.13)
Sensory receptors are the apparatus which are stimulated
by a change in the external or internal environment. These
receptors convey impulses to the peripheral processes of
the 1st order sensory neurons.
S E C T I O N-1
Neuromuscular spindle and sensory hair cells of
inner ear.
3. Interoceptors: These are located within the body
in relation to the various viscera. They conduct
impulses via the afferent component of the
autonomic nervous system.

Classification of sensory receptors according to their

Classification according to modalities of sensation
position in respect to the stimuli.
1. Mechanoreceptors: Respond to deformation of
1. Exteroceptors: These respond to external stimuli.
receptor cells, example touch and pressure
They are further divided into two:
receptors.
a. General exteroceptors: They receive the
2. Chemoreceptors: Stimulated by soluble chemical
cutaneous sensations of touch, pain,
substances. Example: olfactory (smell) and
temperature, pressure from skin, hair follicles
gustatory (taste) receptors, carotid body
and subcutaneous tissue
3. Photoreceptors: Stimulated by light, example: Rods
b. Special exteroceptors: They receive special
and cones in retina of eye.
sensations namely smell (olfactory), vision,
4. Nociceptors: Respond to local tissue damage. They
hearing (acoustic) and taste (gustatory)
produce unpleasant sensations. Example: free nerve
2. Proprioceptors: These receptors are responsible for
endings in the epithelia of respiratory and
the detection of position, movement and mecha-
alimentory tracts.
nical stresses on various parts of the body. Example:

Fig. 7.13: Sensory receptors in skin and subcutaneous tissue


e. Thermoreceptors: Respond to cold and heat.
Example: free nerve endings in dermis of skin.
f. Osmoreceptors and baroreceptors: Respond to
osmolarity and pressure changes respectively,
example, carotid body.
CUTANEOUS RECEPTORS
Cutaneous nerves are made up of somatic sensory fibres
and postganglionic sympathetic fibres. These nerves
form a plexus at the base of dermis. From this plexus,
sensory fibres reach to the hair follicles and epidermis.
These nerve endings are either free or encapsulated to
form receptors.
Free nerve endings: They consist of C and A- fibres.
These endings act as nociceptors and thermoreceptors
when they lie between the cells of the basal layer of
epidermis. When related to outer root sheath epithelium
of hair follicles they also act as rapidly adapting
mechanoreceptors.
CLINICAL AND APPLIED ANATOMY
While putting on and taking off clothes, rapidly
adapting mechanoreceptors that lie in relation to
hair folicles are stimulated. Once they have
adapted they do not send any further impulses.
Hence, we are not aware of the clothes on our body
except while taking them off or putting them on.
Meissners corpuscles are most numerous in the
finger pads.
SENSORY PATHWAY (ASCENDING PATHWAY)
The general sensations of touch, pressure, pain,
temperature, vibration and proprioception are carried
from the sensory receptors in skin, viscera, muscles,
tendons and joints via spinal nerves, from limbs and
trunk and via cranial nerves (trigeminal,
glossopharyngeal. vagus and accessory spinal) from
head and neck.
The nerve fibers relay accordingly in the CNS at
dorsal horn of spinal cord or trigeminal sensory nucleus
in brain stem. Second order neurons form the
corresponding spinothalamic, medial lemniscus or
trigeminothalamic tracts which ascend up to the brain
and relay in thalamus. From thalamus 3rd order neuron
ascend to the primary somatosensory cortex in post
central gyrus of parietal lobe of brain.
MOTOR PATHWAY (DESCENDING PATHWAY)
The pathway originates in the primary and secondary
motor cortex of frontal lobe and forms the corticobulbar
and corticospinal tracts that descend down and relay in
Nervous System 93
brain stem (motor pathway for cranial nerves) or spinal
cord (motor pathway for spinal nerves). These are also
known as upper motor neurons and they form the
pyramidal pathway. Lower motor neurons are the ones
that finally innervate the extrafusal fibers of skeletal
muscles. Pyramidal tracts are responsible for initiation
of all voluntary movements of the body.
Other motor pathways arise from basal ganglia and
cerebellum. These form the extra pyramidal pathway.
They have connections with cerebral cortex, brainstem,
thalamus and subthalamus and reticular system. They
regulate the quantity and quality of movements and are
responsible for control of tone, posture and equilibrium
of the body.
EFFECTOR ORGAN
Skeletal musculature of the body forms the effector organ
of the somatomotor system. The motor fibres end on
extrafusal skeletal muscle fibres and result in contraction
of muscles.
Final common pathway: The motor neurons that supply
C H A P T E R-7
extrafusal fibers of skeletal muscles are stimulated by
various reflex arcs and are also responsible for voluntary
movements in the body. Thus the stimulation of -motor
neurons is the final common pathway that causes
contraction of muscles. It responds by integrating inputs
from reflex arc, pyramidal tracts from cerebral cortex,
reticular formation, cerebellum and vestibular nuclei.
REFLEXES
Reflex is a motor response to a stimulus which is
independant of voluntary control which means it is
brought about without the involvement of cerebral
cortex. The basic unit of a reflex is the reflex arc which
consists of the following parts (Fig. 7.14):
1. Sense organ.
2. Afferent neuron, usually from dorsal root ganglia
of spinal cord or cranial nerve ganglia.
3. Synapses, single or multiple that set up excitatory
post synaptic potentials (EPSP) or inhibitory post
synaptic potentials (PSP).
4. Efferent neuron.
5. Effector organ.
Monosynaptic Reflexes
These have a simple reflex arc and consist of a single
synapse between the afferent and efferent neurons.
Stretch Reflex (Fig. 7.14)
It is a monosynaptic reflex.
When skeletal muscle is stretched, it contracts. This
is stretch reflex.
 94 Human Anatomy For Dental Students
Fig. 7.14: Reflex arc
Clinical examples are; knee reflex, in which tapping
on tendon of quadriceps femoris muscle leads to
knee jerk; triceps reflex, by tapping on tendon of
triceps brachii there is reflex extension of elbow.
S E C T I O N-1
Reflex arc of stretch reflex:
1. Sense organ: It is the skeletal muscle spindle. It
is made up of specialized muscle fibers enclosed
in connective tissue. This forms intrafusal fibers.
Extrafusal fibers are the contractile units of
muscle. Intrafusal fibers are of two types:
a. Nuclear bag fibers: Supplied by annulospiral
endings of group I a sensory nerve fibers.
b. Nuclear chain fibers: Supplied by flower
spray endings of group II sensory nerve
fibers.
Muscle spindle fibers have their own motor
supply derived from A -efferents.
2. The afferent neurons are from the correspond-
ing dorsal root ganglion of spinal cord.
Stretching of muscle causes stretching of muscle
spindles and this distortion produces action
potentials in afferent nerves.
3. Each afferent neuron synapses with an efferent
neuron in spinal cord.
4. Efferent neurons arise from ventral horn of
spinal cord and supply the extrafusal fibers of
the same muscle.
5. Effector organ are the extrafusal muscle fibers.
Their stimulation causes contraction of muscle.
Stronger the stretch, stronger will be contraction.
-efferent Stimulation
-efferent discharge is controlled by the descending
motor tracts from various parts of the brain. Stimulation
of -efferents leads to contraction of muscle spindle fibers
which further stretches the nuclear bag fibers. Thus they
indirectly stimulate reflex contraction of muscle via stretch
reflex.
Golgi Tendon Organ
It is a net like collection of nerve endings present among
the fascicles of muscle fibers at the tendinous ends.
Stimulation of this organ sets up impulses in afferent
neurons which end on inhibitory interneurons and
inhibit the efferent neurons supplying the muscle. These
nerve endings are stimulated by contraction of muscle
fibers and lead to a reflex relaxation response. They are
also stimulated when the muscle is excessively stretched
and cause relaxation instead of contraction. Hence, they
are responsible for inverse stretch reflex.
The muscle spindles and golgi tendon organs thus
regulate the extent and force of muscle contraction.
They also act as protective reflexes.
Polysynaptic Reflex
The reflex arc of a polysynaptic reflex has a number of
inter neurons intersposed between the afferent and
efferent neurons.
Withdrawal Reflex
It is a typical example of polysynaptic reflex.
When a painful stimulus is applied to the skin,
subcutaneous tissue or muscle it leads to withdrawl
of stimulated area away from stimulus. This
generally occurs due to stimulation of flexor
muscles and inhibition of extensor muscles.
Multiple interneurons which may vary from 2 to
100 are present between afferent and efferent
neurons.

CENTRAL NERVOUS SYSTEM
Cavity present in cranium of skull is known as cranial
cavity. It lodges brain, meninges, CSF and blood supply
of brain.
CEREBROSPINAL FLUID (CSF)
Cerebrospinal fluid is a clear, colourless and odourless
fluid which fills the subarachnoid space and surrounds
the brain and spinal cord. Biochemical studies have
shown a higher concentration of Na+, Cl and Mg2+ions
and a lower level of K+, Ca2+ and glucose in CSF as
compared to the plasma. It is considered to be actively
secreted by the choroid plexus instead of the previous
belief that it is an ultrafiltrate of the plasma.
Secretion of CSF: Cerebrospinal fluid is secreted by the
choroid plexus of the lateral, 3rd and 4th ventricles. A
Fig. 7.15: CSF circulation and subarachnoid cisterns
Nervous System 95
small amount of CSF is also secreted by the ependymal
cells of the central canal of spinal cord.
Characteristics of CSF
1. Total volume: It is about 130 to 150 ml. Out of this
25 ml lies in the ventricles and the rest is in the
subarachnoid space.
2. Daily rate of production: 600 to 700 ml.
3. Rate of CSF formation per minute: 0.3 ml/min.
4. Normal CSF pressure: 80 to 180 mm of water or 60
to 150 mm of CSF.
5. PH: 7.35
6. Specific gravity: 1007.
Circulation of CSF (Fig. 7.15): CSF is produced in the
lateral ventricles. It passes into the 3rd ventricle via the
two interventricular formamina (foramen of Monro).
Then it flows into the 4th ventricle through the aqueduct
C H A P T E R-7
 96 Human Anatomy For Dental Students
of Sylvius. From here, it enters the cerebello-medullary
cistern through the foramen of Lusckha and Magendie.
Finally, it fills the entire subarachnoid space. The CSF
is absorbed back into circulation via the arachnoid villi
from where it enters the superior sagittal sinus.
Absorption of CSF: CSF drains into the superior sagittal
sinus through arachnoid granulations. A small amount
of fluid is absorbed into the cervical lymphatic system
through the sheaths over the cranial nerves.
Functions of CSF
1. Acts as a hydraulic shock absorber by providing a
fluid filled jacket to the brain and spinal cord.
2. Provides a constant environment to neurons as they
are highly sensitive and specialized cells.
3. Helps in the reduction of weight of brain due to
forces of buoancy.
4. It conveys nutritive material to the central nervous
system and helps in removal of waste products.
Ventricular System
S E C T I O N-1
It consists of a series of interconnecting spaces and
channels within the brain which contain the
cerebrospinal fluid secreted by the choroid plexuses.
There are a total of five ventricles present in the central
nervous system (Fig. 7.15). These are
In Brain
1. 2 lateral ventricles: One lateral ventricle is present
in each of the cerebral hemispheres. It is a C-shaped
cavity lined by ependyma and filled with
cerebrospinal fluid.
2. One 3rd ventricle: It is a midline space present
between the two thalami. It is lined by ependyma
and represents the primitive cavity of forebrain
vesicle.
3. One 4th ventricle: 4th ventricle is the cavity of the
hind brain. It lies between the cerebellum dorsally
and the pons and upper open part of medulla
ventrally. It is almost shaped like a diamond. Three
formina connect the 4th ventricle to the sub
arachnoid space of brain. These are, two formina
of Luschka and one foramen of Magendie which
lie in the lower part of roof of 4th ventricle.
In Spinal Cord
Terminal ventricle: It lies at the level of conus medullaris
of spinal cord.
CEREBRAL HEMISPHERES (Figs 7.2 and 7.16)
There are two cerebral hemispheres, each made up of
cortical grey matter on the surface and white matter in
Fig. 7.16: Lobes and poles of cerebral hemisphere
the core. The cerebral hemispheres are separated from
each other by a median longitudinal fissure. This fissure
is incomplete.
Corpus callosum obliterates the fissure in its middle
part and connects the two hemispheres. A sickle shaped
fold of meningeal layer of duramater, falx cerebri,
occupies the median longitudinal fissure above the
corpus callosum. A cavity is present in each cerebral
hemisphere known as the lateral ventricle.
The nuclear masses of grey matter embedded in the
white matter are known as the basal nuclei. Till the 3rd
month of intra-uterine life each cerebral hemisphere
remains smooth. Later sulci appear on them to
accommodate more and more number of neurons. The
surface of each cerebral hemisphere becomes convoluted
to form gyri and sulci.
Each cerebral hemisphere presents with a convex
superolateral surface inner to vault of skull, a flat medial
surface and an irregular inferior surface.
The anterior end is known as frontal pole. The
posterior end is known as occipital pole. Temporal pole
lies below and in front.
Each hemisphere presents classically with six lobes
namely frontal lobe, parietal lobe, temporal lobe,
occipital lobe, insular lobe and limbic lobe.
Functions of cerebral hemispheres: The cerebral
hemispheres contain motor and sensory areas. Cerebral
cortex is the highest level of control of motor activities
both voluntary and involuntary. It is also the highest
integration of various afferent inputs from the general
and special sensory system.
Left cerebral hemisphere predominates in right
handed person and the right cerebral hemisphere pre-
dominates in left handed person.
Functional Areas of Cerebral Cortex (Figs 7.17
and 7.18)
Cortical areas have been divided into different functional
areas by different neurobiologists namely Campbell
Brodmann and Vogt. The most widely used classification
is the Brodmanns classification (Figs 7.17 and 7.18).
 Nervous System 97

Cortical areas are divided into motor, sensory and psychical areas.
Sensory areas
Primary somesthetic area: 3, 1, 2
Secondary somesthetic area: below
4, 3, 1, 2
Somesthetic association area: 5, 7, 40
Primary visual area: 17
Association visual area: 18, 19
High visual association area: 39
Primary auditory area: 41
Auditory association area: 42
Wernicks area: 22
Area for smell: 28
Area for taste: 43
Motor areas
Motor area: 4
Premotor area: 6, 8
Frontal eye field: 8
Prefrontal speech area: 44, 45
Supplementary motor area: Posterior
part of medial frontal gyrus
Second motor area: Superior lip of
posterior ramus of lateral sulcus
Psychical cortex and area related
to limbic system
Anterior part of temporal lobe and
temporal pole
Areas related to limbic lobe: 23, 27,
36, 28, 38

C H A P T E R-7
Fig. 7.17: Brodmanns functional areas of left cerebral cortex on supero-lateral surface

Fig. 7.18: Functional areas of cerebral cortex on the medial surface

 98 Human Anatomy For Dental Students
CLINICAL AND APPLIED ANATOMY
Brodmanns classification divides the cerebral
cortex into 52 areas.
The effects of any lesion of area no. 4 or motor area
are as follows:
Initially there will be flaccid paralysis of contra-
lateral side. Generally there is no isolated lesion of
area 4. It is usually associated with lesion of area
no. 6 and 8. In such cases there is an upper motor
neuron paralysis.
The effect of lesion of prefrontal cortex :
It usually occur due to a tumor of frontal lobe
where patient presents with the following
a. Lack of self responsibility
b. Vulgarity in speech
c. Clownish behavior
d. Feeling of euphoria
The effect of lesion of area no. 40 is astereognosis
and tactile aphasia.
When patient is unable to recognise the written
S E C T I O N-1
words even when written by the patient himself.
This is known as word blindness. It is seen in lesion
of area no. 39.
In the lesion of area no. 22, patient will develop
sensory aphasia or word deafness. Patient cannot
interpretate words spoken by himself or others.
Fluency of speech is maintained but patient speaks
nonsense words in between.
Following are the four speech centres inter-
connected with each other which help in the
development of speech in a child.
Area no. 39, 40 and 22 are interconnected with each
other. The child starts learning speech with the
help of these areas. Area no. 22 is further connected
to the area no. 45, 44 with the help of arcuate fasci-
culus. Area 45, 44 is the motor speech area that
controls the movement of muscles involved in all
three components of speech.
Area no. 22: Comprehension of spoken
language and recognition of familiar sounds
and words.
Area no. 39: Recognition of object by sight and
storage of visual images
Area no. 40: Recognition of object by touch and
proprioception
Area no. 45, 44: Is the motors speech area and
controls movement of lips, tongue, larynx,
pharynx and palate.
The lesion of area no. 45, 44 will lead to loss of
fluency of speech or motor aphasia.
In the involvement of posterior cerebral artery, the
part of the visual cortex which represents macula
will be spared as this part is supplied by both
posterior cerebral and middle cerebral artery.
In the involvement of anterior cerebral artery there
is incontinence of urine and feaces due to damage
to paracentral lobule of cerebral cotex.
White Matter of Cerebrum
White matter of cerebrum is arranged in the following
three types:
1. Association fibres: These fibres connect one
functional area of the cerebral cortex to the other of
the same cerebral hemisphere. Example, cingulum,
superior longitudinal fasciculus.
2. Projection fibres: These fibres connect cerebral
cortex to other parts of brain and spinal cord. They
include to and fro fibres from the cerebral cortex.
These are fimbria, fornix, corona radiata and
internal capsule.
Internal capsule: It is a compact V shaped band of
neocortical projection fibres. It lies in the deep
substance of each cerebral hemisphere (Fig. 7.19).
3. Commissural fibres: These fibres connect
functional area between the two cerebral
hemispheres. Example, anterior commissure,
hippocampal commissure, and corpus callosum
(Fig. 7.18), etc.
CLINICAL AND APPLIED ANATOMY
A small lesion of internal capsule produces wide spread
paralysis because of the compact arrangement of fibres
in it. The usual clinical presentation of a lesion in
internal capsule is contralateral cranial nerve palsy with
contralateral hemiplegia.
BASAL GANGLIA (Fig. 7.20)
Basal ganglia are primarily masses of grey matter which
lie in the white core of each cerebral hemisphere. The
basal ganglia receive inputs from thalamus and cerebral
cortex. They comprise of corpus striatum, claustrum, and
amygdaloid body.
Corpus Striatum: It is divided into two parts by the fibres
of internal capsule.
1. Caudate nucleus: It is the medial band of grey
matter.
 Nervous System 99

C H A P T E R-7
Fig. 7.19: Internal capsule (horizontal section of left cerebral hemisphere)

2. Lentiform nucleus: It consists of a biconvex mass of

grey matter that lies lateral to the caudate nucleus. It
is further divided into two parts namely putamen
and globus pallidus.
Claustrum: It is a thin sheet of grey matter present
between the putamen and the insular cortex.
Amygdaloid Body: It is continuous with the tail of
caudate nucleus but structurally and functionally it is
related to the limbic system.

Functions of Basal Ganglia

Basal ganglia belong to the extra pyramidal system.
Their exact function is not clear. However, they are
believed to help in regulation of muscle tone, suppress
abnormal involuntary movements and play an
important role in controlling the movements and
positioning of the body.
Fig. 7.20: Components of basal ganglia
 100 Human Anatomy For Dental Students
CLINICAL AND APPLIED ANATOMY
Lesions in basal ganglia lead to following conditions
1. Parkinsonism (Paralysis agitans): It is character-
ised by increased muscular rigidity, lead pipe
rigidity, mask like face, pill rolling movements of
fingers
2. Chorea: These are brisk, jerky purposeless
movements of distal parts of the extremities,
twitching of facial muscles
3. Athetosis: It is characterised by slow worm like
writhing movements of the extremities mainly
affecting wrists and fingers.
DIENCEPHALON
It is also known as the interbrain. The diencephalon
consists of grey matter which lies between the two
cerebral hemispheres around the cavity of the 3rd
ventricle. Inferiorly, it is continuous with the midbrain.
Parts of Diencephalon
S E C T I O N-1
Diencephalon is made up of the following parts
(Fig. 7.21)
1. Thalamus (dorsal thalamus): It lies in the dorsal
part of the diencephalon.
2. Epithalamus: It lies dorsomedial to the dorsal
thalamus. It consists of pineal gland, habenular
nucleus, habenular commissure and posterior
commissure.
Fig. 7.21: Thalamus, Epithalamus, Hypothalamus
3. Metathalamus: It is formed by the medial and lateral
geniculate bodies which are incorported into the
caudal part of thalamus.
4. Subthalamus (ventral thalamus): It lies lateral to
the hypothalamus and consists of the subthalamic
nuclei and rostral extension of red nucleus and
substantia nigra.
5. Hypothalamus: It lies below the hypothalamic
sulcus and forms the most ventral part of the
diencephalon.
Dorsal Thalamus (Thalamus) (Fig. 7.21)
There are two thalami. Each thalamus is an ovoid mass
of grey matter present on each side in relation to the
lateral walls of the 3rd ventricle, dorsal to hypothalamic
sulcus. Both thalami act as the highest relay centre for
all sensations except olfaction.
Functions of Thalamus
1. The thalamus is the major relay station for sensory
inputs from all over the body. It receives impulses
from somatic afferents, special afferents (except
smell) and reticular afferents. It integrates and
relays inputs to cerebral cortex.
2. It has a significant role in arousal and alertness.
3. It regulates the activities of motor pathway.
4. It is associated with the autonomic control of viscera
through its connections with the hypothalamus
Hypothalamus
Hypothalamus lies in the ventral part of the dience-
phalon and consists of collection of nerve cells in a matrix
of neuroglial tissue (Figs 7.21 and 7.22).
Hypothalamus is divided into lateral and medial
areas by a column of fornix, mamillo-thalamic tract and
fasciculus-retroflexus. The nuclei are arranged in four
regions as shown in figure 7.22.
Functions of Hypothalamus
1. Neuro-endocrine control: It secretes following
hormones:
a. CRH: Corticotropin releasing hormone
b. GnRH: Gonadotrophin releasing hormone
c. Prolactin releasing hormone
d. Prolactin inhibitory hormone (identified as
neurotransmitter dopamine)
e. Growth hormone releasing hormone
f. TRH: Thyrotropin releasing hormone
g. ADH
h. Oxytocin
 Nervous System 101

Fig. 7.22: Nuclei of hypothalamus

C H A P T E R-7
Fig. 7.23: Components of limbic system (medial and inferior surface of right cerebral hemisphere)

2. Regulates body temperature number of structures present on the infero-medial

3. Regulates circadian (day-night) rhythm of various surface of cerebral hemispheres.
activity eg. sleep, appetite
4. Controls emotional behaviour, e.g., fear and anger Components of Limbic System (Fig. 7.23)
etc. It integrates autonomic motor and endocrinal
1. Olfactory pathway
responses to various afferent stimuli.
a. Olfactory nerve
5. Regulates various functions for body preservation
b. Olfactory bulb
like hunger and satiety, thirst and sexual behaviour.
c. Anterior olfactory nucleus
6. Regulates autonomic nervous system activity.
d. Olfactory tract
e. Medial and lateral olfactory stria and their
LIMBIC SYSTEM termination
f. Olfactory cortex
The term limbic system was introduced by Broca in 1878. 2. Pyriform lobe
Its functions are concerned with preservation of 3. Amygdaloid body and its efferent pathways
individuals and furthering of species. It includes a 4. Hippocampus formation
 102 Human Anatomy For Dental Students
5. Limbic lobe
6. Other structures related to limbic system:
Hypothalamus, habenular nucleus, anterior
nucleus of thalamus, midbrain, etc.
Functions of Limbic System
It is primarily concerned with the following
1. Preservation of individual: Searching for food and
drink, defense mechanisms .
2. Preservation of species: Sexual and mating
behavior, rearing of new born, social behavior.
3. Emotional behavior: Mood, fear, anger, pleasure,
physical expression of emotions.
4. Recent memory: Storage of events, sense of time.
RETICULAR FORMATION
It is a diffuse network of nerve fibres and neurons which
occupy the ventral part of the entire brain stem
(midbrain, pons and medulla). It occupies the area
between the cranial nerve nuclei, sensory and motor
nuclei and the named long and short white tracts. It is
S E C T I O N-1
considered as the most ancient part of the central
nervous system in vertebrate phylogeny. However, now
it is believed that the highly specific pyramidal and
extrapyramidal systems and the non-specific network
of reticular formation are both indispensable and have
evolved as interdependant paths which contribute to the
total response of the organism.
Functions of Reticular Formation
It forms an important component of the somatic and
visceral functions of the body. Unilateral stimulation of
Fig. 7.24: Base of brain showing interpeduncular fossa
the reticular pathway often leads to a bilateral response.
1. It is essential for life. The neurons of reticular
formation are grouped in medulla forming centres
for respiration, cardiovascular function etc.
2. It is responsible for conscious perception of surrou-
ndings at each time.
3. Control of the stretch reflexes, movement and
posture of body.
MID BRAIN
Midbrain is the shortest segment of the brain stem (only
2 cm long). It extends ventro-rostrally from the pons to
the diencephalon and lies in the posterior cranial fossa
between the dorsum sellae of sphenoid bone in front
and the notch of tentorium cerebelli behind (Figs 7.24
and 7.25).
Components of Midbrain
The mid brain can be divided into two cerebral
peduncles, one on each side of midline which enclose
the cerebral aqueduct. Each cerebral peduncle further
consists of four parts arranged venterodorsally. These
are (Fig. 7.25):
1. Crus cerebri: Extends from the cranial border of
pons to undersurface of the cerebral hemispheres
2. Substantia nigra: A pigmented nerve cell zone
present between the crus cerebri and the tegmen-
tum.
3. Tegmentum: Tegmentum is the part which lies
ventral to an imaginary coronal plane passing
through the cerebral aqueduct and dorsal to
substantia nigra.

Fig. 7.25: Ventral surface of medulla, pons, cerebellum, midbrain
4. Tectum: Dorsal part of midbrain present posterior
to the line passing through cerebral aqueduct. It is
made up of a pair of superior and inferior colliculi.
Interpeduncular fossa: This fossa is present in relation
to base of brain between optic chiasma and crus cerebri
(Fig. 7.24).
CLINICAL AND APPLIED ANATOMY
Perinauds syndrome results from a lesion in the
superior colliculus this occurs when this area is
compressed by a tumor of the pineal body. The
characteristic feature of Perinauds syndrome is the
paralysis of upward gaze without any affect on
other eye movements. The anatomical basis for this
is obscure but experiments indicate that this area
may contain a centre for upward movement of
the eyes.
Benedikts syndrome results from a lesion in the
tegmentum of midbrain. This destroys the medial
lemniscus, red nucleus and fibres of oculomotor
nerve and superior cerebellar peduncle (brachium
conjuctivum).
Characteristic features of Benedikts syndrome
(Fig. 25.8)
1. External strabismus (lateral squint) and ptosis
on the same side. This is due to involvement of
oculomotor nerve fibres
2. Loss of tactile, muscle, joint position, vibratory,
Nervous System 103
C H A P T E R-7
pain and temperature sense in the opposite of
the body including face. This is due to involve-
ment of medial lemniscus which at this level
has been joined on its lateral side by lateral
spino-thalamic tract.
3. Tremor and irregular twitching movements of
opposite arm and leg. This is due to involve-
ment of red nucleus and superior cerebellar
peduncle, which contain afferent fibres from
the opposite cerebellar hemisphere.
Webers syndrome occurs mostly due to a vascular
lesion of the midbrain involving third cranial nerve
nucleus and corticospinal tract.
Characteristic Features
1. Ipsilateral divergent strabismus (squint), due
to involvement of third cranial nerve.
2. Contra-lateral hemiplegia, due to involvement
of cortico-spinal tract.
PONS
Pons means bridge. It is that part of brain stem which
connects the midbrain to medulla and is also known as
the metencephalon. Ventrally, it is related to clivus and
dorsally, to the 4th ventricle and cerebellum. Laterally,
on each side, are present the middle cerebellar peduncles
which connect it to the corresponding lobes of
cerebellum (Figs 7.2, 7.3 and 7.25).
It extends from upper end of medulla oblongata to
the cerebral peduncles of midbrain.
 104 Human Anatomy For Dental Students
CLINICAL AND APPLIED ANATOMY
A tumour in the cerebello-pontine angle, where the
cerebellum, pons and medulla meet, causes the
cerebello-pontine syndrome. It affects the 7th and
8th cranial nerves which are attached here.
It is characterised by ringing in ears or loss of
hearing on the affected side due to the involvement
of VIII cranial nerve, ataxia and tremors due to
pressure on the cerebellum, facial nerve palsy.
MEDULLA OBLONGATA
Medulla oblongata is the caudal and ventral part of the
hind brain. It is lodged in the inferior cerebellar notch
and lies on the basi-occiput (Fig. 7.2, 7.3, 7.24 and 7.25).
It is piriform in shape. It extends from the lower
border of pons (ponto medullary sulcus) to an imaginary
horizontal plane which passes just above the attachment
of first pair of cervical nerves on the spinal cord. This
plane corresponds with the upper border of atlas and
cuts the middle of the odontoid process of axis vertebra.
S E C T I O N-1
CLINICAL AND APPLIED ANATOMY
Medial medullary syndrome is also known as
alternating hypoglossal hemiplegia. It results from
the occlusion of anterior spinal artery and its para-
median branches which supply the symmetrical
halves of medial zone of the medulla on each side
of midline. Characteristic features are (Fig. 25.2).
Ipsilateral lower motor neuron paralysis of.
tongue muscles with atrophy.
Contralateral upper motor neuron hemiplegia
Loss of discriminative sense of position and
vibration of the body.
Lateral medullary syndrome is also known as
Wallenbergs syndrome. It is usually due to the
thrombosis of posterior inferior cerebellar artery
that produces damage to the dorsolateral part of
the medulla. Characteristic features are: (Fig. 25.2)
Loss of pain and temperature on the opposite
half of the body below the neck
Loss of pain and temperature on the same side
of the face
psilateral paralysis of the muscles of the soft
palate, pharynx and larynx
Ipsilateral ataxia
Giddiness, nystagmus
CEREBELLUM
It is the part of hind brain which lies in the posterior
cranial fossa below the tentorium cerebelli. It lies behind
the pons and medulla, separated from them by the cavity
of 4th ventricle (Figs 7.2 and 7.25).
Cerebellar nuclei: There are four pairs of deep nuclei
that lie in the medullary core of the cerebellum. These
Fig. 7.26: Deep nuclei of cerebellum
nuclei are arranged in each hemisphere from medial to
lateral side as follows (Fig. 7.26):
1. Nucleus fastigii
2. Nucleus globosus
3. Nucleus emboliformis
4. Nucleus dentatus
Axons of these nuclei form the final efferent
pathways from cerebellum.
Functions of Cerebellum
1. Controls body posture and equilibrium
2. Controls muscle tone and stretch reflexes: Inhibits
the -efferent discharge to muscle spindles.
3. Responsible for coordination of movements both
voluntary and involuntary.
4. Controls eye movements: Integrates inputs to
coordinate eye movements with body movements,
helps in judgment of distance and focusing on one
object.
CLINICAL AND APPLIED ANATOMY
Archicerebellar syndrome is caused by the
involvement of flocculo-nodular lobe. Patients
presents with
1. Disturbance of equilibrium
2. Wide base walk
3. Inability to maintain an upright posture and
swaying from side to side.
Lateral cerebellar syndrome is also known as the
neocerebellar syndrome. It affects the neocerebellar
part of the cerebellum and presents as follows:
1. Disturbance of posture, due to atonia or
hypotonia and nystagmus.
2. Disturbances of voluntary movement:
asthenia which is feebleness of movement, ataxia
which is the incoordination of movements.
3. Disturbances in gait: The patient has an
unsteady gait with the feet kept apart while
walking.
4. Effect on speech (Dysarthria or scanning
speech): It is slow, imperfect due to inco-
ordination.
 Nervous System 105

The cerebellar lesion of one hemisphere produces

dysfunction on the same side of the body whereas
the lesions of the vermis affect both the sides.

SPINAL CORD
Spinal cord is the caudal, elongated and cylindrical part
of the central nervous system which lies in the vertebral
canal. It extends from the medulla oblongata above to
the conus medullaris below (Fig. 7.27).
Extent
In adults: It extends from the upper border of C1 vertebra
just above the origin of 1st cervical nerve to lower border
of L1 vertebra.
In infants: it extends from the upper border of C1
vertebra to lower border of L3 vertebra.
In intrauterine life (upto 3 months): In the intrauterine
life the spinal cord occupies the entire length of vertebral
canal. Eventually, with the rapid growth of vertebral
column the cord comes to occupy only the upper 2/3rd
of the vertebral canal. Thus, any particular spinal
segment lies at a higher level that the corresponding
vertebra of the same number.

C H A P T E R-7
Enlargements: There are two fusiform enlargements
present in the spinal cord to accommodate more number
of neurons which supply the muscles of upper and lower
limbs.
1. Cervical enlargement: It extends from C4 to T2
spinal segments. The maximum width is at the level
of C6 segment. It is 38 mm wide.
2. Lumbo-sacral enlargement: It extends from L2 to
S3 spinal segments. The maximum width is 35 mm.
which lies at the level of S1 segment.
Conus medullaris: The spinal cord tapers at its lower
end to form the conus medullaris. It lies at the level of
L1 vertebra in adult. The terminal ventricle is present at
this level.
Segments of spinal cord: The part of spinal cord which
gives attachment to a pair of spinal nerves is known as
spinal cord segment. There are 31 pair of spinal nerves
hence, 31 spinal cord segments. These are
1. 8 cervical segments
2. 12 thoracic segments
3. 5 lumbar segments
4. 5 sacral segments Fig. 7.27: Spinal cord, spinal roots and nerves in relation to
5. 1 coccygeal segment vertebral column

Coverings of the spinal cord: The spinal cord is covered

by three meninges in the vertebral canal. These are, from Tracts of spinal cord: The tracts are made up of axons
within outwards of neurons and are of two types:
1. Pia mater 1. Ascending tracts: These consist of fibres (sensory)
2. Arachnoid mater arising from a somatic or a visceral receptor which
3. Duramater
ascend to the brain via spinal cord.
The arachnoid mater is separated from the piamater
2. Descending tracts: These consist of fibres (motor)
by a subarachnoid space containing CSF. A potential
space known as subdural space is present between the descending down from various parts of brain to
arachnoid and the dura mater. spinal cord for distribution to the body.
 106 Human Anatomy For Dental Students

Fig. 7.28: Transverse section of spinal cord showing grey matter and main fibre tracts of spinal cord (Diagrammatic
representation)

The various tracts of spinal cord are tabulated below (Fig. 7.28):
Funiculus Ascending tracts Descending tracts
Anterior 1. Anterior spinothalamic 1. Anterior corticospinal
2. Tectospinal
S E C T I O N-1

3. Vestibulospinal
4. Medial reticulospinal
Lateral 2. Posterior spino-cerebellar 5. Lateral corticospinal
3. Anterior spino-cerebellar 6. Rubrospinal
4. Lateral spinothalamic 7. Lateral reticulospinal
5. spino-tectal tract
6. Dorsolateral tract of Lissauer 8. Olivo spinal
Posterior 7. Fasciculus gracilis or tract of Gall 9. Fasciculus septomarginalis
8. Fasciculus cuneatus or tract of Burdach 10. Fasciculus interfasciculus

Description of ascending tractssalient features

Tract Origin Termination Crossing over Sensations carried
1. Anterior Lamina I to IV of Joins with medial Ascends 2 to 3 spinal Non-discriminative
spinothalamic tract spinal grey matter lemniscus in lower segments and then touch
(Axons of second medulla and then to crosses to the pressure
order sensory terminates in the opposite side
neurons) ventroposterolateral
nucleus of the thalamus
2. Lateral Lamina I to IV of Forms the spinal Crosses to opposite Pain
spinothalamic tract spinal grey matter lemniscus in the side in the same Temperature
(Axons of second medulla and ends in spinal cord segment
order sensory the ventro-postero-
neurons) lateral (VPL) nucleus
and intra laminar
nuclei of thalamus
3. Anterior spino- Lamina V to VII of Ipsilateral anterior It crosses twice Unconscious
cerebellar tract or spinal grey matter cerebellar vermis a. 1st it crosses to proprioception and
ventral spino- (T1-L2) opposite side exteroceptive
cerebellar tract in the same information from
(Axons of second spinal segment the lower part of
order sensory b. Crosses back to the body and
neurons) same side at the lower limbs
level of midbrain Responsible for
through the maintaining posture
superior cerebellar and gross movement
peduncle of entire lower limb.
 Nervous System 107

Tract Origin Termination Crossing over Sensations carried

4. Posterior spino- Lamina VII of spinal The fibres pass via No crossing over. Unconscious
cerebellar tract grey matter or the ipsilateral inferior The fibres ascend proprioception and
or dorsal spino- Clarkes column cerebellar peduncle ipsilaterally. touch and pressure
cerebellar tract (T1 to L2) to terminate in rostral from lower half of
(Axons of second and caudal part of the body and lower
order senosry cerebellar vermis extremity
neurons) Responsible for the
fine coordination
between movements
of various muscles
of lower limb.
5. Dorsal column of Conscious kinetic and
white matter static proprioception,
(Axons of first order vibration sense,
sensory neurons) discriminatory touch
a. Fasciculus gracilis Sensory neurons in Nucleus gracilis in Uncrossed and pressure from
dorsal root ganglia lower medulla lower limb and lower
half the body is carried
by fasciculus gracilis
b. Fasciculus Sensory neurons in Nucleus cuneatus in Uncrossed and from upper limb
cuneatus dorsal root ganglia medulla and upper half of the
body by fasciculus
cuneatus
6. Dorso-lateral tract Lateral division of Lamina I to IV Uncrossed Pain and temperature
dorsal nerve root

C H A P T E R-7
Description of descending tractssalient features
Tracts Origin Termination Crossing over Function
1. Corticospinal or Area no.4, 6, 3, 1, 2 Lamina of IV to VII a. Lateral Responsible for
pyramidal tract of cerebral cortex of spinal grey matter corticospinal tract skillfull voluntary
Occupies the interneurons and then crosses over in movements
pyramid of to lamina IX lower part of Facilitates flexors
medulla medulla and is inhibitory
b. Anterior to extensors
corticospinal tract
crosses to opposite
side in the
corresponding
spinal segment
2. Rubrospinal tract Red nucleus of Lamina V to VII and Midbrain at the level Same as corticospinal
midbrain then to IX of spinal of superior colliculus tract
grey matter
3. Tectospinal tract Superior colliculus Lamina VI and VII of Midbrain at the level Reflex pathway for
spinal grey matter of superior colliculus turning head and
moving arm in
response to visual and
hearing stimuli
4. Vestibulo-spinal tract
a. Lateral Lateral vestibular Lamina VII, Uncrossed Facilitates extensor
vestibulo-spinal nucleus in upper VIII and IX of motor neurons and is
tract medulla spinal grey matter inhibitory to flexors
b. Medial Medial vestibular Lamina VII, VIII and Uncrossed (few No definite function is
vestibulo-spinal nucleus in upper IX of spinal grey fibres cross) defined, probably is
tract medulla matter same as the lateral
tract.
5. Reticulo-spinal tract
a. Medial Pontine reticular Lamina VII, VIII, IX Uncrossed a. Facilitates extensor
formation of spinal grey matter motor neurons and is
b. Lateral Giganto-cellular Lamina VII, VIII and Uncrossed inhibitory to flexors.
component of IX of spinal grey b. Inhibit extensor
medullary reticular matter motor neurons and is
formation of medulla facilitatory to flexors
6. Olivo-spinal tract Inferior olivary nucleus Anterior grey column Uncrossed Uncertain
 108 Human Anatomy For Dental Students
CLINICAL AND APPLIED ANATOMY
There are 1 million fibres in each pyramidal tract.
Myelination of corticospinal tract starts at 3 years
of age and completes by puberty.
Lesion of corticospinal tract leads to an upper motor
neuron type of paralysis. It is characterized by
a. Spastic paralysis.
b. Hyperreflexia: Exaggerated tendon reflexes.
c. Hypertonia: Increased muscle tone.
d. Babinski extensor response is positive.
Generally it is associated with a lesion in the
extrapyramidal tracts also. Rarely, there is an
isolated lesion of corticospinal tract.
If the corticospinal tract is involved above the
pyramidal decussation in medulla then
contralateral side will be affected. Below pyramidal
decussation, same side of the body will be affected
as the side of lesion.
Babinskis sign: When the lateral aspect of the sole
of a patient is scratched, there occurs dorsiflexion
of great toe and fanning out of other toes.
S E C T I O N-1
Babinski sign is positive in:
a. Pyramindal tract involvement.
b. Infants
c. Poisoning
In normal individuals scratching of sole leads to
dorsiflexion of all toes.
A lower motor neuron consists of axons of ventral
horn cells that supply a motor end plate. It consists
of alpha and gamma motor neurons and pre-
ganglionic autonomic fibres in the thoracolumbar
and sacral region. Following are the characteristic
features of lower motor neuron paralysis.
a. Segmental paralysis of voluntary and reflex
movements.
b. Loss or diminished muscle tone due to loss of
stretch reflex. This is called as atonia or
hypotonia.
c. Muscle paralysed is flaccid.
d. Segmental loss of reflexes: Both superficial and
deep tendon reflexes are lost.
e. Fasciculations occur after few weeks.
f. Atrophy or wasting of affected muscles.
g. If autonomic fibres are involved the
corresponding area of skin becomes cyanotic
and dry. There is lysis of bones and joints.
Disturbances in function of the rectum and
urinary bladder are also present.
Fibres of pyramidal tract (descending tracts above
the ventral horn cells) are known as upper motor
neurons. Following are the manifestations of upper
motor neuron paralysis:
a. Loss or impairment of voluntary movements
of the affected part.
b. Hypertonia.
c. Hyper reflexia due to reduction of inhibitor
influences upon the gamma motor neurons.
d. Spasticity of the muscles.
AUTONOMIC NERVOUS SYSTEM (ANS)
The term autonomic is convenient rather than appro-
priate, because this system is intimately responsive to
changes in somatic activities. The function of autonomic
system is to maintain the homeostasis of the body and
regulates body functions for survival and existence.
Higher autonomic control is from the prefrontal
cortex of cerebrum, nuclei of brain stem, reticular
formation, thalami, hypothalamus and limbic lobe.
This system consists of afferent and efferent fibres
carrying inputs from somatic and cranial sources
and output to innervate various visceral structures.
Autonomic nervous system is responsible for the
involuntary activities of the body and controls
function of heart, lungs, smooth muscles and
various glands.
ANS consists of a sensory (afferent) pathway and a
motor (efferent) pathway.
Neurons of afferent pathway arise from various
visceral receptors and pass through dorsal root of
spinal nerves or corresponding cranial nerves.
Efferent pathway consists of pre-ganglionic and
post-ganglionic neurons:
a. Pre-ganglionic fibers:
These arise from neruons present in the
intermediolateral gray column of spinal cord
or corresponding cranial nerve nuclei and
relay in the autonomic ganglia situated
outside the CNS (Examples are otic and
pterygo palatine ganglion of parasympa-
thetic pathway and various sympathetic
ganglia of the sympathetic chain).
Axons of pre-ganglionic fibers are mostly
myelinated, B-fibers.
The neurotransmitter secreted at the endings
of preganglionic fibers is acetylcholine.
b. Post-ganglionic fibers:
These arise from the neuronal cells in various
autonomic ganglia and pass to the
corresponding effector organs.
Axons of post-ganglionic fibers are mostly
unmyelinated, C fibers.
 Nervous System 109

C H A P T E R-7

Fig. 7.29: Sympathetic innervation

 110 Human Anatomy For Dental Students
The neurotransmitter secreted at the endings
of post-ganglionic parasympathetic fibers is
acetylcholine while of post-ganglionic
sympathetic fibers is nor-adrenaline.
Postganglionic fibres are more numerous. This
helps in diffusion of activity.
The ratio of postganglinic : preganglionic fibres is
more in the sympathetic than in parasympathetic
nervous system.
Autonomic nervous system can be studied in two
parts:
1. Sympathetic nervous system
2. Parasympathetic nervous system
SYMPATHETIC NERVOUS SYSTEM
It is the larger component of autonomic nervous system.
It is made up of two ganglionated trunks and their
branches, plexuses and subsidiary ganglia (Fig. 7.29). It
innervates the following structures:
1. All sweat glands
2. Arrector pilorum muscle
3. Muscular wall of arteries
4. Abdomino-pelvic viscera
S E C T I O N-1
5. Esophagus, lung, heart
6. Non striated muscles of the urogenital system
7. Iris
8. Eye lids
Efferent pathway of sympathetic nervous system
forms the lateral grey column of T1 to L2 spinal segments
hence it is also known as thoraco-lumbar outflow.
Parts of Sympathetic Nervous System
It consists of the following parts (Fig. 7.29)
1. Sympathetic trunks with sympathetic ganglia
(lateral ganglia): There are two sympathetic trunks,
one lying on each side of vertebral column. Each
trunk extends from the base of skull to the coccyx.
At the level of 1st coccygeal vertebra the two trunks
unite to form a single ganglion called gaglion impar.
Each trunk presents with 22 to 23 ganglia. These
are:
a. Three cervical ganglia
b. 10 to 12 thoracic ganglia
c. 4 lumbar ganglia
d. 4 to 5 sacral ganglia
2. Subsidiary ganglia: These consist of the following:
Intermediate or collateral ganglia
a. Coeliac ganglia
b. Superior mesenteric ganglia
c. Inferior mesenteric ganglia
d. Aortico renal ganglia
e. Neurons in the superior hypogastric plexus
Terminal ganglia: It is formed by the suprarenal
medulla and consists of chromaffin cells.
3. Preganglionic neurons and fibres: The pregang-
lionic neurons are located in the lateral horn or
intermediomedial and intermediolateral groups of
neuronal cells of the spinal grey column. They
extend from the 1st thoracic to 2nd or 3rd lumbar
segments of the spinal cord.
Preganglionic fibres are known as the white rami
communicantes and they emerge from T1 to L2
spinal segments through the ventral root and trunk
of the spinal nerves to reach the corresponding
ganglion of the sympathetic chain.
These fibres are thinly myelinated.
4. Postganglionic neuron and fibres: Postganglionic
neurons lie either in the ganglia of sympathetic
chain or in the collateral or subsidiary ganglia.
Postganglionic fibres arise from these ganglia. They
are nonmyelinated.
Some postganglionic fibres pass back to the
corresponding spinal nerve via the grey rami
communicantes. Postganglionic fibres also pass
through medial branches of the ganglia and supply
the viscera. Postganglionic fibres arising from
collateral ganglia reach the target organs via
plexuses around corresponding arteries
(periarterial sympathetic plexuses).
Components of Sympathetic System
1. Sensory component: It conveys the visceral
sensation of pain. The cell bodies of these nerves
lie in the dorsal root ganglia of the thoracic and
upper two lumbar spinal nerves.
2. Motor component: The cell bodies of preganglionic
neurons lie in the thoracic and upper two lumbar
segments of spinal cord in the lateral horn of spinal
cord while the postganglionic neurons lie in the
sympathetic chain ganglia and the collateral
ganglia. The postganglionic fibres primarily supply
the heart, smooth muscles and glandular cells. They
secret non-adrenaline on the surface of effector cells.
Hence the sympathetic nervous system is also called
the adrenergic system.
Functions of Sympathetic System
1. Fibres which return to spinal nerve are:
a. Vasoconstrictor to blood vessels
b. Accompanying motor nerves are vasodilatory
to muscles
c. Secretomotor to sweat gland
d. Motor to arrector pilorus
2. Those reaching viscera cause:
a. Vasoconstriction
b. Bronchial, bronchiolar dilatation
c. Modification of secretion
d. Pupillary dilatation
e. Alimentary contraction.
PARASYMPATHETIC NERVOUS SYSTEM
It is also known as the cranio-sacral outflow (Fig. 7.30).
This system regulates the internal environment of the
body in resting condition.
 Nervous System 111

C H A P T E R-7

Fig. 7.30: Cranio-sacral out flow of parasympathetic system

 112 Human Anatomy For Dental Students
Parts of Parasympathetic Nervous System
It is made up of the following parts (Fig. 7.30):
1. Cranial part: It includes four parasympathetic
ganglia related to head and neck. These are:
a. Ciliary ganglion
b. Pterygopalatine ganglion (spheno palatine)
c. Submandibular ganglion
d. Otic ganglion
Preganglionic fibres are carried by II, VII, IX, X
cranial nerves. Parasympathetic nuclei present in
the brain:
1. Edinger-Westphal nucleus
2. Superior salivatory nucleus
3. Inferior salivatory nucleus
4. Dorsal nucleus of vagus
2. Sacral part: Preganglionic fibres arise from lateral
horn cells of S2 S3 and S4 spinal segments. These
fibres form the pelvic splanchnic neves, also known
as nervi erigentes. Pelvic splanchnic nerves relay
into terminal ganglia which lie close to the pelvic
viscera. The postganglionic fibres supply the
following organs
S E C T I O N-1
a. Left 1/3 of transverse colon
b. Descending colon
c. Sigmoid colon
d. Rectum
e. Anal canal
f. Urinary bladder
Differences in sympathetic and parasympathetic nervous system
Sympathetic nervous system
1. Forms the thoraco-lumbar outflow. Preganglionic
neurons are located in the T1 to L2 spinal segments.
2. Preganglionic fibres are usually shorter than
postganglionic fibres.
3. Sympathetic ganglia are mostly located in the
sympathetic trunk. Few are collateral or terminal
ganglia.
4. Noradrenaline is the neurotransmitter produced at
postganglionic nerve endings (except in region of
sweat gland and blood vessels of skeletal muscles).
5. It is the system for reaction to an emergency.
Produces a mass reaction mobilising all resources
of the body.
6. Stimulation of sympathetic nervous system causes
a. Increase heart rate
b. Increase blood pressure
c. Dilatation of pupils
d. Decreased intestinal peristalsis
e. Closure of sphincters
Inhibition of micturition and defecation
f. Constriction of cutaneous vessels
g. Dilatation of coronary and skeletal vessels
7. Posterior part of hypothalamus controls sympathetic
activity.
g. Testes or ovaries
h. Penis or clitoris
i. Uterine tubes and uterus in females
j. Prostate
Components of Parasympathetic System
1. Sensory component: Sensory fibres of parasympa-
thetic system convey following sensations:
a. Hunger
b. Nausea
c. Visceral reflexes like carotid sinus reflex, Hering
Breuers reflex, reflex act of micturition and
visceral pain sensations from visceral organs
2. Motor component: It consists of preganglionic
neurons which lie in various brain stem nuclei and
S2, S3 and S4 spinal cord segments (cranio-sacral
outflow). Postganglionic neuronal cell bodies lie in
the four parasympathetic ganglia mentioned above
and the various terminal ganglia.
Functions of Parasympathetic System
Parasympathetic system is responsible for regulating the
homeostasis in normal conditions. Hence, it
predominates during normal, usual functioning of the
human being. Sympathetic system on the other hand
predominates in emergency conditions.
Parasympathetic nervous system
1. Forms the cranio-sacral outflow. Preganglionic
neurons are present in various brain stem nuclei and
S1, S2 and S3 sacral segments.
2. Preganglionic fibres are usually longer than
postganglionic fibres.
3. Parasympathetic ganglia are primarily terminal
ganglia, located close to the effector organs.
4. Acetylcholine is the neurotransmitter produced at
the postganglionic ends.
5. It is an essential system to maintain the resting
internal homeostasis of body. Thus it has a basal tone
related to actions that conserve body resources.
6. Stimulation of parasympathetic nervous system causes
a. Decrease in heart rate
b. Constriction of pupils
c. Increased peristalsis
d. Promotes glandular secretion
e. Aids in evacuation of bladder and bowel
7. Anterior part of hypothalamus controls parasympathetic
activity.
 Chapter
8
Cardiovascular System
INTRODUCTION
Cardiovascular system consists of the heart which
pumps blood for circulation and the blood vessels which
carry the oxygenated blood (arteries) to the various
organs and return the deoxygenated blood (veins), from
various tissues and organs to the heart. It is responsible
for the transport of nutritive substances from gastro-
intestinal tract, transport of waste products for removal
to liver and kidneys. It also distributes hormones and
other agents that regulate various body functions and
helps in regulation of temperature and the internal
milieu (internal environment).
PERICARDIUM (Fig. 8.1)
Pericardium is a fibro-serous sac that encloses the heart
and the roots of great vessels arising from it. The sac is
Fig. 8.1: Fibrous and serous pericardium
conical in shape with apex upwards and base down-
wards. It extends from 2nd to 6th costal cartilages which
corresponds to T5 to T8 vertebral levels.
Pericardium is made up of two parts
1. Fibrous pericardium
2. Serous pericardium
Fibrous pericardium (Fig. 8.1): It is a conical open sac
made of fibrous tissue. The apex blends with the serous
coat of great vessels at their origin and the pretracheal
fascia. The base is fused with upper surface of the central
C H A P T E R-8
tendon of diaphragm.
Serous pericardium (Fig. 8.1): It is a closed sac made
up of mesothelium. It consists of parietal and visceral
layers. Parietal layer is adherent to the fibrous
 114 Human Anatomy For Dental Students
pericardium while the visceral layer is adherent to the
myocardium of the heart. Visceral layer is also known
as epicardium. The visceral layer continues with the
parietal layer at the site of origin (roots) of the great
vessels. A potential space, called the pericardial space,
is present between these two layers. It contains a thin
capillary layer of fluid.
CLINICAL AND APPLIED ANATOMY
Inflammation of pericardium is known as
pericarditis.
Paracentesis of pericardial fluid or aspiration of
pericardial effusion is done by two routes
a. Parasternal route: A needle is inserted close to
the sternal margin in the 4th or 5th intercostal
space on the left side to prevent injury to left
pleural sac and internal thoracic artery.
b. Subcostal route: The patient is placed in a
slightly propped up position. Aspiration is
performed through the left costoxiphoid angle
with an upward inclination of the needle of 45.
Intracardiac injection of adrenaline is given through
the parasternal route described above during the
S E C T I O N-1
process of cardiopulmonary resuscitation.
HEART
Heart is the organ that pumps blood into various parts
of the body. It is a hollow, conical shaped, muscular organ
which lies in the middle mediastinum. (Figs 8.2 to 8.4).
Heart has four chambers, 2 atria and 2 ventricles
which contract in an orderly fashion to pump blood into
circulation. The 2 atria and the 2 ventricles are separated
from each other by interatrial and interventricular septae
respectively. The left atrium opens into the left ventricle
and the right atrium opens into the right ventricle. Each
of the openings is guarded by a valve to allow blood
flow from atria to ventricle only and not reverse. Each
ventricle has an outflow tract, right draining into
pulmonary arteries and left draining into aorta. Each of
these are also guarded by valves to allow unidirectional
flow.
Measurements
Antero-posterior diameter 6 cm
Widest transverse diameter 8 to 9 cm
Length from apex to the base 12 cm
Weight (less in females) 230 to 340 gm
External Features
The heart presents with an apex, a base, 3 borders and 3
surfaces.
Apex: It is entirely formed by the left ventricle. It is
directed downwards, forwards and towards the left. It
lies in the 5th intercostal space, just medial to mid
clavicular line.
Base: It constitutes the posterior surface of heart and is
directed backwards and to the right. It is formed by the
posterior surfaces of right atrium (1/3rd) and left atrium
(2/3rd). It is bounded by the pulmonary trunk above
and posterior atrioventricular groove with coronary
sinus below.
Right border: It is formed by the right atrium and
extends vertically down from the right side of superior
vena caval opening to the inferior vena caval opening.
Inferior border: It extends horizontally from the opening
of inferior vena cava to the apex of heart.
Left border: It is ill defined and extends from the left
auricle to the apex of the heart.
Sternocostal surface: This surface lies in relation to the
posterior surface of the body of sternum and to the inner
surfaces of 3rd to 6th costal cartilages of both sides. It is
formed by
Anterior surface of right ventricle which makes
upto 2/3rd of this surface.
Anterior surface of left ventricle which makes upto
1/3rd of this surface.
It is also formed by anterior surface of right atrium,
right auricle and part of left auricle.
It presents with anterior part of atrio-ventricular
groove on the right which lodges the right coronary
artery. On the left side it presents the anterior inter-
ventricular groove which indicates the anterior
attachment of the interventricular septum. This groove
lodges the anterior interventricular branch of left
coronary artery and the great cardiac vein.
Diaphragmatic or inferior surface: It lies over the central
tendon of the diaphragm. It is formed by
Left ventricle, upto 2/3rd
Right ventricle, upto 1/3rd.
It presents with the posterior interventricular groove.
This indicates the posterior attachment of inter-
ventricular septum. The groove lodges the posterior
interventricular branch of right coronary artery,
branches of both coronary arteries and the middle
cardiac vein.
Left surface: It is directed upwards, backwards and to
the left and lies in relation to mediastinal pleura and
left lung. It is formed by
Left ventricle
Part of left atrium and auricle
It presents with the left part of atrio-ventricular
groove. It intervenes between the left auricle and left
ventricle. It lodges the trunk of left coronary artery,
beginning of coronary sinus and termination of great
cardiac vein.
Anatomical Position of Heart
Heart lies in the middle mediastinum in such a fashion
that the apex of heart faces downwards, forwards and
 Cardiovascular System 115

Fig. 8.2: Features of the heart (Sternocostal surface)

C H A P T E R-8
Fig. 8.3: Features of the heart (diaphragmatic, posterior surface)

Fig. 8.4: Anatomical position of heart

 116 Human Anatomy For Dental Students
towards the left just medial to the mid clavicular line, in
the 5th intercostal space. Base of heart lies upwards and
backwards on right side extending to the right 3rd costal
cartilage (Fig. 8.4).
Right Atrium
It is roughly quadrilateral in shape. It receives deoxy-
genated blood from the body. It extents from orifice of
superior vena cava to the orifice of inferior vena cava.
This corresponds to 3rd to 6th costal cartilages on the
right side.
External characteristics (Fig. 8.2): The superior vena
cava opens at its upper end and inferior vana cava at
the lower end.
Right auricle: It is a hollow conical muscular projection
from the antero-superior aspect of the atrium which
covers the root of aorta.
Sulcus terminalis: It is a shallow vertical groove that
runs along the right border of the heart. It corresponds
with the crista terminalis of the interior of the atrium.
Interior of right atrium (Fig. 8.5): It presents with the
S E C T I O N-1
following two parts:
1. Anterior rough part or atrium proper: This rough
part is separated from the posterior smooth part by
a ridge of smooth muscle fibres called the crista
terminalis.
2. Posterior smooth part or sinus venosus: This is the
smooth part and it receives the following tributaries:
a. Opening of superior vena cava
b. Opening of inferior vena cava
c. Opening of coronary sinus
d. Foramina venarum minimarum
e. Opening of anterior cardiac vein
f. Intervenous tubercle of lower
Interatrial Septum
It is present between the two atria. The right side of
septum presents the following features
Fig. 8.5: Interior of right artium
1. Fossa ovalis: An oval depression lying above and
to the left of opening of inferior vena cava. It is the
site of embryonic septum primum.
2. Limbus fossa ovalis/annulus ovalis: It is the sickle
shaped margin of fossa ovalis which forms the
upper, anterior and posterior border of fossa. It is
the remnant of free border of septum secundum.
Right Ventricle
It is a triangular chamber situated to the left of right
atrium. It receives blood from the right atrium and
pumps it into the pulmonary trunk.
External features: It has three surfaces (Figs 8.2 and 8.3)
1. Sternocostal or anterior surface: It is in relation to
sternum and ribs
2. Inferior surface: It is in relation to diaphragm
3. Posterior surface: It is convex to the right and is
formed by the inter-ventricular septum
Interior of right ventricle: It presents with two parts
divided by a muscular ridge, known as the supra-
ventricular crest (Fig. 8.6).
1. Ventricle proper or inflow tract: Ventricle proper
receives blood from right atrium via the right atrio-
ventricular orifice. The interior is rough due to
presence of muscular ridges known as trabeculae
carnae. It develops from right part of primitive
ventricle.
Trabeculae carnae: These are ridges made up of
bundles of muscle fibres arranged in three forms:
a. Ridges: These present as linear elevations.
b. Bridges: These are muscular elevations with
fixed ends on ventricular walls. The centre is
however free.
c. Papillary muscles: These are concical projec-
tions of muscle fibre bundles. Their base is
attached on the ventricular wall and the apex is
attached to the chordae tendinae. The cordae

Fig. 8.6: Interior of right ventricle
tendinae are further attached to the cusps of the
valves of atrioventricular orifices. The papillary
muscles regulate closure of these valves and
hence the blood flow across the orifices.
There are three papillary muscles in the right
ventricle namely, anterior, posterior and septal.
2. Infundibulum/outflow tract: It is also called conus
arteriosus and ejects blood from right ventricle to
the pulmonary trunk. It is the remanant of right
part of bulbus cordis.
The infundibulum is conical, smooth walled and is
directed upwards, backwards and to the left. The
upper end or apex presents with the pulmonary
orifice.
Right Atrio-ventricular Orifice (Fig. 8.5)
It is an oval to circular shaped opening present
between the right atrium and right ventricle.
It is directed ventrically downwards, forwards and
to left making an angle of 45 with the sagittal plane.
Circumference of the orifice is about 10 to 12 cm.
It is guarded by the tricuspid valve complex. This
consists of three cusps anterior, posterior and septal.
The cusps are separated by three commisures
namely, anteroseptal, posteroseptal and anteropost-
erior.
Pulmonary Orifice
It is circular in shape. It is guarded by three
semilunar valves, 2 anterior and one posterior
valves.
The free margin of cusps project into the pulmonary
trunk.
The orifice is open during systole and closed during
diastole. The valves meet in centre in a triradiate
manner during diastole. This prevents flow into
pulmonary trunk during ventricular filling phase.
Cardiovascular System 117
Left Atrium
It is also a quadrangular chamber which lies in a more
posterior plane than the right atrium, separated from it
C H A P T E R-8
by the interatrial septum. Left atrium receives oxygena-
ted blood from the lung via pulmonary veins and pumps
it to the left ventricle.
External features (Fig. 8.3): It forms the base of heart
and the anterior boundary of oblique pericardial sinus.
The pulmonary veins open into its posterior wall. It
presents with a conical projection on its anterosuperior
aspect, the left auricle.
Interior of left atrium (Fig. 8.7): The muscular wall of
left atrium is thicker than the right atrium. It is about
3 mm. Its inner surface is mostly smooth. Musculi
pectinati are present within the auricle. The posterior
wall presents with openings of four pulmonary veins.
The anterior wall is formed by interatrial septum.
The septal wall has a semilunar fold with concavity
directed upwards. This is the upper margin of septum
primum. Above this is present fossa lunata which
corresponds to the fossa ovalis of right side.
Left Ventricle
Left ventricle is situated posterior to the right ventricle
and is conical in shape. The musculature is 3 times
thicker than right ventricle. It is about 8-12 mm thick.
On cross section the cavity is circular. It receives
oxygenated blood from left atria which is pumped out
to the aorta.
External features: It has three surfaces (Figs 8.2, 8.3)
1. Sternocostal or anterior surface
2. Diaphragmatic or inferior surface
3. Left surface
 118 Human Anatomy For Dental Students
Fig. 8.7: Interior of left atrium and left ventricle
S E C T I O N-1
Interior of left ventricle: It presents with two parts
(Fig. 8.7)
1. Ventricle proper/inflow tract: Ventricle proper
conducts blood across the atrioventricular orifice
from left atrium to the apex. It lies below and behind
the outflow tract.
The interior is rough due to presence of trabeculae
carnae which are more prominent than that in right
ventricle. Left ventricle has only two papillary
muscles, anterior and posterior. It develops from
the left part of primitive ventricle.
2. Aortic vestibule/outflow tract: The vestibule is
smooth walled and truncated with a conical shape.
It ejects blood from left ventricle into the aorta. The
summit of infundibulum presents with the aortic
orifice. Developmentally it is the remanant of left
part of bulbus cordis.
Left Atrioventricular Orifice
It is smaller than the right orifice with a circumfe-
rence of 7 to 9 cm.
It is also directed downwards and forwards but lies
postero-superior to the right orifice.
It is guarded by the bicuspid or mitral valve
complex. It consists of two cusps namely anterior
and posterior separated by two deep indentations,
anterolateral and posteromedial commissures.
Aortic Orifice
It is circular in shape and is directed upwards and
to the right.
It is guarded by three semilunar cusps which are
thicker than pulmonary cusps. There are one
anterior and two posterior cusps.
During systole the cusps open and are stretched
along the aorta. They close during diastole
preventing regurgitation of blood into the ventricle.
The aorta at its origin also presents with a dilatation
above each cusps known as aortic sinuses of
Valsalva.
Interventricular Septum (Fig. 8.7)
Interventricular septum divides the two ventricles and
is directed obliquely and backwards. It bulges into the
right ventricle. Externally the site of interventricular
septum is indicated by presence of anterior and posterior
interventricular grooves (Figs 8.2 and 8.3).
It consists of two parts
1. Membranous part: It is a small oval part which
forms the posterosuperior part of septum.
2. Muscular Part: Rest of the entire septum is
muscular.
Crux of the Heart (Fig. 8.9)
It is the site of meeting of following structures
1. Inter-atrial septum
2. Posterior interventricular septum
3. Posterior part of atrio-ventricular groove
Arterial Supply of Heart
The heart is primarily supplied by the right and left
coronary arteries. They are also known as vasa vasorum,
as developmentally the heart is itself an artery.
The coronary arteries behave as end arteries
functionally. Anatomically however they do anastomose
 Cardiovascular System 119

Fig. 8.8: Right and left coronary arteries (anterior view of heart)

C H A P T E R-8
Fig. 8.9: Right and left coronary arteries (postero-inferior view of heart)

with each other. The inner 0.5 mm thickness of heart Left coronary artery: It is wider and larger than the right
receives nutrition directly from the blood in its chambers. coronary artery. It arises from the left posterior aortic
sinus of ascending aorta (Figs 8.9 and 8.10).
Right coronary artery: It arises from the right aortic sinus
of ascending aorta (Figs 8.8 and 8.9). It lies between the Branches
pulmonary trunk and right auricle. It ends by
1. Anterior interventricular artery
anastomosing with the circumflex branch of left
2. Circumflex artery
coronary artery.
Branches Myocardial Circulation
1. Right conus artery
The myocardial circulation presents with the following
2. Right anterior ventricular rami
anastomosis which are important to maintain flow in
3. Right atrial rami
minor blockages.
4. Sino-atrial artery
1. Interarterial anastomosis: The right and left
5. Right posterior ventricular rami
coronary arteries anastomose at the precapillary
6. Right posterior atrial rami
level. These anastomosis increase with age.
7. Posterior interventricular branch
 120 Human Anatomy For Dental Students

2. Arterio-venous anastomosis Nerve Supply of the Heart

3. Arterio-sinusoidal anastomosis: Few terminal
branches of coronary arteries end in sinusoids.
4. Sinu-sinusoidal and sinu-luminal: The sinusoids
open into coronary sinus. Few directly open into
lumen of atria
5. Arterio-luminal: Some terminal branches of coro-
nary arteries open into lumen.
Collateral circulation: A potential communication exists
between branches of coronary arteries and those which
supply the fibrous and parietal pericardium namely
1. Internal thoracic artery.
2. Pericardial, bronchial and esophageal branches of
descending aorta.
3. Phrenic arteries.
Venous Drainage of Heart
The heart is primarily drained by coronary sinus and its
tributaries. It is also drained by anterior cardiac veins,
small cardiac veins or Thebesian veins (venea cordis
minimi) and right marginal vein which directly drain
S E C T I O N-1
The heart is supplied by sympathetic and parasympa-
thetic fibres. The sympathetic and parasympathetic
fibres form a superficial cardiac plexus, which lies below
the arch of aorta and a deep cardiac plexus, which lies
in front of the bifurcation of trachea.
1. Sympathetic supply: These consist of both efferent
and afferent fibres. Preganglionic fibres are derived
from T1 to T5 segments of spinal cord. Postgang-
lionic fibres arise from superior, middle and
inferior-cervical sympathetic ganglia and T1 to T5
thoracic ganglia.
2. Parasympathetic supply: These consist of both
efferent and afferents. Preganglionic fibres are
derived from nucleus ambiguus and dorsal nucleus
of vagus. Postganglionic fibres lie in the cardiac
plexus.
Effect on Heart
1. Sympathetic fibres supply the atria, ventricles and
conducting system of the heart. Sympathetic

into the right atrium. stimulation leads to increase in heart rate, increase
Coronary sinus: It is the largest venous channel of heart in cardiac output and vasodilation of coronary
and is 2 to 3 cm in length. It lies in the posterior artery.
atrioventricular groove, also known as coronary sulcus 2. Parasympathetic fibres supply only the atria and
(Fig. 8.10). It opens into the right atrium in the lower conducting system of heart. Stimulation of vagus
part of inter-atrial septum between the opening of nerve leads to decrease in heart rate and decrease
inferior vena cava and atrio-ventricular orifice. in coronary blood flow.
Tributaries
Conducting System of Heart
1. Great cardiac vein
2. Middle cardiac vein The musculature of heart consists of special cardiac
3. Small cardiac vein myocytes that initiate and conduct the cardiac impulse
4. Posterior vein of left ventricle from the pacemaker region of the heart to the atrial and
5. Oblique vein ventricular myocardium (Fig. 8.11).

Fig. 8.10: Coronary sinus and its tributaries


CLINICAL AND APPLIED ANATOMY
Fig. 8.11: Conducting system of heart
The conducting system of heart includes the
following
1. Sino-atrial node (SA-node): It is the pacemaker of
the heart situated in the right atrium. The node
consists of special myocytes which are made up of
rhythmically discharging cells, P-cells (pacemaker
cells).
2. Atrio-ventricular node (AV-node): It is smaller
than SA node. AV node lies on right side of posterior
part of atrial septum, just above the opening of
coronary sinus.
3. Internodal pathways: These are modified atrial
muscle fibers, present as three bundles which
connect the SA node to AV node.
4. Atrio-ventricular bundle (Bundle of His): It
consists of a bundle of fibres that extend from the
antero-inferior part of the AV node to the muscular
part of ventricular septum. It divides into right and
left branches at the crest of muscular part of
ventricular septum.
4. Purkinje fibres: These are the terminal fibers
originating from the right and left bundle branches.
These fibers are longer that the rest of musculature
and spread to all parts of ventricular myocardium.
Spread of Cardiac Excitation (Fig. 8.11): The depolari-
zation wave initiated from the SA node spreads from
atrial fibers via the internodal pathways to converge on
AV node. Atrial depolarization is complete in 0.1 second.
AV node conduction is slower and presents a delay of
0.1 seconds before spread of depolarization to ventricles.
The wave of excitation spreads from AV node to
Purkinje fibers via bundle branches. The Purkinje system
is rapidly conducting and depolarization of ventricles
is complete in 0.080.1 second.
Cardiovascular System 121
Heart sounds: The heart contracts (beats) at a rate
of 72 to 80/mt and the beats can be felt on palpation
in the 5th intercostal space, in midclavicular line.
On auscultation, heart beats are heard as two
distinct sounds namely:
First heart sound, S1: It is due to closure of
atrioventricular valves coinciding with
contraction of ventricles.
Second heart sound, S2: It is due to closure of
pulmonary and aortic valves and coincides with
relaxation of ventricles.
3rd heart sound (S3): It is a very soft sound,
usually heard after S2. It coincides with period
of rapid ventricular filling.
4th heart sound (S4): It is heard just before S1
and coincides with ventricular filling due to
atrial systole.
Sites of Auscultation of Various Valve Sounds
(Fig. 8.12)
C H A P T E R-8
Fig. 8.12: Sites of auscultation of valve sounds
Aortic valve sound: It is heard in the right 2nd
intercostal space just next to the lateral margin
of sternum.
Pulmonary valve sound: It is heard in the left
2nd intercostal space just next to the lateral
margin of sternum.
Tricuspid valve sound: It is heard in the left
5th intercostal space just next to the lateral
margin of sternum.
Mitral valve sound: It is heard at the apex of
heart in the left 5th intercostal space in
midclavicular line.
On auscultation of heart, primarly two heart sound
are heard namely LUB (S1) followed by DUB (S2)
First heart sound (S1) occurs due to simultaneous
 122 Human Anatomy For Dental Students
closure of atrioventricular valves and second heart
sound (S2) occurs due to simultaneous closure of
aortic and pulmonary valves.
Increased heart rate is known as tachycardia and
decrease in heart rate is bradycardia.
An alteration in regularity is known as arrythmia.
Arterial pulse: The pressure of blood forced into
aorta during systole leads to a pressure wave along
the arteries. This expands the arterial wall and can
be felt as a pulse in the periphery. Clinically, it is
most often palpated in the distal forearm as the
radial pulse. It is felt in the radial artery at the wrist
0.1 sec after the peak of systole.
Electrocardiogram (ECG): ECG is the record of the
changes in electrical potentials of the myocardium
during the rhythmic discharge and spread of
excitatory impulses. This record is obtained from
external body surface as the body fluids are good
conductors of electricity due to presence of
numerous electrolytes.
S E C T I O N-1
Normal ECG
BLOOD VESSELS
According to size and structure vessels are divided into
arteries, veins, venules and capillaries.
Functional Classification of Blood Vessels
They are classified into following types of vessels
according to their function:
1. Conducting vessels: These are large arteries which
arise from the heart and their main branches. They
are low volume, high pressure vessels.
Example: Aorta, Carotid artery, Subclavian artery
2. Distributing vessels: These are smaller arteries
which reach the various organs. Muscular arteries
are included in this group.
3. Resistance vessels: These are arterioles. They have
a muscular wall with a precapillary sphincter.
Arterioles control the flow of blood into various
tissues.
4. Exchange vessels: Capillaries, sinusoids, and post
capillary venules are termed as exchange vessels.
Exchange of various substances, e.g., O2, CO2 and
nutrients between blood and tissues occurs through
these vessels.
5. Capacitance vessels: Large venules, small and large
veins constitute capacitance vessels. These vessels
convey blood back to the heart.
Structure of Blood Vessels
Classically, there are three coats present in all blood
vessels except in capillaries and sinusoids (Fig. 8.13).
1. Tunica intima: It is the inner most layer made up
of endothelium supported by fibrous connective
tissue.
2. Tunica media: It consists of smooth muscle fibres
and extends from internal elastic lamina to external
elastic lamina. Thickness of tunica media depends
upon the type and function of vessel.
3. Tunica adventitia: It is present outside the tunica
media and is made up of connective tissue. It
contains the blood and nerve supply of the blood
vessel.
Internal and external elastic lamina is a layer of elastic
fibres present between intima and media, media and
externa respectively.
Fig. 8.13: Structure of blood vessel (Transverse section of
elastic artery)
Arterioles
These vessels have a diameter of about 50 to 100.
Arterioles have layers of smooth muscle fibers in their
tunica media. Internal elastic lamina is absent. Arterioles
are of two types, muscular arteriole and terminal
arteriole.

Structure of Capillaries
Capillaries are tubular structures made up of a single
layer of polygonal endothelial cells lying on the basal
lamina. Between the endothelial cells and basal lamina
special cells called pericytes are present. A fine layer of
reticular tissue is present outside the basal lamina.
Fenestrated Capillaries
In these type of capillaries there is a gap present between
endothelial cells of capillary but basal lamina is intact.
Fenestrated capillaries are present in choroid plexus etc.
Sinusoids
Sinusoids are type of capillaries in which there is a gap
between endothelial cells along with deficiency of basal
lamina. They are present in various endocrine glands
and liver.
Venules
Diameter of a venule is generally is 20 to 30 . The wall
consists of endothelium, basal lamina and adventitia.
Anastomoses (Fig. 8.14)
Arteries unite to form anastomoses. The interconnection
between various arteries is called anastomosis. This
intercommunication occurs at the precapillary level.
Collateral Circulation
When an anastomotic channel enlarges to provide an
alternative route for circulation of blood following the
interruption of flow in the primary artery of a region it
is known as collateral circulation. Collateral circulation
Fig. 8.14: Arterial anastomosis around scapula
Cardiovascular System 123
develops rapidly in young people as compared to the
elderly.
Vascular Shunts
These are channels which bypass the capillaries. These
are of three types:
1. Thoroughfare channel (Fig. 8.15): It is the channel
which connects the terminal arteriole to the venule.
Hence, the capillary network is bypassed. Capilla-
ries are branches of these channels regulated by
precapillary sphincters. During period of less
demand in the tissues this thoroughfare channel is
preferred. In case of increase in cellular demands,
precapillary sphincters open and blood then passes
through the capillaries.
2. Arteriovenous anastomosis: It is the direct connect-
ion between smaller arteries and veins. The connect-
ing vessel is made up of a thick tunica with rich
sympathetic control. When this connecting vessel
closes, blood flows through the capillary network.
Example: Tip of the nose, lip, aural skin.
3. Glomera: These are special type of arteriovenous
C H A P T E R-8
anastomoses. These are present in the skin of hand
and feet, deep in the corium.
Each glomus is made up of the following:
a. Afferent arteriole, given at right angles from the
parent artery.
b. Periglomeral branches of afferent arteriole,
given at a short distance from its origin.
c. Short funnel shaped veins: It is the continuation
of afferent arteriole. It opens into the collecting
vein at right angles. This vein further curves
round the glomus and ends in a deeper
cutaneous vein.
Fig. 8.15: Blood vessels and thoroughfare channel
 124 Human Anatomy For Dental Students
Functions of arteriovenous anastomoses
1. They regulate the body temperature with the help
of cutaneous arteriovenous anastomosis.
2. Regulation of blood pressure
3. Secretion of epitheloid cells.
Functional Anatomy of Blood Vessels
The blood vessels carry blood from the heart to various
tissues supplying oxygen, nutrients and endocrinal
inputs. The blood flows back from the tissues to the heart
carrying deoxygenated blood and waste products of
tissue metabolism.
1. Arteries: Larger arteries like aorta and its branches
have larger amount of elastic tissue. The flow in
these is governed by pumping of the heart, and the
elastic recoil during diastolic phase.
2. Arterioles contain more muscular fibers and are
richly innervated with sympathetic nerve fibres.
They are the site for resistance to blood flow. Hence,
are known as resistance vessels. A small change in
their caliber due to neural or hormonal stimulation
S E C T I O N-1
leads to large changes in total peripheral vascular
resistance.
3. Capillaries: These are the exchange vessels which
allow exchange of gases and nutritive substances
across, to and fro from tissues.
They are made up of a single layer of endothelial
cells, being only 1 thick. Capillaries provide
channels between small arterioles and venules.
They have a diameter of 5 at arterial end and 9
at venous end. The flow in capillaries is regulated
by precapillary sphincters which determine the size
of capillary exchange area.
4. Venules and veins: They are called capacitance
vessels. They have thinner walls than arteries with
little muscle fibers. Hence, they easily distend to
accommodate large volumes of blood. However,
they collapse easily also.
The intima of veins is folded at intervals to form
valves which allow flow in one direction only, that
is towards the heart. There are no valves in small
veins, very large veins, in cerebral and visceral
veins. Flow in veins is determined by compression
of veins by skeletal muscle action, negative
intrathoracic pressures during respiration and
pumping of heart.
ARTERIAL SUPPLY OF BODY
The oxygenated blood pumped out of left ventricle is
carried by the aorta and its branches to the entire
body (Fig. 8.16).
Aorta (Figs 8.16 and 8.17)
Aorta is the arterial trunk of the body. It arises from the
left ventricle of the heart and is divided anatomically
into the following parts:
1. Ascending aorta
2. Arch of aorta
3. Descending aorta: This is further divided into
thoracic aorta and abdominal aorta.
Branches of ascending aorta
1. Right coronary artery
2. Left coronary artery
Branches of arch of aorta
1. Brachiocephalic trunk
2. Left common carotid artery
3. Left subclavian artery
Branches of Descending Aorta
1. Posterior intercostal arteries: 9 pairs from 3rd to 11th
intercostal spaces
2. Subcostal artery: 2 in number
3. Left bronchial artery: 2 in number
4. Oesophageal branches
5. Pericardial branches
6. Mediastinal branches
7. Superior phrenic arteries
Branches of Abdominal Aorta
1. Coeliac artery
2. Superior mesenteric artery
3. Inferior mesenteric artery
4. Lateral branches: These are paired
a. Inferior phrenic artery
b. Middle suprarenal artery
c. Renal artery
d. Gonadal artery: Testicular artery in male,
ovarian artery in female.
5. Dorsolateral branches: Four pairs of lumbar arteries.
6. Terminal branches: Right and left common iliac
arteries.
7. An unpaired median sacral artery
Common Carotid Artery
It is the chief artery supplying head and neck. Right
common carotid artery arises from brachiocephalic trunk
and left common carotid artery directly arises from the
arch of aorta. The details of common carotid artery and
its branches are discussed in head and neck (see page
no. 349).
Arterial Supply of Upper Limb (Fig. 8.17)
Axillary artery: It is the continuation of subclavian
artery and it extends from the outer border of Ist rib to
 Cardiovascular System 125

C H A P T E R-8
Fig. 8.16: Ascending aorta, arch of aorta, descending aorta, thoracic and abdominal aorta

the lower border of teres major muscle from where it Brachial artery: It is the continuation of axillary artery.
continues as brachial artery. It ends at the neck of radius by dividing into terminal
branches namely, radial artery and ulnar artery.
Branches of axillary artery
Branches of branchial artery
1. Superior thoracic artery
1. Profunda brachii artery
2. Thoracoacromial artery
2. Nutrient artery to humerus
3. Lateral thoracic artery
3. Superior ulnar collateral artery
4. Subscapular artery 4. Inferior ulnar collateral artery
5. Anterior circumflex humeral artery 5. Muscular branches to anterior compartment
6. Posterior circumflex humeral artery 6. Radial artery
7. Ulnar artery
S E C T I O N-1 126 Human Anatomy For Dental Students

Fig. 8.17: Arterial supply of body

Radial artery: It is the smaller terminal branch of 3. Palmar carpal branch for palmar carpal arch
brachial artery. 4. Dorsal carpal branch for dorsal carpal arch
Branches of radial artery 5. Superficial palmar branch
1. Radial recurrent artery 6. Ist dorsal metacarpal artery
2. Muscular branches 7. Arteria princeps pollicis
8. Arteria radialis indicis

Ulnar artery: It is the larger terminal branch of brachial
artery.
Branches of ulnar artery
1. Anterior ulnar recurrent artery
2. Posterior ulnar recurrent artery
3. Common interosseous artery
4. Anterior interosseous artery
5. Posterior interosseous artery It is the main artery
for extensor compartment of the forearm
6. Palmar and dorsal carpal branches
7. Muscular branches
Arterial Supply of Hand
Hand is supplied by a pair of arterial arches namely,
superficial palmar arch, and deep palmar arch (Fig. 8.28).
Superficial palmar arch (Fig. 8.17): It is an arterial arcade
formed by superficial terminal branch of ulnar artery
and completed on lateral side by superficial palmar
branch of radial artery. Superficial palmar arch lies
beneath palmar aponeurosis.
Deep palmar arch (Fig. 8.17): It is formed by terminal
end of radial artery and deep branch of ulnar artery.
Arterial Supply of Thorax (Fig. 8.17)
The thoracic wall is supplied by intercostal arteries (see
page no. 162). The various viscera of the thorax are
supplied by branches of thoracic aorta which are
described along with the viscera itself.
Arterial Supply of Abdomen and Pelvis
The abdominal wall is supplied by branches of superior
and inferior epigastric arteries and lumbar arteries. The
various abdominal and pelvic viscera are supplied by
branches of abdominal aorta. The pelvic structures are
supplied by internal and external iliac arteries.
Blood Supply of Anterior Abdominal Wall
It is primarly supplied by superior and inferior epigastric
arteries. Superior epigastric artery is the terminal branch
of internal thoracic artery while inferior epigastric artery
is a branch of external iliac artery. Blood supply can be
divided into two levels:
1. Skin and superficial fascia are supplied by
superficial branches of the following arteries:
Above umbilicus: musculophrenic artery, anterior
cutaneous branches of superior epigastric artery
and lateral cutaneous branches of lower posterior
intercostal arteries.
Below umbilicus: anterior cutaneous branches of
inferior epigastric artery, superficial epigastric
Cardiovascular System 127
artery, superficial circumflex iliac artery and
superficial external pudendal artery.
2. Muscles, fascia and parietal peritoneum
Above umbilicus: Superior epigastric artery, 10th
and 11th intercostal arteries and subcostal artery.
Below umbilicus: Inferior epigastric artery, deep
circumflex iliac artery.
Coeliac trunk: It is the artery of foregut. It arises from
the abdominal aorta. It supplies lower end of esophagus,
stomach, part of duodenum, spleen and liver.
Branches of coeliac trunk
1. Left gastric artery
2. Splenic artery
3. Common hepatic artery
Superior mesenteric artery (Fig. 8.18): It is the artery
of midgut. It arises from the abdominal aorta. It supplies
most of duodenum, jejunum, ileum, cecum, appendix,
ascending colon and right 2/3rd of transverse colon. It
also supplies pancreas.
C H A P T E R-8
Branches of superior mesenteric artery
1. Inferior pancreaticoduoenal
2. Middle colic artery
3. Right colic artery
4. Ileo-colic artery
5. 12 to15 Jejunal and ileal branches.
Inferior mesenteric artery (Fig. 8.18): It arises from the
ventral aspect of abdominal aorta. It supplies left 1/
3rd of transverse colon, descending colon, sigmoid colon
and part of rectum.
Branches of inferior mesenteric artery
1. Left colic artery.
2. Sigmoidal arteries
3. Superior rectal artery
Marginal artery of Drummond (Fig. 8.18): Anastomoses
of colic branches of superior mesenteric and inferior
mesenteric arteries form the marginal artery of
Drummond. This extends from the ileo-caecal junction
to the rectosigmoid junction. This arterial arcade is
situated along the concavity of colon. Following arteries
contribute to form marginal artery (Fig. 8.18).
1. Iliocolic artery
2. Right colic artery
3. Middle colic artery
4. Left colic artery
5. Sigmoidal arteries
Vasa recta arising from the marginal artery supply
the colon.
S E C T I O N-1 128 Human Anatomy For Dental Students

Fig. 8.18: Superior mesenteric, inferior mesenteric and marginal artery of drummond

Common iliac artery (Fig. 8.17): The abdominal aorta the midpoint of a line joining the anterior superior iliac
terminates by dividing into a pair of common iliac spine and the pubic symphysis. It continues as the
arteries at the level of lower border of L4 vertebra. Each femoral artery and hence is the principal artery of lower
artery gives rise to an internal iliac artery and an limb.
external iliac artery. Branches
1. Deep circumflex iliac artery.
Internal iliac artery (Fig. 8.17): It is also known as 2. Inferior epigastric artery.
hypogastric artery. It arises from, common iliac artery
opposite the corresponding sacroiliac joint.
Arterial Supply of Lower Limb (Fig. 8.17)
Branches
Lower limb is primarily supplied by femoral artery
1. Obliterated umbilical artery
which is a direct continuation of external iliac artery
2. Superior vesical artery
distal to the inguinal ligament.
3. Inferior vesical artery
4. Middle rectal artery Femoral artery: Femoral artery is the direct continuation
5. Obturator artery of external iliac artery at mid inguinal point. It continues
6. Uterine artery as popliteal artery at adductor hiatus or 5th
7. Vaginal artery osseoaponeurotic opening of adductor magnus.
8. Inferior gluteal artery Branches
9. Internal pudendal artery 1. Superficial epigastric artery
10. Iliolumbar artery: Passes upwards and laterally 2. Superficial circumflex iliac artery
11. Superior gluteal artery 3. Superficial external pudendal artery
12. Lateral sacral artery 4. Deep external pudendal artery
External iliac artery: It is the terminal branch of 5. Muscular branches
common iliac artery given off at the level of sacro-iliac 6. Profunda femoris artery
joint. At the level of inguinal ligament the artery lies at 7. Descending genicular artery

Profunda femoris artery: It arises from the femoral
artery in the femoral triangle.
Branches
1. Lateral circumflex femoral artery.
2. Medial circumflex femoral artery.
3. Muscular branches
4. Perforating arteries
Popliteal artery: It is the continuation of femoral artery.
Branches
1. Cutaneous branches
2. Muscular branches
3. Articular branches
4. Terminal branches: It ends by dividing into anterior
and posterior tibial arteries.
Anterior tibial artery: It is the terminal branch of
popliteal artery. It continues as the dorsalis pedis artery
in front of the ankle joint.
Posterior tibial artery: It is the larger, terminal branch
of popliteal artery. It ends by dividing into medial and
lateral plantar arteries.
Arterial Supply of Foot
Foot is supplied by medial and lateral plantar arteries
which are branches of posterior tibial artery.
Medial plantar artery: It is the smaller branch of
posterior tibial artery.
Branches
1. Anastomosing branch to 1st metatarsal artery
2. Muscular branches to abductor hallucis and flexor
igitorum brevis
3. Cutaneous branches
4. Articular branches
5. 3 superficial digital branches which anastmose with
the 1st, 2nd, 3rd plantar metatarsal arteries
Lateral plantar artery: It is the larger branch of posterior
tibial artery.
Branches
1. Superficial branch supplies lateral side of little toe
both skin and muscles.
2. Deep branch supplies muscles, gives rise to
articular branches and forms plantar arterial arch
by anastomosing with terminal part of dorsalis
pedis artery
Plantar arterial arch: It is formed by deep branch of
lateral plantar artery and deep plantar branch of dorsalis
pedis artery. It is situated across the base of 5th, 4th, 3rd
and 2nd metatarsals between the 4th and 6th layers of
the sole.
Cardiovascular System 129
VENOUS DRAINAGE OF BODY (Fig. 8.19)
The blood from various parts of the body is ultimately
drain into the superior and inferior vena cava. Superior
vena cava receives blood mostly from the upper part of
the body (above diaphragm) while the inferior vena cava
drains the lower part of body (below diaphragm). The
two veins finally open into the right atrium of the heart.
Superior Vena Cava
It is one of the two venous channels which drains the
blood from the body into the right atrium of the heart. It
drains the blood from the upper part of the body. It is
formed behind the lower border of right 1st costal
cartilage by the union of right and left brachiocephalic
veins. It pierces the fibrous pericardium opposite 2nd
costal cartilage. It ends in the postero-superior smooth
part of right atrium at level of 3rd costal cartilage.
Features: It has no valves, It is 7 cm long and 2 cm wide,
Lower half is covered by pericardium.
Tributaries
1. Right and left brachiocephalic veins
C H A P T E R-8
2. Azygos vein
3. Pericardial veins
4. Mediastinal veins
Inferior Vena Cava
It is the venous channel which drains the blood from
the body, below the diaphragm to right atrium of heart.
It is formed in front of the body of L5 vertebra by the
union of left and right common iliac veins. It ends in the
right atrium of heart through inferior vena caval opening
(Figs 8.19 and 8.20).
Length : 22 to 23 cm
Breadth : 2.5 cm
Tributaries: From below upwards
1. Left and right common iliac veins
2. Lumbar veins: There are four pairs of lumbar veins.
The 1st and 2nd lumbar veins form anastomoses
with azygos veins.
3. Right gonadal vein.
4. Right and left renal veins.
5. Right suprarenal vein.
6. Right and left inferior phrenic veins.
7. Right and left hepatic veins.
8. Lumbar azygos vein: It connects the inferior vena
cava to superior vena cava.
Brachiocephalic vein (Fig. 8.19): The brachiocephalic
vein is formed by union of subclavian vein and internal
jugular vein. It begins on each side, behind the sternal
end of clavicle and descends downwards. The two
brachiocephalic veins join behind the sternal end of 1st
right costal cartilage to form superior vena cava.
S E C T I O N-1 130 Human Anatomy For Dental Students

Fig. 8.19: Venous drainage of the body


Fig. 8.20: Inferior vena cava and its tributaries
Subclavian vein: It is the continuation of axillary vein.
External jugular vein: External jugular vein is primarily
the drainage channel of face and scalp.
Internal jugular vein: It is the main venous channel of
head and neck.
Venous Drainage of Upper Limb
Upper limb is mainly drained by a set of superficial veins
which drain into the axillary vein and by the vena
comitantes of brachial artery.
Axillary vein (Figs 8.19): Axillary vein is formed by
union of basilic vein with the two vena comitantes of
the brachial artery. It begins at the lower border of teres
major muscle and it ends at the outer border of 1st rib
where it continues as the subclavian vein.
Superficial Veins of Upper Limb (Figs 8.19)
Superficial veins of upper limb have following
characteristic features:
1. Most superficial veins join together give rise to
larger veins namely, basilic and cephalic veins.
2. They are absent in palm, ulnar boder of fore arm,
and back of arm.
Cardiovascular System 131
C H A P T E R-8
3. Superficial veins are accompanied by lymphatics
and cutaneous nerves.
4. The superficial lymph nodes lie along the superficial
veins
5. Cephalic vein and basilic vein are interconnected
with the each other through medial cubital vein.
Dorsal Venous Arch
It is a plexus of veins present in the dorsum of the hand.
It is formed by three metacarpal veins which receives
two dorsal digital vein from thumb and one dorsal
digital vein from lateral side of index finger. It continues
as cephalic vein.
Cephalic Vein (Fig. 8.19)
Cephalic vein arises from the lateral end of dorsal venous
network, in the anatomical snuff box of hand. It runs
along the lateral border or radial border of forearm and
curves forwards to the anterior aspect of forearm below
the elbow. In front of the elbow it is connected with the
basilic vein with the help of median cubital vein. It passes
upwards in the arm upto the infraclavicular fossa. Then
it pierces the clavipectoral fascia and drains into the
axillary vein.
Basilic Vein (Fig. 8.19)
It begins from the ulnar side of dorsal venous network
and runs along the medial border of the forearm. It
curves to the anterior surface of forearm below the elbow
and runs upwards in front of the arm. It pierces the deep
 132 Human Anatomy For Dental Students

fascia of middle of the arm. Here, it is accompanied by

venae comitantes of the brachial artery. The two venae
comitantes and basilic vein join together and form the
axillary vein.
Median Cubital Vein (Fig. 8.19)
It is an anastomotic channel connecting cephalic vein to
basilic vein in front of the elbow.
Median Antebrachial Vein (Fig. 8.19)
It arises from the anastomotic channels of the superficial
palmar plexus. It ascends in front of forearm and ends
in the cubital vein or basilic vein.
Deep Veins of Upper Limb (Fig. 8.19)
They consist of brachial veins, which are the vena
comitantes of the brachial artery and vena comitantes
of radial and ulnar arteries.

Venous Drianage of Thorax

The thoracic wall is drained by anterior and posterior
intercostal veins (see page no. 378). The venous drainage
of various viscera of thorax is described in the
S E C T I O N-1

corresponding chapters. The final pathway of venous

drainage of this region is via the azygos system of veins
which is described below.
Azygos System of Veins (Fig. 8.21)
Azygos means unpaired. These veins are not accomp-
anied with the corresponding arteries. Following are the
characteristic features of azygos system of veins
1. They are straight veins.
2. These venous channels are situated in the posterior
mediastinum and are paravertebral in position. Fig. 8.21: Azygos system of veins
3. They are provided with valves.
4. These veins have communicating channels with the Venous Drainage of Abdomen and Pelvis
vena caval system, in front and the vertebral venous
plexus, behind. The abdomen and pelvis is drained by two sets of venous
5. Thehy drain blood from the back, thoracic wall and drainage system:
abdominal wall. 1. Caval system: It consists of the veins draining into
the inferior vena cava. These are on each side
The three main venous channels of azygos system are
a. Common iliac vein: It is formed by the union
1. Azygos vein: The trunk of azygos vein is formed
of internal and external iliac veins.
by the union of lumbar azygos vein, right subcostal
b. Internal iliac vein: It is formed by convergence
vein and right ascending lumbar veins near the leve of various tributaries which are vena
of right renal veins. It enters the thorax either cominantes of the corresponding branches of
through a separate opening in the right crus of internal iliac artery.
diaphragm or along with aorta in the aortic c. External iliac vein: It is the proximal continua-
opening. In the thorax, it lies in front of the lower tion of femoral vein. It receives inferious
eight thoracic vertebrae. It ends by opening into the epigastric vein, deep circumflex iliac vein and
superior vena cava opposite 4th thoracic vertebra. pubic vein.
2. Hemiazygos vein: It is formed by the union of left 2. Portal system: It consists of the portal vein which
ascending lumbar and left subcostal veins. It ends drains most of the viscera of abdomen and pelvis.
into the azygos vein opposite T8 vertebra.
Portal Vein
3. Accessory azygos vein: It begins as the continuation
of 4th left posterior intercostal vein and ends into Portal vein is formed behind the neck of pancreas, at
the azygos vein. level of L2 vertebra, by the union of superior mesenteric

vein and splenic vein in front of inferior vena cava. It is
8 cm in length and runs upwards in the right border of
lesser omentum. It divides into right and left branches
at the porta hepatis and enters the liver. Its branches
end into the hepatic sinusoids (Fig. 8.22).
Tributaries of Portal Vein
1. Superior mesenteric vein
2. Splenic vein
3. Right gastric vein
4. Left gastric vein
5. Cystic vein, from gall bladder
6. Paraumbilical veins
7. Obliterated left umbilical vein (ligamentum teres)
8. Superior pancreaticoduodenal vein
9. Prepyloric vein (sometimes)
Special Features of Portal Vein
Portal vein is a part of the portal system which has
capillaries at both the ends and vein in between.
Fig. 8.22: Portocaval anastomosis
Cardiovascular System 133
1. It begins as a vein and ends as an artery.
2. It is devoid of valves.
3. Portal system can store 1/3rd of total blood in body.
4. In the portal vein, the blood streams of superior
mesenteric vein and of splenic vein remain segre-
gated.
Portocaval anastomosis: The portal vein divides into
smaller branches which end in sinusoids of the liver
along with the blood from hepatic arteries. The blood
drains ultimately via hepatic veins into the inferior vena
cava.
Normally veins drain into the caval system. But in
case of portal system, veins of gastrointestinal tract drain
into the portal vein. There are areas of anastomosis
between the portal and the caval system that provide
collateral circulation, for the drainage of gastrointestinal
tract directly to caval system when there is portal
obstruction.
C H A P T E R-8
 134 Human Anatomy For Dental Students
Following are the sites of the portocaval anastomosis
(Fig. 8.22):
1. Lower end of rectum and anal canal
2. Lower end of esophagus
3. At Umbilicus
4. In the falciform ligament
5. Bare area of liver
6. Posterior abdominal wall
7. In intra uterine life: At the fissure for ductus
venosus (via ductus venosus).
Superior mesenteric vein: It is a relatively large vein
which drains blood from small intestine, caecum,
appendix, ascending colon and right 2/3rd of transverse
colon. It joins with splenic vein to give rise to portal
vein.
Inferior mesenteric vein: It begins as the continuation
of superior rectal vein and terminates in splenic vein or
sometimes at the junction of superior mesenteric vein
and splenic vein.
Splenic vein: It is formed in the splenorenal ligament
by the confluence of veins arising from spleen at its
S E C T I O N-1
hilum. It joins with superior mesenteric vein behind
the neck of pancreas to form the portal vein.
Venous Drainage of Lower Limb
Three distinguishable sets of veins are present in the
lower limb. These are (Fig. 8.19)
1. Superficial veins: They lie in the superficial fascia.
They are thick walled with numerous valves. They
drain into deep veins.
Superficial veins are:
a. Great saphenous vein: Longest vein in the body
(Fig. 8.19) It is the upward continuation of
medial end of dorsal venous arch of the foot
supplemented by medial marginal vein. It
drains into femoral vein at the saphenous
opening, below inguinal ligament.
b. Short saphenous vein: It is an upward continua-
tion of dorsal venous arch supplemented by
lateral marginal vein. It begins behind the lateral
malleolus. It terminates into the popliteal vein.
It usually has 5 to 10 valves.
2. Deep veins: They lie in deep structures under cover
of deep fascia. They accompany arteries and their
branches as vena comitantes. They have more
valves than superficial veins.
Deep veins are, from below upwards, posterior
tibial vein, anterior tibial vein, peroneal vein,
popliteal vein and femoral vein
3. Perforating veins: They connect the superficial
veins with the deep veins by piercing fascia. They
follow intermuscular septae.
Femoral vein: It is the upward continuation of popliteal
vein at the lower end of adductor canal. It continues as
external iliac vein behind inguinal ligament.
CLINICAL AND APPLIED ANATOMY
Median cubital vein is connected to the deep veins
of the upper limb through a perforator which fixes
it. Hence, it does not slip away when intravenous
injections are given. It acts as lifeline in emergency
conditions to give intravenous injections and fluids.
Varicose veins: Dilatation and tortuocity of
superficial veins of lower limb is known as varicose
veins. They are caused due to incompetance of
valves in perforating veins, sapheno femoral
junction or any other valves in superficial veins. It
results in dilatation and tortuocity of veins.
Femoral vein is used for venous blood sampling
and occasionally used for intravenous infusion in
cases of peripheral circulatory collapse. The
femoral vein is localized by feeling the pulsations
of the femoral artery which is lateral to it, below
the inguinal ligament.
 Chapter
9
Blood and Its Components
INTRODUCTION
Blood forms 8% of total body weight, that means, in an
adult weighing 60 to 70 kg circulating blood volume
would be 4800 to 5600 ml (5 to 6 liters). It primarily has
two components:
1. Cellular elements: These consists of red blood cells,
white blood cells and platelets. It is 45% of total
blood volume (Fig. 9.1).
2. Plasma: It is the clear fluid component of blood
which suspends the cellular elements. It forms 55%
of total blood volume.
Functions of Blood
1. Blood carries O2 from lungs to tissues and CO2 from
tissues to lungs.
2. It carries various nutritive substances absorbed
from gastrointestinal tract to the tissues.
3. It transports products of metabolism for excretion
from kidneys.
4. It helps in circulation of various hormones and
chemical agents from their site of secretion to the
effector organ and tissues.
Fig. 9.1: Diagrammatic representation of various cellular components of blood
5. It helps in regulation of temperature.
6. Blood forms an important buffer to control the pH,
temperature and electrolyte content of the body.
7. The white blood cell component of blood is
responsible for providing defence, i.e., immunity
both against infections and foreign bodies.
8. It contains platelets and other complex factors that
regulate haemostasis, i.e., clotting of blood on
injury.
C H A P T E R-9
9. Plasma protein component maintains the intra-
vascular oncotic pressure and helps in transport of
various substances like iron, thyroid hormones etc.
to various sites.
RED BLOOD CORPUSCLES OR CELLS (RBCS)/
ERYTHROCYTES (Figs 9.1 and 9.2)
RBCs are biconcave, disc like cells with a diameter
of 7.5 and thickness of 2 . This shape allows them
to easily fold upon themselves and pass through
capillaries. They have a larger surface area to allow
proper exchange of gases.
 136 Human Anatomy For Dental Students
Fig. 9.2: Erythrocyte (RBC)
Mature RBCs do not have nucleus and lack
important organelles like mitochondria. RBCs
mainly contain haemoglobin. They depend entirely
on glucose metabolism for energy supply.
Total RBC count in blood varies from 4.0 to 6.5
million/ml.
The old RBCs are removed from circulation by
tissue macrophage system of spleen and liver. Life
span of RBCs in blood is 120 days.
The primary function of RBCs is transport of O2
which is bound to hemoglobin.
Erythrocyte Sedimentation Rate (ESR)
When blood is collected in a tube with anticoagulant
and allowed to stand upright, it gets separated into two
layers. The RBCs pile on each other forming aggregates
(known as rouleaux formation). The aggregates settle
S E C T I O N-1
down leaving a clear pinkish layer on top. ESR is defined
as the rate of settling down of RBCs at the end of one
hour and is expressed in millimeters. ESR is higher in
females especially during pregnancy. It is increased in
anaemia, acute infections, chronic conditions like
tuberculosis, arthiritis and malignancies.
Packed Cell Volume (PCV)
It is also known as the haematocrit. It is the percentage
of cellular component of blood which include WBCs, RBCs
and platelets. As mentioned it is normally 45%. Practically,
PCV denotes the RBC content of blood as these cells are
the most predominant of the cellular component.
Haemoglobin (Hb)
It is a large protein molecule consisting of two pairs
of polypeptide chains. Each polypeptide chain
forms a complex with iron containing porphyrin,
haeme. This imparts red color to the RBCs.
The adult haemoglobin is named haemoglobin A
(Hb A). It is made up of two and two chains
(22).
Other types of hemoglobin are:
a. Haemoglobin A2 (Hb A2) which has two and
two chains (22).
b. Fetal haemoglobin (HbF) which has two and
two chains ( 2 2 ). This is the primary
haemoglobin present in fetus which has very
high affinity for O2. It gradually disappears after
birth and is replaced by HbA by end of 1 year
of life.
Each haeme moiety has one Fe2+ ion (ferrous form
of iron) and each Fe2+ binds to one molecule of O2.
Hence, each molecule of Hb carries 4 molecules
of O2.
Hb binds to O2 to form oxyhaemoglobin. When O2
is removed from Hb it is termed deoxygenated Hb.
O2 dissociates from Hb in tissues due to fall in pH
and rise in temperature which happens secondarily
to cellular metabolism. Lack of O2 also releases O2
into tissues from Hb. The deoxygenated Hb is
transported via circulation to the lungs where it
combines with O2 again as the levels of O2 are high
there.
Hb also binds to CO2 in blood to form carbamino-
Hb.
Normal levels of hemoglobin :
In Newborn 20 to 22 gm%
In Infants 10.5 to 12.5 gm%
In Adult males 14 to 16 gm%
In Adult females 12 to 14 gm%
Synthesis of hemoglobin requires adequate protein
and iron in diet. Copper and vitamin C in diet are
essential to promote iron absorption.
Hemoglobin is released from RBCs when they are
destroyed by tissue macrophage system and protein
part is re-utilized. Iron is also re-utilized or stored
as tissue ferritin. Haeme is metabolized to biliverdin
that is converted to bilrubin in liver. Bilirubin is
excreted in bile and urine and imparts yellow color
to stool and urine.
Functions of Hb
It primarily transports O2. It also transports little
CO2.
It provides for 70% of buffering capacity of blood
(binds to H+ ions).
Hemopoesis
Hemopoesis is the development of cells of blood.
The blood cells are derived from pleuripotent stem
cells of bone marrow also known as hemo-
cytoblasts. Active bone marrow or red bone marrow
is present in marrow cavities of all bones in
children. In adults active bone marrow is limited
to ends of long bones like humerus and femur, the
rest of marrow cavities get infiltrated by fat forming
the yellow marrow.
In fetal life, upto infancy, hemopoesis occurs in liver
and spleen. This is called extra-medullary
hemopoesis. In adults it is seen only in conditions
that are associated with destruction or replacement
of bone marrow like blood cancer or myelofibrosis.
The stem cells provide for the pool of precursor cells
and differentiate to form progenitor cells of a
particular cell line namely erythroid, lymphoid,
granulocyte or megakaryocyte progenitor cells.
Erythropoesis
It is the orderly development of mature RBCs from
stem cells. The steps of erythropoesis are shown
above (Fig. 9.3).

Fig. 9.3: Steps of erythropoesis
Proerythroblast is the earliest appearing different-
iated cell of erythroid series.
As the cell matures there is reduction in cell size,
due to decrease in cytoplasm and nuclear size. The
decrease in nucleus is associated with decrease in
RNA and ribosomal content of cell making it more
acidophilic from the initial basophilic staining.
Hemoglobin appears in the intermediate normo-
blasts. In final stages (late normoblast) there is
condensation and degeneration of nucleus. The
nucleus is seen as a small dot, which is known as
pyknotic nucleus. The nucleus finally degenerates.
Reticulocytes contain fragments of RNA and no
definite nuclear material. Mature RBCs have
eosinophilic cytoplasm since they do not have any
DNA, RNA or cytoplasmic organelles.
The mature RBCs or erythrocytes are released into
circulation. Only 1% circulating RBCs are reticulo-
cytes. Immature form of RBCs are not seen in
circulation normally.
Factors necessary for RBC synthesis are:
1. Proteins: Proteins are needed for synthesis of
globin chains of hemoglobin.
2. Trace elements: Trace elements are minerals
that are required in trace amounts for the
normal functioning of body. Iron is needed for
synthesis of haeme moiety of haemoglobin.
Other trace elements like copper, cobalt and
manganese also help in heme formation.
3. Vitamins: Vitamin B 12 and folic acid are
required for synthesis of DNA of dividing cells.
Vitamin C is required for iron absorption and
synthesis of nucleotides (important cofactor for
haemoglobin synthesis).
Haemolysis: Breakdown or destruction of RBCs is called
haemolysis. Under normal conditions life span of RBCs
is 120 days after which they are destroyed by phagocytic
tissue macrophage system of spleen, liver and bone
marrow.
Blood Groups
The cell membrane of RBCs have a specific
oligosaccharide-lipid complex which are known as blood
group antigens. The expression of the antigen is
genetically determined. There are primarily two types
Blood and Its Components 137
of antigens which have been named, type A and type B.
Circulating plasma contains antibodies against these
RBC antigens. It is seen that in individuals with type A
blood antigen, anti-B antibodies are present and vice
versa. Four blood types are identified according to
antigens present. These are:
Blood group Type of surface Type of circulating
type antigen antibodies
Blood group A A Antigen Anti-B antibodies
Blood group B B Antigen Anti A antibodies
C H A P T E R-9
Blood group AB A and B No antibodies to
antigens either A or B
Blood group O Both A and Anti-A and anti-B
B antigens antibodies are present
are absent
If blood of one individual is transfused to another
individual having a different blood group from the
donor, immediate antigen antibody reaction takes place
due to presence of antibodies in circulation. There is
destruction of donor RBCs. This is called transfusion
reaction. The reaction can vary from mild skin eruptions
to severe anaphylactic shock and death.
Other minor blood group antigens have also been
identified now. These are Rh, MNS, Lutheran, Kell, Kidd
etc. Out of which Rh antigen is of greatest clinical
importance after A and B types. Rh-group of antigens is
named after the rhesus monkey in which it was first
studied. It consists of C, D and E antigens which are
also present on the red cell membrane. D antigen is the
most important component.
Rh positive individuals have D antigen on their RBCs
while Rh negative individuals do not have D antigen.
Exposure of Rh negative individuals to Rh positive blood
results in production of anti-D antibodies. The Rh
antibodies (IgG) can cross placenta.
WHITE BLOOD CELLS (WBCs)/LEUCOCYTES
The white blood cells are responsible in providing
defense against infections like viral or bacterial,
worm infestations and provide immunity even
against tumors.
 138 Human Anatomy For Dental Students

WBCs are larger, rounded, nucleated cells with a

diameter of 10 to 14 m.
The normal WBC count in blood is 4000 to 11000
per ml of blood.
They are broadly grouped into two types:
1. Granulocytes: These cells have cytoplasmic
granules which contain vesicle bound bio- Fig. 9.5: Eosinophil
logically active substances in them. They are
Basophils: They are < 1% of total circulating WBC. They
further of three types
also have a bilobed nucleus with cytoplasm which is
a. Neutrophils
granular but the granules take up basic stains. They appear
b. Eosinophils
bluish with hematoxylin stain. They have mild phagocytic
c. Basophils
activity. The granules contain histamine and heparin
2. Agranulocytes: They are of two types
which are responsible for acute allergic (hypersensitivity)
a. Lymphocytes
reactions and anticoagulation of blood respectively
b. Monocytes
(Fig. 9.6).
Neutrophils: They form 50 to 70% of toal WBC
population. They have a multilobed nucleus. Cytoplasm
has neutrophilic cytoplasm, granules take up both acid
and basic stains on staining. Neutrophils are mainly
responsible for phagocytosis and destruction of microbes
(Fig. 9.4). Fig. 9.6: Basophil
S E C T I O N-1

Lymphocytes: They form 20 to 40% of circulating WBCs.

They are primarily part of lymphatic system and are
present in large number in lymph nodes, spleen and
thymus. They are further of two types T-lymphocytes
and B-lymphocytes and are responsible in providing the
acquired immunity (Fig. 9.7).
Fig. 9.4: Neutrophil

Invasion by microbes, mainly bacteria, leads to

production of an inflammatory response by plasma
which releases chemotaxins. Chemotaxins are
substances that attract leukocytes to the infected area.
They consist of leukotrines, complement system factors Fig. 9.7: Lymphocytes
and other proteins from plasma.
Neutrophils are mobile cells. They attach to the Monocytes: They form 1 to 8% of total circulating WBCs.
endothelial surface and pass through them into the These are relatively larger cells with irregular shape.
tissues by a process called diapedesis. They have a single kidney shaped nucleus. They enter
The movement of neutrophils towards infected site circulation from bone marrow and remain there for 72
is called chemotaxis and they form clumps at that site. hours after which they enter tissues and become tissue
The bacteria are engulfed by neutrophils by macrophages. Examples of tissue macrophages are
endocytosis and are presented to the intracellular Kupffer cells in liver, pulmonary alveolar macrophages,
lysosomes and peroxisomes that hydrolyse the contents microglia in brain. They have the same phagocytic action
of endosomes. This is called phagocytosis. as neutrophils and appear at the site of infection after
neutrophils providing for long term defence (Fig. 9.8).
Eosinophils: They form 1 to 6% of total WBC count. They
have a bilobed nucleus which stains with acidophilic
dyes, appear pink with eosin stain. They are less motile
and hence less phagocytic. They also undergo diapedesis
and chemotaxis. They are mostly involved in providing
mucosal immunity as are maximally present in respira-
tory, gastrointestinal and urinary tracts. (Fig. 9.5).
Fig. 9.8: Monocyte

Fig. 9.9: Steps of Leucopoesis
Leucopoesis
It is the orderly development and formation of WBCs
from pleuripotent stem cells of bone marrow. There is a
slight difference in synthesis of granular WBCs versus
agranulocytes as shown in figure 9.9.
Lymphoblasts and myeloblasts are the first
identifiable precursors of WBC series. As the cell
matures the cell size reduces, cytoplasm becomes
granular and nucleus takes its characteristics
appearance.
The final maturation of lymphocytes to T-lympho-
cytes occurs in thymus and to B-lymphocytes occurs
in bone marrow.
PLATELETS
Platelets are small, 2 to 4 in diameter, rounded,
granulated cells. The normal circulating platelet levels
range from 1.5 to 4 lacs per ml of blood. Platelets have a
half life of 4 days.
Characteristics features of platelets are:
The cell membrane shows extensive invaginations
creating a fine system of canals with ECF in them.
The cell membrane has specific receptors for Von
Willie brand factor, collagen and fibrinogen.
Phospholipids of cell membrane produce arach-
idonic acid which is a precursor for prostaglandins
and thromboxane.
Cytoplasm shows characteristic arrangement of
microtubules in periphery responsible for invagina-
tion of cell membrane.
Fig. 9.10: Steps of thrombopoiesis
Blood and Its Components 139
Cytoplasm has contractile filaments namely, actin
and myosin. It also has endoplasmic reticulum,
golgi apparatus and mitochondria which stores
Ca2+ ions and provides ATP.
Two types of cytoplasmic granules are present:
Dense granules which contain non protein
substances like serotonin, ADP, ATP etc.
-granules which contain proteins namely the
clotting factors, and platelet derived growth
C H A P T E R-9
factor (PDGF). PDGF promotes wound healing
by stimulating mitosis of vascular smooth
muscle cells.
Megakaryocytopoiesis or Thrombopoiesis
The steps of synthesis of platelets are given below
(Fig. 9.10).
Megakaryocytes are giant multinucleated cells and
each megakaryocyte gives rise to 3000 to 4000 platelets
by pinching off bits of cytoplasm.
Functions of Platelets
The primary function of platelets is haemostasis.
Platelets help in arresting the bleeding from an injured
vessel by stimulating vasoconstriction, forming a
haemostatic plug and stimulating the intrinsic clotting
pathway. This is brought about by:
An injury to vessel wall exposes underlying
collagen and Von Willie brand factor. Platelets
adhere to these by their receptors. Platelet adhesion
 140 Human Anatomy For Dental Students
does not require energy. Collagen, Ca2+ and
thrombin aid in adhesion.
Platelet adhesion leads to platelet activation which
is characterized by:
Change in shape, formation of pseudopodia
Platelet aggregation
Degranulation: Release of contents of granules
This process utilizes energy in form of ATP.
Platelet activation factor is produced by neutrophils
and monocytes during injury and this further
stimulates platelet aggregation.
Aggregation and agglutination of the platelets
forms a temporary hemostatic plug.
The net effect of the above reactions also stimulates
release of arachidonic acid from cell membrane of
platelets.
Platelet also stimulate the intrinsic pathway of
clotting mechanism that leads to formation of
definitive fibrin clot.
The platelets are responsible for clot retraction by
function of their contractile proteins.
S E C T I O N-1
Arachidonic acid: It is a polyunsaturated fatty acid
which on release from cell membrane acts as a precursor
to formation of various local hormones namely
prostaglandins, thromboxanes and leukotrienes.
PLASMA
Plasma is the acellular fluid part of blood, which
constitutes 55% of blood volume and 5% of total body
weight. It contains 90% water. The rest is made up of
inorganic molecules like Na+, Ca2+, HCO3, K+, PO33,
Fe2+ etc. and organic molecules like plasma proteins and
other non protein nitrogenous substances, sugars, fats,
enzymes and hormones.
Serum is the fluid remaining after the blood clots. It
is similar to plasma but does not have clotting factors
especially fibrinogen, factor II, V and VIII.
Plasma Proteins
Normal plasma proteins values are 6.5 to 8.0 gm%. They
are primarily of three types namely:
1. Albumin: It forms 55% of total plasma proteins. It
is synthesized in liver. The two primary functions
of albumin are
a. It acts as a carrier protein for various hormones,
aminoacids, ions, drugs etc.
b. It helps to maintain the plasma oncotic pressure.
2. Globulin: It is produced by liver, plasma cells,
lymphocytes and tissue macrophages. It forms a
part of plasma lipoprotein complexes that helps in
transport of fatty acids, triglycerides and choles-
terol. Derivates like transferrin and ceruloplasmin
are involved in transport and storage of iron and
copper ions respectively. Immunoglobulins are
derivatives of -globulin fraction of plasma protein.
Albumin to globulin ratio in blood is usually 1.5 to
1.7 : 1.
3. Fibrinogen: It is synthesized in liver and is
responsible for clotting of blood.
Functions of Plasma Proteins
1. Plasma proteins help in maintainance of intra-
vascular colloidal oncotic pressure.
2. They act as carriers for various substances example
hormones like TSH and gonadal hormones for their
action at appropriate sites.
3. Regulate clotting of blood.
4. Act as an accessory blood buffers: Plasma proteins
provide for 20% of buffering capacity of blood to
maintain acid-base balance.
5. Immunological function: -globulin fraction of the
plasma proteins gives rise to antibodies.
CLOTTING OF BLOOD
The process of formation of clot to arrest bleeding from
an injured vessel is hemostasis. It is brought about by
the following mechanisms:
1. Constriction of injured blood vessels
2. Platelets aggregation (see text)
3. Clotting of blood
Clotting factors: These are soluble protein molecules
present in the plasma. These are 13 clotting factors
named from factor I to factor XIII.
Clotting mechanism: It is the process of formation of
insoluble fibrin from the soluble plasma protein
fibrinogen. Fibrin consists of polypeptide strands that
get associated with each other to form a mesh like
structure, the definitive clot.
Fibrinogen is a soluble plasma protein (factor I). It is
converted to fibrin by the action of thrombin (activated
factor II). Thrombin is derived from prothrombin by the
action of prothrombin activator. The activator is formed
by a series of reactions that result in formation of active
factor X (Xa). There are two pathways by which
activation of factor X takes place (Fig. 9.11).

Fig. 9.11: Diagrammatic representation of mechanisms of clotting
Anticlotting mechanism in blood: The blood does not
clot unless there is injury to vessels. Also the clotting
tendency after injury is regulated to limit the process to
the affected site only. This is brought about by
antithrombin III, thrombomodulin and fibrinolytic
mechanism, plasminogen-plasmin system.
CLINICAL AND APPLIED ANATOMY
Anemia is defined as the decrease in circulating
levels of RBCs below 4 million per ml or decrease
in Hb below 12 gm%.
Anemia can occur due to
1. Impaired production of RBCs/ haemoglobin,
e.g., in iron deficiency, vitamin B12 and folic acid
deficiency; destruction or depressed function
of bone marrow due to tumors like leukemia
and radiation exposure, etc.
2 Increase destruction of RBCsHaemolytic
anemias: This is seen in congenital defects like
sickle cell anemia and spherocytosis or
hemolytic disease of newborn. Acquired causes
can be autoimmune diseases, mismatched
blood transfusion, etc.
3. Loss of blood: This can be due to injury, worm
infestation (hook worm), etc.
Polycythemia: This is a condition associated with
increase levels of RBCs in blood. This leads to
increase viscosity of blood which favours stasis and
clotting of blood.
Blood and Its Components 141
C H A P T E R-9
Physiological polycythemia is seen in infants, and
in patients living at high altitudes. Pathological
polycythemia is usually secondary to tumors of
bone marrow.
Erythroblastosis fetalis: Haemolytic disease of the
new born (erythroblastosis fetalis). This condition
occurs when an Rh negative mother is carrying
an Rh positive baby. At the time of delivery small
amount of fetal blood passes into the maternal
circulation and induces production of anti-D
antibodies. In subsequent pregnancies these anti-
D antibodies cross the placenta and destroy the
RBCs of the second Rh positive baby. This leads to
haemolysis and jaundice in the baby.
Neutrophilia: Increased neutrophil count is seen
in:
Acute bacterial infections.
Tissue injury due to burns, surgery etc.
Leukemia (blood cancer).
Miscellaneous causes like smoking, acute
inflammation like gout, arthritis.
In normal conditions like after exercise, later
half of menstruation, pregnancy.
Neutropenia: Low neutrophil count is seen in
Infants: Neutophils form 30 to 40% of toal
WBCs
Typhoid fever
Viral fever
Suppression of bone marrow.
 142 Human Anatomy For Dental Students
Eosinophilia: Eosinophil count is increased in
allergic conditions like asthma, worm infestations
and allergic skin conditions.
Eosionopenia: Eosionophil count is suppressed by
use of corticosteroids.
Lymphocytosis: Increase in lymphocytes is seen in:
Chronic infections like tuberculosis
Viral infections
Leukemia
Normally in children lymphocytes are 60% and
form most of circulating WBC.
Lymphopenia: Low counts of lymphocytes are seen
in immunosupressed patients, either taking steroids
or suffering from AIDS.
Thrombocytopenia: It is the decrease in platelet
count and occurs due to bone marrow depression,
increase destruction of platelets due to viral
infections like dengue and drug reactions. It often
is idiopathic in nature.
Thrombocytosis: It is a condition characterised by
increase platelets levels of more than 5,00,000/mm3
of blood. It is often seen after removal of spleen or
(spleenectomy), or as a response to stress.
S E C T I O N-1
CLOTTING OF BLOOD
Anticoagulants: These are substances that inhibit
clotting of blood by various mechanisms. Drugs
and their action are shown below.
a. Heparin: Stimulates antithrombin III, antithro-
mbin III is a circulating protease inhibitor that
prevents activation of factors IX, X, XI and XII.
b. Warfarin and dicoumarol: These act by
blocking action of vitamin K. Vitamin K helps
in the synthesis of clotting factors in liver.
c. Ca2+ chelators: In vitro, addition of salts like
EDTA (ethylene diamino tetra acetic acid) to
blood prevents blood clotting. This is because
EDTA binds to Ca 2+ in blood. Ca 2+ is an
important cofactor in activation of factor X and
conversion of fibrinogen to fibrin.
Disorders of coagulation: These are characterised
by defective coagulation due to deficiency of one
or more clotting factors in the plasma. They are
mostly congenital due to genetic defects. Common
causes of acquired coagulation defects are vitamin
K deficiency and liver diseases.
Hemophilia A: It is the most common clinical
condition of deficiency of clotting factors. It is
caused by deficiency of clotting factor VIII. This is
an X-linked genetic defect and hence manifests
only in males while females are carriers. It is
characterised by spontaneous bleeding tendencies.
It is associated with prolonged coagulation time.
Thrombosis: It is a clinical condition characterized
by clotting of blood with in intact blood vessels.
The important causes are:
Stasis or stagnant blood flow: This is an impor-
tant cause of venous thrombosis of lower limb
in patients with obesity, prolonged immobiliza-
tion.
Damage to vascular endothelium that trigger
clotting cascade. This is the most important
cause of thrombosis in arteries due to
hypertension, deposition of cholesterol plaques
especially in coronary and cerebral arteries.
Increase coagulability of blood: This usually
occurs in condition associated with deficiency
of coagulation inhibition.
Emboli: These are small pieces of clotted blood that
get detached from main thrombus and enter
circulation.
 Chapter

10
Lymphatic System
INTRODUCTION Components of Lymphatic System
1. Lymph and lymph vessels
Lymphatic system is a closed system of vessels which
a. Lymph
draws the extra tissue fluid into the blood vascular
b. Lymph capillaries
system (Fig. 10.1).

C H A P T E R-10

Fig. 10.1: Main lymphatic drainage of body

 144 Human Anatomy For Dental Students
c. Lymph vessels proper
d. Terminal lymph ducts (trunks)
2. Lymphoid tissue
a. Primary lymphatic follicles
b. Lymph nodes
c. Haemolymph nodes
d. Thymus
e. Bone marrow
Functions of Lymph and Lymphatic System
It helps to maintain interstitial tissue pressure
Lymph carries protein molecules, electrolytes and
other macromolecules back from interstitial fluid
to circulation.
It helps to transport lymphocytes, red blood cells,
antigens and antigen presenting cells to the
secondary lymphoid organs.
Lymph nodes and spleen help to destroy any
foreign particles and microorganisms in circulation,
thus guarding against them.
The digested fats in small intestines are absorbed
into the lymph vessels and carried to the liver and
the circulation.
It supplies oxygen and nutrients to selected parts
S E C T I O N-1
of the body.
Lymph: The tissue fluid which enters the lymphatic
system is known as lymph. Protein concentration of
lymph fluid is equal to tissue fluid but lower than the
plasma. Lymph carries particulate material, colloids and
macromolecules from tissue fluid. This helps to maintain
the low protein concentration of tissue fluid. Lymph also
clots on standing due to presence of clotting factors.
Lymphocytes are the most abundant cellular component
of the lymph.
Lymph capillaries: These begin blindly in the
extracellular spaces and communicate freely with
adjacent lymph capillaries. They are lined by single layer
of endothelial cells which do not have any definite basal
lamina. Pericytes and muscle layer are absent. Lymph
capillaries are numerous in mucous membrane specially
in the intestines, serous surfaces, dermis of skin and
skeletal muscles. Capillary wall is anchored to
connective tissue. Hence the capillary lumen remains
patent.
Places Where Lymph Capillaries are Absent
1. Avascular structures like epidermis, cornea,
cartilage
2. Brain and spinal cord
3. Splenic pulp
4. Bone marrow
5. Liver lobule
6. Lung units
7. Superficial fascia
Lymph vessels proper: They are formed by the
convergence of lymph capillaries. They consists of single
layer of endothelium surrounded by smooth muscle
fibres and elastic tissue in their walls. Large trunks have
three distinct layers, tunica intima, tunica media and
tunica adventitia.
Valves are present that give them a beaded
appearance. This ensures that the lymph flows in one
direction only. They accompany the blood vessels
supplying the area and are more numerous than the
vessels and form plexuses. The lymphatic vessels are
connected to and traverse various lymph nodes in their
path. Retrograde flow may take place if the vessels are
obstructed.
Terminal lymph ducts: These are formed by
convergence of lymph vessels. They consist of cisterna
chyli, thoracic duct and right lymph duct.
Cisterna Chyli
It is a dilated, sac like structure present at level of L1
vertebra and lies between the right and left crura of
diaphragm, just behind the right side of aorta. It is
formed by the confluence of various lymph trunks
(vessels) namely (Fig. 10.1):
a. Right and left lumbar lymph trunks
b. Intestinal lymph trunks
It continues upwards as the thoracic duct.
Thoracic Duct (Figs 10.1 and 10.2)
It is a common lymphatic trunk which begins at upper
end of the confluence of lymphatics or the cysterna chyli,
at the level of lower border of T12 vertebra. It enters
thorax along with the aorta through aortic opening of
diaphragm. It passes up in posterior mediastinum, above
the level of T5 vertebra it shifts gradually to the left side
of mid-line. It runs in the posterior part of superior
mediastinum along the left margin of esophagus. It
enters the neck and runs up 3 to 4 cm above the level of
clavicle. Then it arches down and ends by opening into
the junction of subclavian vein and internal jugular vein.
Tributaries of thoracic duct: Thoracic duct drains the
lymphatics from the entire body except, the right side
of head and neck, right upper limb, right lung, right
thoracic wall, right half of heart and the convex surface
of liver (Fig. 10.2).
1. A pair of ascending lymph trunks: Each drains the
upper lumbar lymph nodes.
2. A pair of descending lymph trunks: Each drains
the posterior intercostal lymph nodes of right and
left lower six intercostal spaces.
3. Vessels which drain posterior mediastinal lymph
nodes.
 Lymphatic System 145

4. Posterior intercostal lymph nodes of upper six

intercostal spaces of the left side.
5. Left jugular lymph trunk.
6. Left subclavian lymph trunk.
7. Left broncho-mediastinal lymph trunk.

Right Lymph Duct

This is also a large terminal lymphatic trunk. It may be
single, double or plexiform, formed by lymphatic vessels
of right side of head and neck (right jugular trunk), right
upper limb (right subclavian trunk), posterior intercostal
lymph nodes of upper six intercostal spaces of right side,
thorax and lung (right bronchial and broncho-media-
stinal trunk) (Figs 10.1 and 10.2).

LYMPHOID TISSUE
Lymphoid tissues are part of tissue macrophage system
(also known as reticulo-endothelial system) that plays
an important role in the immunological surveillance of
body . They are formed by aggregation of lymphocytes,
macrophages, plasma cells and dendritic cells arranged
on a background framework of reticular fibers. They help

C H A P T E R-10
to destroy bacteria, foreign bodies, old RBCs and WBCs.
They also process foreign antigens and act as antigen
presenting cells to the lymphocytes.
Tissue macrophages are scattered at the following
sites in the body:
1. Kupffer cells of liver.
2. Reticulum cells of red and white pulp of spleen.
3. Lymph nodes.
4. Pulmonary alveolar macrophages.
5. Cells lining bone marrow.
6. Osteoclasts of bone.
7. Microglia of brain.
8. Dendritric or Langerhans cells in skin.
The Lymphoid tissues can be grouped into two type
of organs:
1. Primary lymphoid organs: These generate new
lymphocyte population from stem cells which are
released into circulation. There are two primary
lymphoid organs in our body, bone marrow and
thymus.
2. Secondary lymphoid organs: These contain mature
B and T-lymphocytes with antigen presenting cells
and hence help in initiating immunological respo-
nse to an infection or trauma. The lymphocytes and
antigen presenting cells originate from the stem
cells of bone marrow and reach the organs via
circulation. They enter the organs by migrating
across blood or lymph-capillaries. The various
secondary lymphoid organs in the body are lymph
nodes, spleen and various mucosal lymph
aggregates, e.g., Palatine tonsil, Peyers patches in
small intestine etc.
Fig. 10.2: Diagrammatic representation of area drained by
thoracic duct and right lymphatic duct
 146 Human Anatomy For Dental Students
Lymph Nodes
These are small oval to bean shaped bodies that are
present along the path of lymphatic vessels. There are
about 800 lymph nodes present in human body. The
nodes may be aggregated in groups or chains at certain
areas like axilla, neck, around coeliac trunk etc.
Structure of lymph nodes: Grossly, they appear bean
shaped with an indentation on one side, that is the hilum.
Hilum is the site of entry and exit of blood vessels and
efferent lymphatic vessels. A number of afferent vessels
traverse through the periphery of lymph node. Each
lymph node consists of a capsule and the gland
substance (Fig. 10.3).
1. Capsule: A fibrous capsule invests the entire node
and is separated from the gland substance by a sub-
capsular space known as subcapsular sinus.
2. Gland substance: It is made up of an outer cortex
and an inner medulla. Cortex is cellular and con-
sists of densely packed B lymphocytes with plasma
cells, macrophages and dendritic cells arranged on
a background of reticular fibres. The cells are
S E C T I O N-1
arranged in the form of lymphatic follicles. Medulla
is made up of lymphoycytes arranged in the form
of irregular cords. They are known as medullary
cords and have intervening network of lymphatic
channels or sinuses. Macrophages and plasma cells
are present in medulla.
Fig. 10.3: Transverse section through a lymph node
Functions of Lymph Nodes
1. They filter lymph and remove particulate matter
and noxious agents.
2. They are made up of numerous lymphocytes which
provide for the immune response of the body.
Plasma cells produce antibodies and provide
immunity against antigens.
SPLEEN
It is the organ of reticuloendothelial system lying in the
abdominal cavity. It is a haemo-lymph organ as it filters
blood by taking out worn out RBCs, leucocytes, platelets
and microbial antigens from circulation. Spleen lies in
left hypochondrium, partly extending into epigastrium
(Fig. 10.4). It is the largest lymphoid organ of the body.
It has an outermost serous layer derived from perito-
neum.
Dimensions: It is 1 inch thick, 3 inches in breadth, 5
inches in length, and weighs 7 oz (150 gm). It extends
from 9 to 11th rib. This is easy to remember with the
help of Harris dictum 1, 3, 5, 7, 9, 11.
Anatomical Features
It is oblong in form and has an expended anterior or
lateral end. Posterior or medial end is rounded and is
directed backward and medially. Inferior border is

Fig. 10.4: Visceral surface of spleen
rounded while superior border is notched and indicates
lobulated origin of spleen.
Diaphragmatic surface is convex and smooth and is
related to diaphragm,left lung and pleural sac with 9th,
10th and 11th ribs and respective intercostal spaces.
Visceral surface is irregular and presents with
impressions due to surrounding structures, e.g., Gastric
impression, renal impression, colic impression and
pancreatic impression.
Hilum of spleen is a cleft present along the long axis
of spleen which transmits splenic vessels and nerves and
also provides attachment to gastrosplenic and lienore-
nal ligaments.
Functions of Spleen
It is a store house of T and B-lymphocytes and plays
an important role in the immune response of the
body.
It contains numerous macrophages which are
responsible for the removal of old RBCs, WBCs and
platelets from the circulation.
Spleen is the site of haemopoesis in fetal life.
Fig. 10.5: Thymus and its relations
Lymphatic System 147
THYMUS
It is a symmetrical bilobed structure present in the
superior and anterior mediastinum. At birth, it is
prominent and weighs about 10 to 15gm, it is about 20
gm at puberty. It rapidly diminishes after puberty
(Fig. 10.5).
Functions of Thymus
It is the central organ of lymphatic system, one of
the primary lymphoid organ of our body.
It is essential in the early weeks of neonatal life and
regulates the functioning of peripheral lymphoid
tissues.
It provides the mature T-lymphocytes population
of the body.
MUCOSA ASSOCIATED LYMPHOID TISSUE
(MALT)
These are aggregates of B and T-lymphocytes
present under various mucosal surfaces.
C H A P T E R-10
They are supported within a fine network of
reticular fibres. However, they are not covered by
capsule. They do not have afferent vessels but are
drained by efferent lymphatic channels. Hence they
do not filter lymph but provide local immunity.
They are seen in the mucosal walls of intestine
(Payers patches), respiratory, reproductive and
urinary tracts.
Larger collections form the various tonsils in the
body namely: Palatine tonsil, lingual tonsil, etc.
 148 Human Anatomy For Dental Students
LYMPHATIC DRAINAGE OF BODY
Lymphatic drainage of head and neck is described in
chapter no. 33.
Lymphatic Drainage of Upper Limb
Upper limb is primarily drained by axillary group of
lymph nodes. Other lymph nodes identified are
infraclavicular lymph nodes, present below clavicle and
supratrochlear lymph nodes, present behind the medial
epicondyle of humerus (Figs 10.6 and 10.7).
The lymphatics of upper limb are arranged in
superficial and deep lymphatic vessels.
Superficial Lymphatics: These run along cephalic vein
and basilic vein. Vessels running along cephalic vein
drain into infraclavicular and apical group of lymph
nodes. Vessels along the basilic vein drain into supra-
trochlear group of lymph nodes.
Deep lymphatic vessels: These run along the radial,
ulnar and brachial arteries. They drain into lateral group
of axillary lymph nodes.
S E C T I O N-1
Axillary Group of Lymph Nodes (Figs 10.6 and 10.7)
They are 20 to 30 in number and are divided into five
groups.
1. Anterior group: Lie along lateral thoracic vein.
2. Posterior group: Lie along subscapular vein.
3. Lateral group: Lie along axillary vein.
Fig. 10.6: Flow of lymph in axillary lymph nodes
4. Central group: Are embedded in the fat of axilla.
5. Apical group: Lie at the apex of the axilla, medial
to axillary vein.
Upper limb is mainly drained by lateral group of
axillary lymph nodes. The anterior, posterior and lateral
groups of lymph nodes drain into central group.
Efferents from central group are given to apical group
of lymph nodes. Efferents from apical group form the
subclavian trunk which drains into circulation at the
junction of subclavian and internal jugular vein.
Lymphatic Drainage of Thorax
Superficial lymph nodes of thorax consist of intercostal,
parasternal and superior diaphragmatic lymph nodes.
The deep group of lymph nodes are present along
the various viscera of thorax and form the lymphatic
channels draining the thorax. These ultimately join the
thoracic duct (see page no. 144).
LYMPHATIC Drainage of Abdomen and Pelvis
Lymphatic drainage of anterior abdominal wall:
Umbilicus acts as water shed line for lymphatics
(Fig. 10.8). Superficial lymphatics of anterior abdominal
wall drain as follows:
1. Above the level of umbilicus they drain into axillary
group of lymph nodes.
2. Below the level of umbilicus they drain into
superficial inguinal lymph nodes.
Fig. 10.7: Axillary group of lymph nodes
 Lymphatic System 149

The various viscera and peritoneum of abdomen are

drained by the following lymph nodes
1. Pre-aortic group of lymph nodes: These are present
along the arteries of corresponding names and
consist of (Fig. 10.9), coeliac lymph nodes, superior
mesenteric and inferior mesenteric lymph nodes.
They receive afferents from stomach, esophagus,
duodenum, jejunum, ileum, colon, rectum, upper
part of anal canal, liver, pancreas, spleen. The
efferents from pre-aortic lymph nodes join to form
the intestinal lymph trunk.
2. Para-aortic lymph nodes: These are situated on
both sides of abdominal aorta, anterior to the crura
of diaphragm on the medial margins of psoas major
muscle. They receive afferents from common iliac,
internal iliac, external iliac, circumflex iliac,
epigastric, sacral lymph nodes. Hence they drain
lower limb, pelvis and perineum, infra-umbilical
abdominal walls, pelvic viscera, gonads, kidneys
and suprarenal glands. Efferents from para-aortic
lymph nodes form the right and left lumbar lymph

C H A P T E R-10
trunks.

Lymphatics of Lower Limb

Lymph from lower limb is primarily drained by inguinal
group of lymph nodes. Only few peripheral nodes are
present in the leg, mainly in popliteal fossa.

Inguinal Lymph Nodes

Inguinal lymph nodes are divided into two groups
Fig. 10.8: Superficial lymphatics of anterior abdominal wall 1. Superficial inguinal lymph nodes
2. Deep inguinal lymph nodes

Fig. 10.9: Lymphatic drainage of small and large intestine

 150 Human Anatomy For Dental Students

Fig. 10.10: Superficial group of inguinal lymph nodes Fig. 10.11: Deep inguinal group of lymph nodes
S E C T I O N-1

Superficial inguinal lymph nodes: They are distributed IMMUNITY

in a T-shape manner and are divided into an upper
horizontal group and a lower vertical group (Fig. 10.10). It is the ability of the body to protect itself against
invasion by organisms like bacteria, viruses and
1. Upper horizontal group consists of 56 nodes
parasites; against foreign particles and against tumors.
present below the inguinal ligament and are made
Immunity is classified into two types:
up of lateral group and medial group.
1. Innate immunity: This type of immunity is present
Lateral group drains gluteal region, medial group
at birth by virtue of the genetic and constitutional
drains anterior abdominal wall below umbilicus,
development of the body. It is independent of any
perineum, anal canal below pectinate line. In males,
previous exposure to the organism. It hence
it also drains penis, prepuce and scrotum. In
provides the first line of defense against infections.
females, it also drains vulva, vagina below hymen,
2. Acquired immunity: This type of immunity is
cornu of uterus.
acquired by the body after it is exposed to an
2. Lower vertical group is made up of 4-5 lymph nodes
organism or an immunogenic substance during the
which lie along the great saphenous vein. All
lifetime. It is brought about by activation of specific
superficial lymph vessels from the lower limb
lymphocytes.
except along the short saphenous vein territory, Differences between innate and acquired immunity
drain into this vertical group. Vertical group is the
main lymphatic drainage of the lower limb. Innate immunity Acquired immunity
Deep inguinal lymph nodes: They are 1 to 3 in number 1. It is present at birth 1. It is acquired during life
and lie on the medial side of femoral vein. Lymph node 2. It is independent of 2. It develops only after
that lies in femoral canal is known as Cloquets gland exposure of an organism exposure to the organism
3. It involves mechanisms 3. It has a latent period
(Fig. 10.11). Deep lymph vessels accompany femoral
already present in the which is required to
vessels. They drain glans penis in male, glans clitoris in body. Hence, there in no produce the desired
female and receive efferents from superficial inguinal latent period. immunological response.
lymph nodes. 4. It is non-specific. 4. It is specific and results in
Efferents from deep inguinal group of lymph nodes resistance only against
drain into the external iliac group of lymph nodes. the particular stimulus.

Innate or Natural Immunity
Innate immunity of body is provided by the following
factors:
1. Physical barrier provided by intact skin and mucus
membrane of the body.
2. Barrier due to secretions produced by the mucus
membrane of nose and respiratory tract, saliva of
the mouth, hydrochloric acid of stomach, mucus
lining the intestinal lumen.
3. Natural anti-bacterial and antiviral substances in
various parts of body like lysozymes in saliva and
lacrimal fluid, mucopolysaccharidases in nasophar-
yngeal secretions, normal bacterial flora of distal
ileum and colon.
4. Antimicrobial molecules in circulation.
a. Complement system
b. Cytokines (interferons)
c. Antibacterial peptides
5. Cellular defences:
a. Phagocytic cells in the body like macrophages
present in alveoli of lung, tissue fluids etc. and
polymorphonucleocytes (neutrophils) present
in the circulation. These cells accumulate at the
site of injury or invasion and ingest and destroy
the foreign particles or organisms.
b. Natural killer cells: These are large lympho-
cytes present in the circulation that are specially
active against viral particles, few bacteria and
fungi and also tumor cells without any prior
sensitization. They activate complement system,
secrete cytokines and causes lysis of cells by
damaging cell membrane.
c. Eosinophils: These are a type of WBC which
contain toxic granules that are active against few
parasites.
6. Inflammatory responses of the body:
a. Injury or infection at a site leads to vasodila-
tation, leaking of phagocytes from capillary
circulation into the tissues and destruction of
the organism. Increase in local temperature due
to vasodilatation also is directly lethal to the
invading microorganisms.
b. Fever: Increase in body temperature is usually
seen during an infection or inflamation. It acts
by directly inhibiting the growth of micro-
organisms and by stimulating interferons.
Acquired Immunity
It is the immune response brought about by an antigenic
stimulus. It is of two types:
1. Humoral immunity: Humoral immunity is
mediated by production of antibodies against an
antigen. The antigen is usually a foreign substance
Lymphatic System 151
(protein molecule) for example cell components of
bacteria or viruses. Antibodies are produced by
activated B-lymphocytes or plasma cells.
2. Cellular or cell mediated immunity: Cell mediated
immunity is mediated primarily by the action of T-
lymphocytes. It not only destroys microorganisms
but plays an important role in immunity against
cancer, is responsible for graft reactions and
occurrence of certain autoimmune diseases.
Acquired immunity can be obtained in two ways:
1. Active acquired immunity: This immunity is
acquired after being exposed to an antigen. The
immunological machinery of the body is activated
and results in production of antibodies or
immunocompetent cells against the antigen. It can
be further acquired in two ways:
a. Natural active immunity: This immunity devel-
ops after an apparent infection, e.g., after an
episode of chicken pox the individual acquires
immunity against the infection which protects
him against any second attack.
b. Artificial active immunity: This immunity
C H A P T E R-10
develops after exposure to an antigen adminis-
tered by way of vaccines. Examples of bacterial
vaccines are BCG for tuberculosis, typhoid
vaccine, viral vaccines are oral polio vaccine,
measles and chicken pox vaccine.
2. Passive acquired immunity: This immunity is
acquired by the passive administration of anti-
bodies to an individual. The immunological mach-
inery of the individual is not stimulated. It can also
be acquired in two ways:
a. Natural passive immunity: It is the immunity
acquired by fetus from mother due to
transmission of antibodies across placenta. It is
acquired by babies by the transmission of
antibodies in milk from the mother during
lactation.
b. Artificial passive immunity: It is the immunity
acquired by an individual by the administration
of antibodies directly into circulation, e.g., Use
of hyperimmune serum in the treatment of
tetanus, diphtheria and gas gangrene infections.
Lymphocytes
These are the second most common type of circulating
white blood cells or leucocytes. Lymphocytes are broadly
divided into B-lymphocytes and T-lymphocytes.
B-Lymphocytes: These develop and differentiate from
haemopoetic stem cells of bone marrow. They are
transported via blood to secondary lymphoid organs like
lymph node and spleen. Mature B-lymphocytes have
antigen receptor sites on their cell membrane. Activated
B-lymphocytes are called plasma cells. They produce
 152 Human Anatomy For Dental Students
antibodies in response to antigenic stimulus. Some
activated B-lymphocytes do not form plasma cells and
instead remain as memory B-cells.
Antibodies (Immunoglobulins): Antibodies are also
termed as immunoglobulins (Ig). They are produced by
plasma cells. Immunoglobulins are glycoprotein
molecules and are made up of two pairs of polypeptide
chains, two small or light and two large or heavy chains.
They are classified into five classes namely IgG (It is the
most abundant of immunoglobulins), IgA, IgM, IgE and
IgD. Only IgG can cross placenta.
Mechanism of action of antibodies:
They neutralize bacteria toxins by binding to them
They bind to viral cell membranes and prevent
intracellular invasion of viruses. Since viral
replication needs incorporation into host DNA, it
ultimately leads to viral death.
Antibodies bind to bacterial cells and favours their
phagocytosis (opsonization)
Antibody-antigen complexes stimulate comple-
ment system.
S E C T I O N-1
Primary immune response: When the body is exposed
to an organism for the 1st time there is production of
antibodies which help limit the infection. The first
antbody to appear is IgM. The immune response has a
lag phase of 14 weeks because there is initiation of
immunological response for the first time. Also, the
antibody levels decline gradually by four weeks. Hence,
it is usually a short lived response.
Secondary immune response: This is brought about
when there is a second exposure to same organism. The
response is mediated via memory B-lymphocytes and
occurs immediately against the organisms. This is
mediated by production of IgG antibodies. The level of
antibody production is higher and also the level of IgG
antibodies decline slowly and usually persist for many
years or throughout life.
T-lymphocytes: They originate from bone marrow but
first migrate to thymus where they become
immunologically mature thymic lymphocytes or T-
lymphocytes. They then re-enter circulation and are
distributed to the secondary lymphoid organs namely:
lymph nodes and spleen. T-lymphocytes are further
divided into three subgroups
1. Helper T-lymphocytes
2. Suppressor T-lymphocytes
3. Cytotoxic T-lymphocytes
4. Memory T-lymphocytes
T-lymphocytes are responsible for cell mediated
immune response against an antigen.
Cytokines
These are a group of hormone like molecules produced
by lymphocytes. Other cells producing cytokines are
macrophages, somatic cells etc. They consist of the
following molecules:
1. Interleukins (IL)-13 types have been identified,
named IL-1 to IL-13
2. Tumor necrosis factor (TNFa and TNFb)
3. Interferons (INFa, INFb and INFg)
4. Tumor growth factor (TGFb)
They act in a paracrine fashion to stimulate
leucopoesis. IL-1 is responsible for B lymphocyte proli-
feration, immunoglobulin (Ig) production, phagocytic
stimulation and inflammatory response. It also causes
fever. TNF produces actions similar to IL-1. It also
stimulates vascular thrombosis and tumor necrosis.
Interferons are prime stimulators of cell mediated
immunity. They are most active against viral invasion.
Complement System
The complement system consists of nine plasma
enzymes designated numbers from C1 to C9. The
activation of complement system is brought by binding
of C1 to antigen antibody complex (acquired immunity)
or binding of circulating protein called factor 1 to cell
membrane of bacteria or virus (innate immunity).
This leads to a cascade of reactions that result in:
1. Opsonization of bacteria: The bacteria get coated
with factors that make them easy targets of
phagocytosis by neutrophils and macrophages.
2. The C-factors act as chemotactic agents attracting
neutrophils and macrophages.
3. Stimulate inflammatory response by causing
release of histamine.
4. The activated complement complex formed at end
of reaction forms perforations in cell membrane of
organisms resulting in their death.
CLINICAL AND APPLIED ANATOMY
LYMPH VESSELS AND LYMPH NODES
Chylothorax: Injury to thoracic duct may result in
accumulation of fluid in thoracic or pleural cavities
known as chylothorax.
Chyluria: Thoracic duct obstruction leading to
backflow of intestinal lymph into the lymphatic
capillaries of kidney may produce chyluria.
Filariasis is infestation by microfilaria parasites.
These have predilection for lymphatics and may
block the thoracic duct and other lymphatic

channels causing oedema of the limbs. Bursting of
thoracic duct into pleural cavities can cause a
chylous pleural effusion.
Enlargement of lymph nodes can occur due to
various causes like
Acute infections, e.g., jugulodigastric lymph
nodes are enlarged in tonsillitis, infection of toe
nail of greater toe leads to enlargment of lower
vertical group of superficial inguinal lymph
nodes.
Chronic infections, e.g., tuberculosis
Malignancies, e.g., lymphomas, metastasis
from visceral cancers. Virchows nodes: These
are enlarged lymph nodes which can be felt just
above the medial end of clavicle, lateral to the
insertion of sternocleidomastoid. They are
usually enlarged in patients with advanced
cancers mainly involving the stomach and
pelvic structures.
The tissues and organs devoid of lymphatics are:
Central nervous system
Bone marrow
Eye ball
Intralobular portion of the liver
Internal ear
Red pulp of spleen
Fetal-placenta
Areas devoid of capillaries
Edema: It is accumulation of interstitial fluid in
abnormally large amounts. The various causes of
edema are:
Increase in hydrostatic capillary pressure-This
can occur due to:
a. Arteriolar dilatation: Example, in excess
heat.
b. Increase venous pressure leading to stasis of
blood. Examples are: Heart failure, incompe-
tent venous valves, venous obstruction due
to thrombo-embolism effect of gravity as in
continuous standing, increase in ECF due to
salt and water retention as in pregnancy etc.
Decreased capillary oncotic pressure: Hypo-
proteinemia as seen in liver cirrhosis and
nephrosis results in lowered plasma osmolality.
This causes extravasation of fluid out of capi-
llaries.
Increase capillary permeability: This occurs
due to presence of local substances like kinins,
and histamine as in allergic reactions.
Lymphatic blockade: This leads to accumula-
tion of fluid which is rich in proteins. It is called
lymphedema. Examples are:
Lymphatic System 153
a. Filariasis: In this condition infestation with
filarial worms blocks the lymphatic
channels.
b. Radical mastectomy: Mastectomy is
removal of breast which is usually
performed in cases of breast cancer. The
surgery involves removal of axillary lymph
nodes. This leads to block in drainage and
lymphedema in the corresponding side
upper limb.
SPLEEN
Spleen is palpable per abdomen only when it is
enlarged to atleast twice its normal size.
Spleen is identified by splenic notch.
While ligating splenic vessels, damage to the tail
of the pancreas should be prevented as it lies in
the lienorenal ligament along with splenic vessels.
Patient with ruptured spleen, occasionally
complain of pain in the left shoulder because of
haemorrhage of ruptured spleen irritates the
C H A P T E R-10
diaphragm which is supplied by the phrenic nerve
(C3, C4, C5). Pain is referred to shoulder because
the supraclavicular nerve (which supplies skin
over the shoulder) also has the root value of C3 C4.
There is involvement of same spinal segment.
PALATINE TONSILS
Tonsils are larger in children and atrophy by adulthood.
They are known to increase in size in childhood due to
repeated infections causing tonsillitis. Tonsillectomy i.e.
superficial removal of tonsils is necessary if they become
a site of repeated infections or there is a tonsillar abscess
or they enlarge so much that they block the passage.
Injury to paratonsillar vein during surgery is an
important cause of haemorrhage which is usually
controlled by applying pressure.
ABNORMAL IMMUNE RESPONSES
Autoimmune Diseases
During intrauterine life the antigens presented to the
immune system of fetus are recognised as self antigens
and tolerance to them is produced. However later in
life the immune system may start producing antibodies
against self antigens and results in autoimmune
diseases. Examples are:
1. Rheumatoid arthiritis: In this the body produces
antibodies against the synovial membrane of the
joints.
2. Haemolytic anemia: Antibodies are produced
against ones own RBCs.
 154 Human Anatomy For Dental Students
3. Graves disease: In this condition there is hyper-
thyroidism due to antibodies in the body that
stimulate receptors of thyroid gland cells.
Hypersensitivity Reaction
It is an abnormally exaggerated immune response to
an antigen that causes harm to the body of host. There
are four types of hypersensitivity reactions namely:
1. Type 1: This occurs due to exaggerated IgE media-
ted immune response which results in release of
histamine from the mast cells and basophils. It can
be mild which presents in the form of itching, hives
or urticaria. It can be severe leading to anaphylactic
shock associated with bronchoconstriction and
systemic vasodilatation with severe hypotension
and occasional death.
2. Type 2: This type of hypersensitivity reaction is a
result of antibody mediated toxicity.
3. Type 3: This type of reaction occurs due to excess
production of antigen-antibody complexes in
circulation.
4. Type 4: It occurs due to excess stimulation of
S E C T I O N-1
memory T-lymphocytes. Example of this is graft
rejection.
Immuno Deficiency Diseases
These diseases are associated with decreased or absent
activity of various immunological mechanisms of the
body. Thus, they result in an increased risk of infection
and occasionaly tumor formation. They can be:
1. Congenital, which means present by birth. This is
due to genetic abnormality.
2. Acquired, which is acquired during life it can be
due to
a. Infections, e.g., HIV infection leading to AIDS
b. Malignancies of WBCs, e.g., leukemias.
AIDS
AIDS means acquired immunodeficiency syndrome.
It is caused by the virus named HIV (human immuno
deficiency virus). The virus can enter the body in the
following ways:
1. Sexual contact with infected person.
2. Transmission across placenta from infected mother
to the baby.
3. Innoculation of virus by using contaminated
needles, blood, etc.
HIV has a high affinity for the CD4 receptors of
T-lymphocytes resulting in their destruction. This leads
to deficiency in CD4 helper T-lymphocytes. There is
an increase in opportunistic infections in the body like
tuberculosis, systemic viral and fungal infections. It is
also associated with increase in formation of malignant
tumors like lymphomas.
 Chapter

11
Respiratory System
INTRODUCTION Upper respiratory tract (Fig. 11.2)
a. Nose and paranasal sinuses
Respiratory system deals with absorption of O2 from air
b. Pharynx
and removal of CO2 from the body via lungs. It can be
c. Larynx
studied in two parts (Fig. 11.1):
d. Trachea with two principal bronchi
1. Respiratory tract or air passage: It consists of the
following parts:

C H A P T E R-11

Fig. 11.1: Respiratory system

 156 Human Anatomy For Dental Students

Fig. 11.2: Photograph showing various parts of external nose

S E C T I O N-1

Lower respiratory tract (Fig. 11.3) BRONCHIAL TREE

e. Bronchopulmonary tree on each side
Trachea ends by dividing into two principal bronchi or
f. Two lungs enclosed in pleura
primary pulmonary bronchi, right and left bronchi.
2. Musculo-skeletal framework: It encloses the lung
Each principal bronchus divides at the hilum of the
and pleura and is made up of thoracic cage with
corresponding lung giving rise to lobar bronchi also
intercostal muscles and the diaphragm.
known as secondary pulmonary bronchi. Right bronchus
Upper respiratory tract, i.e., nose, paranasal sinuses,
gives rise to superior, middle and inferior lobar bronchi
pharynx, larynx and trachea are described in head and
while left bronchus gives rise to superior and inferior
neck chapter no. ........
lobar bronchi.

Fig. 11.3: Segmental bronchi or tertiary bronchi

 Respiratory System 157

Differences between right and left bronchus (Fig. 11.3) Each principal bronchus gives rise to 23 generations
Right Bronchus Left Bronchus of bronchi and bronchioles. The 16th generation
1. It is wider and shorter 1. It is narrower and longer bronchioles are known as terminal bronchioles which
2. Extra pulmonary part 2. Extra pulmonary partit is gives rise to respiratory bronchioles (17th to 22nd
it is 2.5 cm in length 5 cm in length generation). The respiratory bronchioles gives rise to
3. It is more vertical and 3. It is more oblique and alveolar ducts and alveoli (alveolar sacs).
makes an angle of 25 makes an angle of 45
with median plane with median plane
4. It enters hilum at level 4. It enters hilum at level of LUNG
of T5 vertebra T6 vertebra Lung is the organ of respiration. A pair of lungs are
5. Intrapulmonary part: 5. Intrapulmonary part: It present in the thoracic cavity separated by mediastinum
It divides into three, divides into two, and heart (Figs 11.4 and 11.5). Each lung is enveloped
superior, middle and superior and inferior
by a double layer of serous membrane known as pleura.
inferior lobar bronchi lobar branches
Lungs are rosy pink in new born and dark gray in
Each lobar bronchus gives rise to segmental or adults due to deposits of carbon particles. They are elastic
tertiary pulmonary bronchi. The tertiary bronchi divide and spongy. Each lung is conical in shape with one side
further into successive generations of smaller bronchi flattened.
and bronchioles within the parenchyma of lung.

C H A P T E R-11
Fig. 11.4: Medial (mediastinal) surface of right lung showing visceral impressions and hilum of lung

Fig. 11.5: Medial (mediastinal) surface of left lung showing visceral impressions and hilum of lung
 158 Human Anatomy For Dental Students

Anatomical Features of Lung 2. Pulmonary artery

Lung presents with apex, base with three borders and 3. Bronchus with its vessels
two surfaces. Impressions and relations of mediastinal surface
1. Apex: It is the rounded upper end of lung which (Figs 11.4 and 11.5): These occur due to various
extends above the anterior end of 1st rib to about mediastinal structures which lie in relation to this surface
2.5 cm above the clavicle. of the lung. The pleura separates these structures from
2. Base: It is semilunar in shape and is concave the lung. They are tabulated below:
downwards as it rests on the dome of diaphragm.
On right side, the right lobe of liver lies below the Right lung Left lung
diaphragm and on the left side are present the left Anterior surface of Left atrium and
lobe of liver, fundus of stomach and spleen. right auricle left auricle
3. Three borders Right atrium Anterior surface of
a. Anterior border: It is thin. Below the 4th costal Part of right ventricle right ventricle
Phrenic nerve Phrenic nerve
cartilage on left side it presents with a cardiac
Superior vena cava Pulmonary trunk
notch to accommodate the heart. Origin of right Arch of aorta
b. Posterior border: It is thick and rounded. It brachiocephalic vein Subclavian artery
extends from above downwards along the Azygos vein-arches Esophagus
anterior surfaces of the heads of 1st to 10th ribs. over the hilum Descending thoracic
c. Inferior border: It is the border external to the Origin of right aorta
base which separates it from upper surface of subclavian artery Esophagus,
lung. Trachea inferiorly
4. Two surfaces Esophagus
a. Costal surface: It is the outer smooth and convex
surface of the lung covered by the costal pleura.
S E C T I O N-1

It is related to inner surfaces of the ribs and the
costal cartilages with intervening intercostal
spaces. The ribs form their impressions on the
lung.
b. Medial surface: It is divided into two parts
i. Anterior or mediastinal surface: It is concave
medially.
ii. Posterior or vertebral surface: This lies
behind the esophagus and is flat. It is related
to the sides of vertebral bodies upto T10,
intervertebral discs, origin of posterior
intercostal vessels and splanchnic nerves.
Mediastinal surface of lung: The characteristic feature
of mediastinal surface of lung is the hilum present in
the posterior half. Hilum is a roughly triangular area
that gives passage to the bronchi, pulmonary and
bronchial vessels, nerves and lymphatics.
The mediastinal pleura at the hilum forms a tubular
sheath which connects the hilum to the mediastinum.
This is called the root of lung.
Contents of Root of Lung
1. Bronchus
2. Pulmonary artery: Single
3. Pulmonary vein: Two are present
4. Bronchial arteries
5. Bronchial veins
6. Pulmonary plexus of nerves
7. Bronchopulmonary lymph nodes
8. Areolar tissue
Arrangement of structures with in the root or hilum of
lung (Figs 11.4 and 11.5). From before backwards
1. Superior pulmonary vein
Lobes of Lung
The right lung is divided into three lobes by an oblique
and a horizontal fissure. The left lung is however divided
into two lobes by a single oblique fissure.
Right Lung Left Lung
1. Upper lobe 1. Upper lobe
2. Middle lobe 2. Lower lobe
3. Lower lobe
Lingula of left lung: It is a tongue shaped projection of
lung below the cardiac notch.
Arterial Supply of Lung
Lung is supplied by bronchial and pulmonary arteries.
1. Bronchial arteries: These arteries supply lung upto
respiratory bronchioles and then anastomose with
pulmonary arteries.
2. Pulmonary arteries: These carry deoxygenated
blood from the right side of heart to the alveoli for
exchange of gases, i.e., oxygenation. Pulmonary
trunk is the continuation of infundibulum of right
ventricle and divides into right and left pulmonary
arteries which enter the respective lungs at the
hilum. The branches of pulmonary arteries supply
alveoli and anastomose with bronchial arteries.
Venous Drainage of Lung
Lung is drained by bronchial and pulmonary veins
1. Bronchial veins
2. Pulmonary veins: These are formed by confluence
of pulmonary capillaries. Two pulmonary veins
arise from each lung and drain into the left atrium
of the heart.
 Respiratory System 159

Broncho-pulmonary Segments an independent branch from pulmonary artery. The

venous drainage is however intersegmental (Figs 11.6
Broncho-pulmonary segment is the independent
and 11.7). Each lung has ten broncho-pulmonary
functional unit of lung made up of a tertiary bronchus
segments.
with its bronchial tree up to the alveoli accompanied by

Fig. 11.6: Broncho-pulmonary segments

C H A P T E R-11

Fig. 11.7: Diagrammatic picture of bronchopulmonary segment

 160 Human Anatomy For Dental Students

Right lung segments Left lung segments

1. Upper lobe 1. Upper lobe
Apical Apical
Posterior Posterior
Anterior Anterior
Upper lingual
Lower lingual
2. Middle lobe 2. Lower lobe
Medial Apical
Lateral Medial basal
3. Lower lobe Anterior basal
Apical Lateral basal
Medial basal Posterior basal
Anterior basal
Lateral basal
Posterior basal
Fig. 11.8: Pleural sac
Functions of Lung and Tracheo-bronchial Tree
2. Parietal pleura: The visceral pleura reflects over
Lung is the organ of exchange of gases, i.e., oxygen
itself at the hilum to form an external layer covering
and carbondioxide which provides for oxygenation
the lung known as parietal pleura. For the purpose
of blood.
Surfactant secreted by pneumocyte-II of alveoli of description parietal pleura is divided into
prevents the collapse of alveoli. This maintains different parts according to the place where it is
present.
S E C T I O N-1

patency of alveoli and allows for exchange of gases

to occur during inspiration and expiration.
Defence Mechanisms of Respiratory System
Mucus secreted by goblet cells of upper respiratory
tract helps to entrap foreign particles. The cilia of
epithelium beat upwards and push the mucus
towards the nose and exterior.
Mucus also contains IgA antibodies that provide
local immunity.
Alveolar macrophages engulf foreign particles and
destroy them by phagocytosis.
Preventing reflexes like cough reflex, sneezing
reflex and bronchoconstriction reflex help to clear
the passage from inhaled foreign particles. The
afferents of the reflex arise from irritant receptors
present in the tracheo bronchial tree and travel in
the vagus nerve.
a. Cervical pleura (Figs 11.9 and 11.10): This
covers the apex of the lung.
b. Costal pleura (Figs 11.9 and 11.10): It covers the
major surfaces of lung.
c. Mediastinal pleura (Figs 11.9 and 11.10): It
covers the medial side of lung and forms the
lateral boundary of the mediastinum on either
side. At the hilum, mediastinal pleura encloses
various structures at the root of lung in a tubular
fashion. It is reflected onto the lung as the
visceral pleura at hilum of lung.

PLEURA (Figs 11.8 to 11.10)

It is a closed serous sac which is invaginated from the
medial side by two lungs. This invagination leads to
formation of two layers of pleura over the lung namely,
visceral pleura and parietal pleura with a potential space
between these two layers. This space is known as pleural
cavity.
1. Visceral pleura (Fig. 11.8): It is also known as the
pulmonary pleura. It is attached with the connective
tissue of lung and can not be separated from it. It
invests the entire lung except at two areas, the hilum
and area of attachment of pulmonary ligament. Fig. 11.9: Extent of parietal pleura and lungs with respect to
ribs and costal cartilagesanterior aspect

Fig. 11.10: Extent of parietal pleura and lungsposterior
aspect
Structures enclosed by the pleura at the hilum,
from before backwards are pulmonary vein,
pulmonary artery and bronchus with its vessels
d. Diaphragmatic pleura: It covers the base of
lung, over the diaphragm.
Recesses of the Pleura (Fig. 11.9)
These act as reserve spaces for expansions of lungs.
1. Costodiaphragmatic recess: It is the potential space
between the lower limit of pleural sac and the lower
border of lung. The lower limit of lungs is however
6th rib in midclavicular line, 8th rib in midaxillary
Fig. 11.11: Thoracic cage with intercostal muscles
Respiratory System 161
line and 10th rib posteriorly. However, along the
costo diaphragmatic reflection the pleura extends
upto 8th rib in midclavicular line, 10th rib in
midaxillary line and 12the rib posteriorly.
Therefore this provides a potential space for the
expansion of lung during forceful respiration. It is
the widest at the midaxillary line.
2. Costomediastinal recess: This recess is present
along the anterior costomediastinal reflection of
pleura. It is maximal in region of cardiac notch.
Pleural Cavity
It is the potential space between the two pleurae which
contains a thin layer of lubricating serous fluid. The intra-
pleural pressure is 2 mm Hg during expiration and
6 mm Hg during inspiration. This prevents collapse
of lung parenchyma and also aids in the venous return
of body.
THORACIC CAGE (Fig. 11.11)
Thoracic cage forms the musculoskeletal framework of
C H A P T E R-11
thorax. It is made up of an osseo-cartilaginous
framework formed by vertebrae, ribs, costal cartilages
and sternum. The osseo-cartilaginous cage with its
muscular attachments encloses a cavity known as
thoracic cavity.
The thoracic cavity is occupied by a pair of pleural
sacs, one right and one left, separated by a soft tissue
space between them known as mediastinum. Each
pleural sac encloses the corresponding lung.
 162 Human Anatomy For Dental Students
Boundaries of Thoracic Cage
Anterior boundary is formed by sternum, anterior part
of ribs and their costal cartilages.
Posterior boundary is formed by bodies of twelve
thoracic vertebrae and their intervening discs and
posterior part of ribs.
On each side, it is formed by twelve ribs, their cartilages
and the intercostal spaces.
Superiorly: Inlet of thorax is reniform in shape and is
formed by upper borders of manubrium, first rib and
first thoracic vertebra. It continues above with the neck.
Inferiorly: Thoracic outlet is wider than the inlet and is
bounded by costal margin, lower border of 11th and 12th
ribs and lower border of 12th thoracic vertebra. It is
separated from the abdomen by a muscular sheet,
diaphragm.
Functions of Thoracic Cage
1. This osseocartilaginous cage with its muscular
attachments is responsible for the movements of
respiration.
2. It protects the vital organs namely, lungs and heart.
S E C T I O N-1
Intercostal Spaces
The space between two adjacent ribs is known as
intercostal space. There are 11 intercostal spaces on each
side of the thorax. The 3rd, 4th, 5th and 6th intercostal
spaces are typical in nature because their contents are
limited within the thorax (Fig. 11.12).
Contents of intercostal spaces
1. Intercostal muscles
2. Intercostal arteries: There are two anterior and one
posterior intercostal arteries in each space.
Fig. 11.12: Typical intercostal space and its contents
3. Intercostal veins: The veins run along with the
corresponding arteries.
4. Intercostal nerves: One intercostal nerve is present
in each space and is the continuation of the ventral
ramus of the corresponding thoracic spinal nerve.
Intercostal Muscles
Each is supplied by the corresponding intercostal nerve.
1. External intercostal muscle: Helps in inspiration
by elevating the ribs.
2. Internal intercostal muscle: Helps in expiration by
depressing the ribs.
3. Inner intercostal: Helps in expiration by depressing
the ribs.
Intercostal arteries (Fig. 11.13): There are two anterior
and one posterior intercostal arteries in each space. They
anastomose with each other at the junction of anterior
1/3rd and posterior 2/3rd.
Fig. 11.13: Anterior and posterior intercostal arteries
Intercostal veins: Anterior and posterior intercostal
veins are present alongwith the corresponding arteries.
Intercostal nerves (Fig. 11.14): One intercostal nerve is
present in each space on each side. They arise as the
ventral ramus of the corresponding thoracic nerve. Each
nerve arises from the corresponding intervertebral
foramina. It runs along with the vascular bundle in
between the costal pleura and posterior intercostal
membrane and then it lies in the costal groove. The
neurovascular bundle consists of the vein superiorly and
nerve inferiorly with the artery in between.
 Respiratory System 163

cavities. It also is an important muscle of respiration.

Origin: Diaphragm originates from sternum, ribs and
vertebral column
1. Sternal origin: By two fleshy slips from the back of
xiphoid process.
2. Costal origin: From inner surfaces of lower 6 ribs
and costal cartilages.
3. Vertebral origin: It arises in the form of a pair of
crura. Right crus extends from anterior surface of
bodies of L 1, L 2 and L 3 vertebrae and their
corresponding intervertebral discs. Left crus is
attached to bodies of L1 and L2 vertebrae and the
intervertebral disc. Both are united to each other in
centre across aorta with the help of median arcuate
ligament. Right crus is longer than the left.
Insertion: The fibres of diaphragm converge to form a
central tendon.
Fig. 11.14: Typical intercostal nerve
It is shaped like a trefoil leaf and presents with
median, right and left leaflets. The central tendon is fused
to the pericardium above and is placed anteriorly, close

C H A P T E R-11
They give rise to cutaneous branches, muscular to sternum.
branches to corresponding intercostal muscles and
sympathetic branches. Nerve Supply of Diaphragm
1. Motor supply is from phrenic nerve (C3, C4, C5).
DIAPHRAGM (Fig. 11.15) 2. Sensory supply is from phrenic nerve and lower 6
Diaphragm is a dome shaped musculoaponeurotic intercostal nerves.
structure which separates the thoracic and abdominal 3. Sympathetic supply is via inferior phrenic plexus.

Fig. 11.15: Thoraco-abdominal diaphragm

 164 Human Anatomy For Dental Students

Openings in Diaphragm Nitrogen (N2) : 78%

Opening
1. Vena caval opening
It lies at the level of T8
vertebra
2. Esophageal opening
It lies at the level of T10
vertebra
3. Aortic opening
It lies at the level of T12
vertebra
4. Space of Larrey
Opening
5. Behind lateral arcuate
ligament
S E C T I O N-1
Structures passing through
1. Inferior vana cava
2. Right phrenic nerve
3. Lymph vessels of liver
1. Esophagus
2. Anterior and posterior
vagal trunks
3. Esophageal branch of left
gastric artery
4. Tributries of left gastric vein
5. Lymphatic from liver
6. Phrenico-esophageal
ligament
1. Abdominal aorta
2. Thoracic duct
3. Azygos vein
Superior epigastric vessels
Structures passing through
Subcostal nerve and vessels
Other inert gases : about 1%
On breathing out (expiration) the air has 16% O2 and
4% CO2.
Respiratory Movements
These consist of two phases
1. Inspiration: Accompanied by expansion of lungs
for uptake of air.
2. Expiration: Is the expulsion of air from lungs due
to retraction of lungs.
These movements are accompanied by correspond-
ing movements of the thoracic cage.
Inspiration: It is an active process. There is expansion
of intrathoracic volume resulting in expansion of lungs.
This creates a negative air pressure in the airway
allowing the air to flow in. In normal conditions
inspiration lasts for two seconds.
Muscles of Inspiration
1. Primary muscles
a. Intercostal muscles: Contraction of external

intercostal muscles; elevates the lower ribs and

6. Behind medial arcuate 1. Sympathetic trunk
expands the thoracic cage.
ligament 2. Lesser splanchnic nerve
b. Diaphragm: Descent of diaphragm accounts for
7. Piercing each crus 1. Right crusazygos vein 75% change in intrathoracic pressure by
2. Left crusinferior
increasing vertical diameter of thoracic cage.
hemiazygos vein
2. Accessory muscles (act during forced inspiration):
3. Greater and lesser
splanchnic nerves Erector spinae, scalene group of muscles,
sternocleidomastoid, pectoralis major, serratus
8. Left cupola of diaphragm Left phrenic nerve
anterior, quadratus lumborum. They help to elevate
thoracic cage in deep inspiration.
ANATOMICAL BASIS OF RESPIRATION
Expiration: It is a passive process in normal breathing.
Respiration is the process of exchange of gases in the It occurs due to recoil of lungs at the end of inspiration.
lung where there is uptake of oxygen in exchange for This pushes out air from lungs.
carbondioxide. This is called external respiration. The In forced expiration the following muscles are
exchange of oxygen and carbondioxide at tissue level is involved:
called internal respiration. 1. Anterior abdominal wall muscles namely; rectus
The first sixteen generations of dividing bronchi and abdominis, internal oblique, transversus abdomi-
bronchioles conduct air till terminal bronchioles. They nis. Contraction of these muscles increases the intra-
form the conducting zone. The remaining seven abdominal pressure and pushes up the diaphragm.
generations consisting of respiratory bronchioles and 2. Internal intercostal muscles: Contraction of these
alveoli form the respiratory zone, where exchange of O2 muscles pull upper ribs downwards. This decreases
and CO2 occurs. the intra-thoracic volume.
At rest, human being breaths about 12-15 times per 3. Accessory muscles: Adductor muscles of vocal cord.
minute. 500 ml of air is taken in each breath which equals Their contraction is primarily protective, to prevent
to 6-8 litres of air in 1 minute. entry of food or fluid into trachea.

Composition of Air Mechanism of Respiration

The inspired air is composed of:
The expansion of thoracic cage creates a negative intra-
Oxygen (O2) : 21%
thoracic pressure and allows the lung to expand during
Carbondioxide (CO2) : 0.03%
inspiration. Expiration is the reversal of inspiration.

Fig. 11.16: Pump handle and piston movement in inspiration
Fig. 11.18: Bucket handle movement in inspiration
The various movements of respiration occur at
costovertebral and the manubriosternal joints and are
described below:
1. Pump handle movementin inspiration
(Fig. 11.16): It increases the anteroposterior
diameter of the thoracic cavity. It occurs in the 2nd
to 6th ribs. 1st rib is involved only during forced
inspiration.
2. Bucket handle movementin inspiration
(Fig. 11.18): This increases the transverse diameter
of the thoracic cavity. It occurs in the 7th to 10th
ribs (vertebrochondral ribs).
3. Piston movementin inspiration (Fig. 11.16): This
increases the vertical length of the thoracic cavity.
It occurs due to the downward movement of the
diaphragm. Maximal movement is seen in the
recumbent position.
During expiration all three movements are reversed
(Figs 11.17 and 11.19).
Respiratory System 165
Fig. 11.17: Pump handle and piston movement in expiration
C H A P T E R-11
Fig. 11.19: Bucket handle movement in expiration
CLINICAL AND APPLIED ANATOMY
TRACHEO-BRONCHIAL TREE
X-ray of neck in lateral view shows a vertical
translucent shadow in front of the cervico-thoracic
vertebral column. This is the trachea filled with
air. Compression of trachea due to an enlarged
thyroid gland is visible on X-ray.
Trachea can be felt in the suprasternal notch in the
median plane. Any shift of trachea to right or left
usually indicates a mediastinal shift which may
be secondary to a lung pathology.
The right principal bronchus is wider, shorter and
more in line with the trachea. Hence a foreign body
is more likely to be aspirated into the right lung.
Apical segment of lower lobe of right lung is the
commonest site of aspiration lung abscess and
aspiration pneumonia (Mendelsons syndrome).
Posterior segment of upper lobe is the second
commonest.
 166 Human Anatomy For Dental Students
LUNG AND PLEURA
Accumulation of air in pleural cavity is known as
pneumothorax.
Naked pleura: At places pleura is not covered by
the skeletal framework of thoracix cage. This is
termed as naked pleura. Thus, it can easily be
injured resulting in pneumothorax. Example:
Cervical pleura can be damaged while administe-
ring brachial plexus block.
Accumulation of fluid in the pleural cavity is
known as pleural effusion
Hydrothorax: It is the accumulation of trans-
udative or exudative fluid.
Pyothorax: Accumulation of pus in pleural
cavity is called pyothorax.
Haemothorax: It is the accumulation of blood
in pleural cavity
Chylothorax: It is due to the rupture of thoracic
duct and accumulation of chyle (lymph) in the
pleural cavity.
Inflammation of pleura is known as pleurisy or
pleuritis. It may or may not be associated with
S E C T I O N-1
effusion.
Costodiaphragmatic recess is the most dependant
part of the pleural sac. When any fluid appears in
the sac, it first collects in the costo-diaphragmatic
recess. This can be seen as obliteration of the
costodiaphragmatic angle which is present on the
infero-lateral sides of the lung shadow on X-ray
chest.
Paracentesis is the removal of fluid or air from the
pleural cavity. In pneumothorax tapping is done
by inserting a chest tube in the 2nd intercostal
space just posterior to mid axillary line. In pleural
effusion tapping is done by inserting a needle in
the 6th intercostal space just posterior to mid
axillary line.
Hyaline membrane disease: Presence of surfactant
in lungs at birth is important to keep the lungs in
expansion after the baby takes its 1st few breaths.
In premature babies where surfactant has not yet
fully formed, the lung remains collapsed at certain
areas leading to infant respiratory distress
syndrome. It is associated with leakage of proteins
into alveoli forming a membrane. It is known as
hyaline membrane disease which can be fatal.
Prevention: Administration of glucocorticoid
injection to mother 24 hours prior to delivery may
help some cases.
Treatment: Is usually difficult but recently use of
bovine surfactant and synthetic preparations have
been used with some beneficial results in reducing
severity of disease.
THORACIC WALL AND DIAPHRAGM
Herpes Zoster infection is a viral infection caused
by Herpes virus similar to chicken pox virus. The
virus lies dormant. The most common site is the
dorsal root ganglion of the inter-costal nerve. The
other site is trigeminal nerve ganglion. Activation
of virus leads to appearance of an erythmatous
(red) vescicular rash which appears along the
distribution of the nerve. This is associated with
intense burning and pain in the dermatome
supplied by the nerve. It is characteristically uni-
lateral and doesnot cross the midline. Treatment
with anti-virul drugs like acyclovir or famcyclovir
decrease the intensity and duration of infection and
reduce the risk of recurrence. Intercostal neuralgia
is the most common complication of this infection.
Diaphragm may fail to arise from the lateral
arcuate ligament on one or both sides. This leads
to congenital diaphragmatic hernia through this
opening which is known as Bockdaleks hernia.
The abdominal contents can herniate into the
thoracic cavity leading to poor development of the
lungs.
Esophageal opening constricts during inspiration,
venacaval opening dilates and there is no effect
on aortic opening.
In the lying down posture the height of diaphragm
is maximum on the side of resting. Thus, the
excursion of diaphragm during respiration would
also be maximal on that side. Hence, a patient with
one side lung disease is asked to rest on the
opposite side so that maximal rest is given to the
diseased side.
Tachypnea: It is increase in respiratory rate.
Bradyapnea: It is decrease in respiratory rate.
Dyspnea: It is defined as difficulty in breathing
when there is conscious effort involved in
breathing which causes discomfort. It occurs due
to the following condition:
Physiological dyspnea is seen after a bout of
moderate to severe exercise because the pul-
monary ventilation is increased to 4 to 5 times.
Pathological dyspnea occurs in various lung
pathologies which decrease its vital capacity:
i. Lung diseases like asthma, emphysema,
pneumonia, pulmonary edema
ii. Pneumothorax
iii. Cardiac diseases, e.g., congestive heart
failure which causes pulmonary edema.
Apnea: It is the complete cessation or stoppage of
respiration.
 Chapter

12
Digestive System
INTRODUCTION Ingestion, digestion and absorption of various compo-
Digestive system or gastrointestinal system is respo- nents of food provide for the daily nutritive requirements
nsible for intake, digestion and absorption of food. of the body (Fig. 12.1).

C H A P T E R-12

Fig. 12.1: Parts of digestive system

 168 Human Anatomy For Dental Students
Ingestion: The food is placed in mouth; it mixes with
secretions of salivary glands. Mastication (chewing)
involves breaking down of large food particles into
smaller pieces by movement of jaws, brought about by
muscles of mastication and by action of teeth. A bolus
of food is thus formed and then swallowed (Deglutition).
Digestion: It is an orderly process that involves breaking
down of various constituents of food like starch, protein
and fat to absorbable units by the various digestive
enzymes of gastro intestinal tract (GIT) aided by saliva in
mouth, hydrochloric acid of stomach and bile from liver.
Absorption: It is the process of passage of various
nutritive components of food like protein, carbohydrates
and fats besides water, minerals and vitamins from
intestinal lumen across mucosal cells into the blood or
lymphatic circulation. These components are made
available to various parts of the body for proper
functioning of tissues. Absorption primarily occurs in
small intestine. Some amount of water and electrolyte
absorption takes place in large intestine.
Elimination: The undigested food particles are removed
from the distal end of GIT or anus by the process of
defecation.
S E C T I O N-1
Parts of Digestive System
Gastrointestinal tract is a tubular tract for the passage
of food. It consists of the following parts:
1. Oral cavity
2. Pharynx
3. Oesophagus
4. Stomach
5. Small intestine
6. Large intestine
7. Rectum and anal canal
It is associated with various organs that help in
digestion and absorption of food. These are
1. Three pairs of salivary glands
2. Liver and biliary tract
3. Pancreas
Fig. 12.2: Parts of stomach
Oral cavity (chapter 27) and associated salivary glands
(chapter 24), pharynx (chapter 29) and esophagus
(chapter 32) are described in respective chapters of head
and neck.
STOMACH
It is also called as ventriculus. It is a muscular bag which
acts as a reservoir for food (Fig. 12.2). It extends from
lower end of esophagus to beginning of small intestine
that is duodenum.
It lies in epigastrium, umbilical region and left
hypochondrium. Shape of stomach is variable and its
capacity is 30 ml at birth, 1000 ml at puberty, 1500 ml in
adults.
Anatomical Features
Stomach can be studied in three parts (Fig. 12.2):
1. Fundus of stomach: It is the part of stomach that
lies above the level of cardiac orifice. It is filled with
air when stomach is empty. On X-ray abdomen, in
erect posture, the air is seen as a black shadow in
the form of a bubble just below left costal margin.
2. Body: It extends from fundus to pylorus.
3. Pyloric part: It is a relatively narrow part which
extends from lower end of body of stomach to
pyloric orifice. It is about 10 cms long. It consists of
pyloric antrum, 7.5 cms, which further leads to the
pyloric canal, 2.5 cms. They are separated from each
other by sulcus intermedius. Pyloric canal ends in
pyloric orifice. At the orifice a thick band of circular
muscle fibres is present forming a sphincter. It is
known as the pyloric sphincter. This regulates entry
of food from stomach to duodenum.
Stomach presents with the following external features:
1. 2 openings
a. Cardiac orifice: It is present at the junction of
esophagus and stomach.
b. Pyloric orifice: Stomach opens into duodenum
via pyloric orifice.

2. 2 curvatures
a. Lesser curvature: It is the posterosuperior or
medial border which extends from medial
aspect of cardiac orifice to pyloric orifice.
b. Greater curvature: It lies anteroinferiorly and is
4 to 5 times longer than lesser curvature. It
extends from cardiac notch to pyloric orifice.
3. 2 surfaces: Anterosuperior and posteroinferior
surfaces.
Stomach bed: The postero inferior surface of stomach is
covered with peritoneum and lies on the following
structures which form the stomach bed (Fig. 12.3).
1. Left crus of diaphragm
2. Left suprarenal gland
3. Anterior surface of left kidney
4. Splenic artery
5. Anterior pancreatic surface
6. Left colic flexure
7. Transverse mesocolon
8. Anterior surface of spleen
Peritoneal Relations of Stomach
Stomach is an intraperitoneal organ and is covered on
both surfaces with peritoneum.
1. Lesser omentum
2. Greater omentum
3. Gastrosplenic ligament
4. Gastrophrenic ligament
Arterial supply of stomach: Stomach is supplied by left
gastric artery, right gastric artery, short gastric arteries,
right gastroepiploic artery, left gastroepiploic artery,
posterior gastric arteries
Venous drianage of stomach: The veins run along the
corresponding arteries. Right gastroepiploic vein, Right
and left gastric veins, Short gastric vein, left
gastroepiploic vein and posterior gastric vein.
Fig. 12.3: Structures forming stomach bed
Digestive System 169
Lymphatic drainage of stomach: Hepatic group of
lymph nodes, pyloric group of lymph nodes, right
gastroepiploic group of lymph nodes, left gastric group
of lymph nodes, paracardiac group of lymph nodes,
pancreaticosplenic group of lymph nodes.
Efferents drain into coeliac group of pre aortic lymph
nodes
Nerve supply of stomach: Sympathetic supply:
Preganglionic fibres are derived from T6 to T9 segments
of spinal cord.
Parasympathetic supply: Gastric branches known as
nerve of Latarjet arise from the anterior and posterior
vagal trunks.
Functions of Stomach
1. Stores food, acts as reservoir for food and converts
food to uniform consistency of chyme.
2. Functions of hydrochloric acid:
a. Activates pepsinogen to pepsin.
b. Kills any ingested bacteria.
c. Stimulates flow of bile and pancreatic juices.
d. Helps to convert Fe3+ to Fe2+.
3. Pepsins digest proteins.
C H A P T E R-12
4. Mucus protects the gastric mucosa from acid.
5. Intrinsic factor produced by parietal cells binds to
vit B12 and facilitates its absorption in the ileum.
SMALL INTESTINE
It is the primary site of digestion and absorption of food.
It extends from the pylorus of stomach to the ileo-caecal
junction and is 6 metres long (Fig. 12.4). It is divided
into three parts:
1. Duodenum: It is 25 cm long and is retroperitoneal.
2. Jejunum: It is the second part of the small intestine.
It is mobile and intraperitonal.
3. Ileum: It is the last part of the small intestine. It is
also intraperitoneal.
Fig. 12.4: Small and large intestine
 170 Human Anatomy For Dental Students

Fig. 12.5: Parts of duodenum

Duodenum (Fig. 12.5) Fig. 12.6: Interior of second part of duodenum

It means equal to twelve fingers. It is devoid of
mesentery. It forms a C-shaped curve.
Duodenum has four parts:
1. First part of duodenum: It is 2 inches or 5 cm long.
It is 2.5 cm on surface projection. It is directed
upwards, backwards and towards the right. It lies
at the level of L1 vertebra.
2. Second part of duodenum(Fig. 12.6): It is 3 inches
or 8 cm long. It lies at the level of L1 to L3 vertebrae
in the right paravertebral gutter. Interior of second
part presents with following features
S E C T I O N-1
Suspensory ligament of treitz: It is a fibro muscular
band which extends from the right crus of diaphragm
to duodenojejunal flexure.
Arterial supply of duodenum: Duodenum is supplied
by supraduodenal artery, gastroduodenal artery, right
gastroepiploic artery, superior and inferior
pancreaticoduodenal arteries.
Lymphatic drainage of duodenum: Lymphatics of
duodenum drain into pancreaticoduodenal group of
lymph nodes.
Nerve supply of duodenum:

a. Plica circularis 1. Sympathetic supply: Preganglionic fibres are

b. Major duodenal papilla: Common opening of derived from T6 to T9 segments of spinal cord.
pancreatic duct and common bile duct is present 2. Parasympathetic supply: It is through vagus.
at the summit of the papilla
Jejunum and Ileum
c. Minor duodenal papilla: Accessory pancreatic
duct opens at the summit of the papilla Jejunum forms the upper 2/5th and ileum forms the
d. Plica semicircularis lower 3/5th of mobile part of small intestine (Fig. 12.4).
e. Plica longitudinalis Functions of Small Intestine
3. Third part of duodenum: It is 4 inches or 10 cm Complete digestion of food particles takes place in small
long. It lies at the level of L3. intestine and it is the primary site of absorption of
4. Fourth part of duodenum: It is 1 inch or 2.5 cm various nutrients of food.
long. It lies 1.25 cm below the transpyloric plane Blood Supply of Jejunum and Ileum
and 1.5 cm to the left of median plane. It lies at the Jejunum and ileum are supplied by superior mesenteric
level of L3, L2 vertebrae. artery, branch of abdominal aorta. They are drained by
the corresponding veins.
Differences between Jejunum and Ileum
Character Jejunum Ileum
Gross features:
1. Wall Thicker Thinner
2. Lumen Wider (4 cm diameter) and often found empty. Narrower (3.5 cm diameter) and often found full.
3. Vascularity More vascular. Less vascular.
4. Circular folds Large and closely set. Small and sparsely set.
(plicae circulares)
5. Mesentery i.
Thinner near the gut. i. Thicker near the gut.
ii.
Jejunal arteries are wider. ii. Ileal arteries are narrower.
iii.
Arterial arcades are 1 or 2 in number. iii. Arterial arcades are 5 or 6 in number.
iv.
Vasa recti are longer and fewer. iv. Vasa recti are shorter and numerous.
v.
Presence of peritoneal windows between
v. No peritoneal windows due to presence of
the vasa recti due to paucity of fat near
Microscopic features: abundant fat between the vasa recti.
the gut.
6. Villi More in number, larger, thicker and leaf like. Less in number, shorter, thinner and finger like.
7. Aggregates of Small, circular and few in number. Large, oval and more in number.
lymphatic follicles
(Peyers patches)
 Digestive System 171

Lymphatic Drainage of Jejunum and Ileum Arterial supply of caecum: It is supplied by anterior and
The lymphatics pass via the mesentery to superior posterior caecal arteries, branches of inferior division of
mesenteric lymph nodes. ileocolic artery.
Venous drainage of caecum: Veins drain into ileocolic
LARGE INTESTINE vein hence in portal system.
Large intestine extends from ileocaecal junction to the Lymphatic drainage of caecum: Lymphatics drain into
anus (Fig. 12.7). It is responsible for reabsorption of water ileocolic group of lymph nodes.
and solutes from the undigested food particles and the Nerve supply of caecum
final expulsion of faeces. It is about 1.5 metres long and 1. Sympathetic supply: Preganglionic fibres are
is divided into derived from T10 to L1 segments of spinal cord.
1. Caecum 2. Appendix 2. Parasympathetic supply is from vagus nerve.
3. Ascending colon 4. Transverse colon Appendix (Fig. 12.9)
5. Descending colon 6. Sigmoid colon
It is also known as vermiform (worm like) appendix. It
7. Rectum 8. Anal canal is a tubular structure that extends from the postero-
medial wall of caecum.
Length: It is variable, between 2 to 20 cm.
Presenting parts: It has a base, body and tip. It is covered
with a peritoneal fold known as mesoappendix.
1. Base: It is attached to the postero-medial wall of
caecum about 2 cm below ileo-caecal junction.
2. Body: It is long, narrow with a lumen. Lumen opens

Fig. 12.7: Parts of large intestine
Caecum
Caecum means blind end. Caecum is the beginning of
large intestine. It lies in the right iliac fossa (Fig. 12.7).
Size: 6 cm in length and 7.5 cm in width.
It is covered by peritoneum from all sides.
Interior of caecum: Two orifices open into caecum
(Fig. 12.8). These are
1. Ileocaecal orifice: It is 2.5 cms in diameter. It opens
into the posteromedial wall of the caecum and is
guarded by a valve.
2. Appendicular orifice: It is a small circular opening
present 2 cm below and slightly behind the
ileocaecal orifice.
C H A P T E R-12
into the caecum
3. Tip: It is directed in various positions. It is least
vascular part of the appendix.
Positions of appendix: Base of the appendix is fixed but
the position of tip varies. Therefore, position of appendix
is defined in respect of position of tip (Fig. 12.9).
1. Retrocaecal: It is the commonest position of
appendix. It is found in 60% population. It lies at
12o clock position and is present behind the caecum.
2. Pelvic position: It is second commonest position
found in 30%. It lies at 4o clock position.
3. Splenic: Present in 1 to 2%. Tip of the appendix
passes upwards and medially anterior or posterior
to terminal part of ileum.
4. Subcaecal or paracolic: 2% appendix lies below the
caecum. It is 11o clock in position.
5. Mid inguinal: Very rare, it is at 6o clock position
6. Promontoric: Very rare again, it is at 3o clock
position.
Arterial supply of appendix: It is supplied by append-
icular artery a branch from inferior division of ileocolic
artery. Artery passes behind the terminal part of ileum.
Appendicular artery is an end artery.

Fig. 12.8: Interior of caecum Fig. 12.9: Various positions of appendix

 172 Human Anatomy For Dental Students
Venous drainage of appendix: Appendicular vein
drains into superior mesenteric vein.
Lymphatic drainage of appendix: Drains into the
superior mesenteric lymph nodes.
Nerve Supply of Appendix
1. Sympathetic supply: Preganglionic fibres are
derived from T10 spinal cord segment. Post gang-
lionic fibres are derived from superior mesenteric
plexus.
2. Parasympathetic supply is from both vagus nerves.
Ascending Colon
It is about 15 cms long and extends from the caecum to
the hepatic flexure which is related to inferior surface of
the right lobe of liver (Fig. 12.7).
Transverse Colon
It is 45 cms long and extends from hepatic flexure of
colon to splenic flexure of colon. In fact, it is not
transverse. It hangs down as a loop. It is suspended by
the transverse mesocolon. It has a wide range of mobility
(Fig. 12.7).
Descending Colon
S E C T I O N-1
It is about 25 cms long, It extends from splenic flexure
of colon to the beginning of sigmoid colon. It is narrower
than the ascending colon (Fig. 12.7).
Flexures of Colon
The junction of transverse colon with ascending and
descending colon is seen as right and left bends or
flexures. The ascending colon forms right colic flexure
(hepatic flexure) and descending colon forms the left
colic flexure (splenic flexure) respectively (Fig. 12.7).
Sigmoid Colon
It is about 35 cm long and extends from pelvic brim to
3rd piece of sacrum. It is suspended by sigmoid
mesocolon (Fig. 12.7).
Rectum (Fig. 12.10)
Rectum means straight. However, at the ano-rectal
junction it is bent by the pubo-rectalis muscle (a part of
levator ani muscle). It extends from the sigmoid colon
(S3 vertebra) to anal canal, which lies 2 to 3 cm below
the tip of coccyx. It is 12 cm long.
Anatomical Features
It can be divided anatomically into three parts:
1. Upper 1/3rd: It is directed downwards and back-
wards.
2. Middle 1/3rd: It is directed vertically downwards.
3. Lower 1/3rd: It is directed downwards and for-
wards.
It has two anterioposterior curvatures, sacral curve
and perineal curve. There are three lateral curvatures in
rectum.
Interior of rectum: The mucosal lining of rectum
presents with temporary longitudinal folds that
disappear on distention of rectum and few permanent
folds. These permanent folds form Houstans valves.
They are semilunar in shape and lie horizontally along
the concavity of lateral curves of rectum. Four such
valves are present.
Arterial supply of rectum: It is supplied by superior
rectal, middle rectal and inferior rectal arteries
Venous drainage of rectum: Venous plexus of rectum
is known as annulus haemorrhoidalis. It encircles lower
part of rectum and anal canal. It has got two sets of
venous plexus.
1. Internal venous plexus: It lies above the Hiltons
line between mucous membrane and sphincter ani
and drains into portal system.
2. External venous plexus: It lies between the perianal
skin and subcutaneous tissue. It drains via
pudendal veins into iliac veins (caval system).
Lymphatic drainage of rectum: The lymphatics are
arranged in two plexuses namely, intramural plexus and
external mural plexus. Upper part drains into left
common iliac lymph nodes and para rectal lymph nodes.
Middle and lower part drain into left internal iliac group
of lymph nodes.
Nerve Supply of Rectum
1. Sympathetic supply: Preganglionic fibres are
derived from L1 L2 spinal segments.
2. Parasympathetic supply: Preganglionic fibres are
derived from S2 S3 S4 spinal segments.
Anal Canal (Figs 12.10 and 12.11)
It is the terminal part of the gastro-intestinal tract. It
extends from anorectal juction to anal orifice which lies
4 cm below and in front of tip of coccyx (Fig. 16.34). It is
separated anteriorly from lower vagina (in female) or
bulb of penis (in male) by the perineal body. It is
surrounded on each side and posteriorly by the fatty
tissue of ischiorectal fossa. A dense connective tissue
layer known as anococcygeal ligament attaches the
posterior surface of anus to the tip of coccyx. It is 3.8 cm.
Interior of anal canal: It is divided into three parts with
help of pectinate and Hiltons lines. Pectinate line is the
Fig. 12.10: Rectum and anal canal in male
 Digestive System 173

Fig. 12.11: Interior of anal canal

muco-cutaneous junction. Hiltons line line indicates the
lower end of internal sphincter muscle.
Functions of Large Intestine
1. Storage of matter
2. Absorption of fluids and solutes
3. Lubrication of undigested matter to facilitate its
passage
4. Protection against bacterial invasion due to
presence of numerous lymphatic follicles
5. Synthesis of vitamin B from colonic flora

C H A P T E R-12
Differences between large and small intestine
Character Large intestine Small intestine
1. Length 1.5 metres 6.5 metres
2. Fixity For the most part, it is fixed in For the most part, it is less fixed
position. Hence, less mobile. in position. Hence, greater mobility.
3. Calibre Greater Lesser
4. Sacculations (haustrations) Present Absent
5. Taenia coli Present Absent
6. Appendices epiploicae Present Absent
7. Mucous membrane
a. Circular folds (plicae circulares) Present Present
b. Villi (microscopic feature) Absent Present

LIVER Anatomical Features

It is the largest gland of the body lies in the upper part
of the abdominal cavity. It lies in the right hypochon-
drium, epigastrium and part of left hypochondrium. It
is wedge shaped. It weighs about 1.5 to 2 kg which is
1/36th of the body weight in adults while it is 1/18th of
the body weight in infants (Figs 12.12 and 12.13)
Fig. 12.12: Superior and anterior surface of liver
Liver has five surfaces, three borders, right, left, caudate
and quadrate lobes, fissure for ligamentum teres, liga-
mentum venosum and porta hepatis.
Surfaces of liver: Liver presents with a right surface, an
anterior and a posterior surface, a superior and a inferior
surface.
1. Right surface: It lies in relation to the undersurface
of diaphragm and is convex all around. It is covered
by peritoneum.
2. Superior surface: It is quadrilateral and shows a
concavity in the middle.
3. Anterior surface: It is triangular and slightly
convex.
4. Posterior surface: This surface lies between postero-
superior and posteroinferior borders which are not
very well defined. In the middle it shows a deep
concavity for the vertebral column. This surface has
following features and relations.
 174 Human Anatomy For Dental Students
Fig. 12.13: Relations of inferior and posterior surface of liver
a. Bare area (Fig. 12.13): It is non peritoneal and
is covered by Glissons capsule.This area is
related to diaphragm, right suprarenal and
upper end of right kidney.
b. Groove for inferior vena cava: It is a vertical
S E C T I O N-1
groove which lodges the inferior vena cava.
c. Caudate lobe: It is covered by the peritoneum
of lesser sac. It is related to crura of diaphragm,
coeliac trunk and right inferior phrenic artery.
d. Fissure for ligamentum venosum: It is deep and
extends to the front of caudate lobe. It contains
two layers of lesser omentum. The floor of the
fissure lodges the ligamentum venosum which
is the remnant of ductus venosus.
e. Groove for esophagus: It is the shallow vertical
groove on the posterior surface of left lobe.
5. Inferior or visceral surface (Fig. 12.13): It has
following features and relations from left to right.
a. Gastric impression
b. Omental tuberosity or tuberomental
c. Fissure for ligamentum teres: It is a deep cleft
extending from inferior border of liver to left
end of porta hepatis. It lodges ligamentum teres
which represents the obliterated left umbilical
vein.
d. Quadrate lobe: It is quadrangular in shape.
e. Porta hepatis: It is a transverse, non peritoneal
fissure which is the gateway to liver. The lips of
porta hepatis give attachement to anterior and
posterior layer of lesser omentum. The
structures passing through porta hepatis are,
from before backward
Right and left hepatic duct
Right and left hepatic artery
Right and left division of portal vein.
f. Caudate and papillary processes of caudate
lobe
g. Fossa for gall bladder: It lodges the gall bladder.
h. Duodenal impression
i. Colic impression
j. Renal impression
Borders of Liver
1. Inferior border: It is well defined and separates the
inferior surface from right and anterior surface.
2. Posterosuperior border: It is demarcated by
superior layer of coronary ligament, upper end of
groove for inferior vena cava and left triangular
ligament.
3. Posteroinferior border: It separates the inferior and
posterior surfaces. It is indicated by inferior layer of
coronary ligament and groove for inferior vena cava.
Lobes of Liver
Liver is divided into two lobes right and left.
1. Right lobe: It is the largest lobe of liver and forms
5/6th of the liver. It presents caudate and quadrate
lobes.
2. Left lobe: Forms 1/6th of the liver. It is flattened
from above downward.
Non-peritoneal areas: These are sites where liver is not
covered by the peritoneum.
1. Bare area
2. Attachment of falciform ligament
3. Groove for vena cava
4. Fossa for gall bladder
5. Porta hepatis
6. Fissure for ligamentum teres and venosum
Blood supply of liver: 80% is derived from portal vein
while 20% is derived from hepatic artery.
EXTRA HEPATIC BILIARY SYSTEM
It includes right and left hepatic ducts, common hepatic
duct, gall bladder, cystic duct and bile duct (Fig 12.14).
Intra Hepatic Circulation of Bile
Bile is secreted by hepatocytes into the bile canaliculi
which join to form canal of Herings. It then drains into
ductules which join to form right and left hepatic ducts.
The two hepatic ducts join at porta hepatis to form the
common hepatic duct.

Bile canaliculi Canal of Herings Ductule
Right and left hepatic ducts
Extra Hepatic Circulation
Common hepatic duct is 3 cm long and is 4 mm in
diameter. It joins with the cystic duct from gall bladder
to form the common bile duct. The bile flows from liver
to gall bladder and via common bile duct to the
duodenum.
Gall Bladder (Fig. 12.14)
It is related to the inferior surface of the liver where it
lies in the gall bladder fossa. It is pear shaped. It is 7 to
10 cm long and 3 cm wide. It has a capacity of 30 to
50 ml. It can be divided into fundus, body and neck. A
small diverticulum extends in the downward and
backward direction from the postero-medial wall of neck
of gall bladder. This forms Hartmanns pouch.
Cystic duct: It extends from neck of gall bladder to bile
duct. It is 3 to 4 cm in length and 2 mm in diameter. The
spiral valves of Heister are present in cystic duct.
Bile duct (Fig. 12.14): It is formed close to porta hepatis
by the union of common hepatic and cystic ducts.
Usually cystic duct joins the right side of common
hepatic duct at an acute angle. It is 7.5 cm in length and
6 mm in diameter.
The bile duct opens into the second part of
duodenum along with pancreatic duct at the summit of
ampulla of Vater. This opening is guarded by smooth
muscle fibres forming a sphincter known as sphincter
of Oddi.
Functions of Liver and Gall Bladder
Liver performs important functions of the body:
1. Synthesis of plasma proteins, clotting factors.
2. Metabolism of glucose, aminoacids and lipids
3. Inactivation of toxic substances
Fig. 12.14: Extrahepatic billary system
Digestive System 175
4. Formation and secretion of bile.
5. Storage for vitamins specially vitamin B12 and folic
acid and iron.
6. Acts as an important part of the mononuclear
phagocytic system of the body. Provides immunity.
7. Is a site for extra medullary haemopoiesis (synthesis
of red blood cells) specially in intra-uterine life.
Bile: Bile is made up of bile salts, bile pigments and other
substances in an alkaline electrolyte solution. It is
secreted by hepatocytes into bile canaliculi and collected
by ducts which join to form hepatic ducts. About 500 ml
of bile is produced per day. Bile passes through cystic
duct to gall bladder for storage between meals. It is
released into 2nd part of duodenum by common bile
duct following contraction of gall bladder as food enters
intestine.
Bile salts reduce surface tension and emulsify fats in
food, facilitating action of lipases and diffusion of lipids
in soluble form to the brush border of intestine for
absorption. 90 to 95% of bile salts are reabsorbed in the
ileum and enter portal circulation back to the liver. This
is called entero-hepatic circulation of bile.
C H A P T E R-12
PANCREAS
It is an exocrine as well as an endocrine gland. It lies in
the C of duodenum in relation to posterior abdominal
wall. It extends from epigastrium to the left hypo-
chondrium at the level of L1 and L2 vertebrae (Fig. 12.15).
Dimensions
Length : 15 to 20 cm
Breadth : 3 cm
Thickness : 0.5 to 2 cm
Weight : 85 to 90 gm
Anatomical Features
Pancreas can be divided into the following parts:
1. Head: It is the enlarged part. It lies in the C of
duodenum. It consists of a superior, Inferior and a
right border. It presents with an anterior and a
posterior surface.
Uncinate process: It is a triangular projection which
arises from the lower and left part of the head.
Anteriorly it is related to the superior mesenteric
vessels and posteriorly to the aorta.
Fig. 12.15: Parts of pancreas with relations
 176 Human Anatomy For Dental Students
2. Neck of pancreas: It is a slightly constricted part
which is directed forwards, upwards and to the
left. It connects the head to the body.
3. Body of pancreas: The body extends from front of
aorta till the left kidney and is triangular on cross
section. It has three surfaces and three borders.
Anterior border provides attachment to root of
transverse mesocolon. Superior border presents
with a conical projection called tuberomentale on
right side. At the right end of inferior border emerge
the superior mesenteric vessels.
4. Tail of pancreas: This is the narrow left end of
pancreas. It lies in the lienorenal ligament together
with splenic artery. It is the most mobile part of
pancreas.
Ducts of pancreas: Pancreas has an exocrine part which
is drained by two ducts.
1. Main pancreatic duct (Duct of Wirsung): It begins
at the tail and runs close to the posterior surface of
the pancreas towards the right. Near the neck of
the pancreas it turns downwards, backwards and
to right to open into the 2nd part of duodenum.
During its course it receives numerous smaller
ducts which open at regular intervals at right angle
S E C T I O N-1
forming a herring bone pattern.
2. Accessory duct (duct of Santorini): It begins in the
lower part of the head and crosses in front of the
main duct passing upwards and to the right. It
opens into the 2nd part of duodenum at the minor
papilla.
Arterial supply of pancreas: It is supplied by pancreatic
branches of splenic artery, superior pancreaticoduodenal
artery, inferior pancreaticoduodenal artery.
Venous drainage of pancreas: Corresponding veins
drain into superior mesenteric, splenic and portal veins.
Lymphatic Drainage of Pancreas
1. Head and neck of pancreas drain into pancreatico
duodenal lymph nodes.
2. Tail and body of pancreas drain into pancreatico-
splenic lymph nodes.
Nerve Supply of Pancreas
Sympathetic: It is derived from superior mesenteric and
coeliac plexus. It is vasomotor.
Parasympathetic: It is derived from bilateral vagi. These
stimulate pancreatic secretion.
Functions of pancreas: Pancreas produces 1200 to
1500 ml of pancreatic juice per day. Pancreatic juice is
alkaline (has high HCO3 content) and consists of various
enzymes that help in digestion of starch, fat and proteins.
CLINICAL AND APPLIED ANATOMY
STOMACH
Peptic ulcer: It is the break in the mucosal lining
of stomach or first part of duodenum. It may occur due
to disruption of mucosal barrier caused by excess
or prolonged use of pain killers, infection with
helicobacter pylori and excess secretion of gastric
acids.
The patient presents with complaints of epigastric
pain especially after meals.
Vomiting: It is the forceful expulsion of contents
of stomach and small intestine (usually food,
gastric secretions along with bile and intestinal
secretions) from the mouth to exterior.
SMAL INTESTINE
Ist part of duodenum has highest risk of peptic
ulcer because it is directly exposed to gastric juices
containing acid.
In malignancy of neck of pancreas a part of
duodenum is also removed because the head of
pancreas and duodenum have a common blood
supply. Head of pancreas cannot be removed
without damaging blood supply to the duodenum.
Hence, both are removed.
LARGE INTESTINE
Taenia coli, converge at the base of appendix as
they do not extend to appendix. This is the
identifying feature for appendix.
Sympathetic preganglionic supply to appendix is
from T 10 spinal segment and the skin over
umbilicus is also supplied by T10 spinal segment.
Hence, pain of appendicitis is felt at the umbilicus
(referred pain).
McBurneys point (Fig. 23.9): It is the point of
junction of medial 2/3rd and lateral 1/3rd of a line
extending from right anterior superior iliac spine
to umbilicus. The initial pain of appendicitis is
refered to umbilicus but later on, with involvement
of parietal peritoneum, pain is felt at McBurneys
point. Maximum tenderness on palpation is also
felt at this point.
LIVER AND GALL BLADDER
Cholecystectomy is the surgical removal of gall
bladder.
Most common pathology for which cholecystec-
tomy is performed is cholelithiasis or gall stones.
Gall stones can cause chronic inflammation of gall
bladder, obstruction of bile duct leading to jaundice
and occasionally are associated with gall bladder
cancer.
PANCREAS
Malignant growth of head of pancreas may
obstruct the bile duct leading to obstructive type
of jaundice.
Steatorrhea: It is the passage of large, bulky, clay
coloured stools due to presence of increased
amount of undigested lipid content of food. It most
commonly occurs due to deficiency of pancreatic
lipase enzyme. It may also occur in patients with
malabsorption syndrome due to damage or
removal of ileum.
 Chapter
13
Urinary System
INTRODUCTION
The excretory function of the body is primarily carried
out by a pair of kidneys. The other excretory organs of the
body are skin (produces sweat), GIT (excretes faeces),
respiratory tract (excretes CO2). Kidneys are responsible
for the filtration of blood and removal of waste substances
like urea, creatinine, uric acid and others from the body.
The filtrate under goes a process of reabsorption and
secretion which results in the formation of urine. The
urine is carried from the kidneys to the urinary bladder
by the ureters and is expelled to exterior during
micturition through urethra. Kidneys, ureters, urinary
bladder and urethra form the urinary system. This system
Fig. 13.1: Parts of urinary system in male
helps in regulating the solute and water content of the
body there by, regulating the composition and volume of
extracellular fluid (Fig. 13.1).
KIDNEYS
Kidneys are a pair of excretory organs lying in relation to
the posterior abdominal wall, on each side of vertebral
column (Figs 13.1 to 13.4).
C H A P T E R-13
The kidneys are bean shaped and reddish brown in
colour. Each kidney extends from T12 to L3 vertebrae. Right
kidney is lower than the left, due to presence of liver.
Long axis of each kidney is directed downwards and
laterally while the transverse axis is directed backwards
and laterally. Hence, upper pole is nearer to the vertebral
column than lower pole.
Coverings of kidney: From within outward (Fig. 13.2)
fibrous capsule, perinephric fat, renal fascia (fascia of
Gerota) and paranephric fat.
Fig. 13.2: Coverings of kidney
Presenting Parts (Fig. 13.3)
Each kidney presents the following parts:
1. Upper end: It is more rounded and is related to
suprarenal gland.
2. Lower end: It is broader and lies about an inch above
iliac crest.
 178 Human Anatomy For Dental Students

3. Kidneys are responsible for control of the acid base

Fig. 13.3: Parts of the right kidney
3. Medial border: It is convex and presents with a
central concavity for the hilum. Hilum is a vertical
cleft through which structures enter or leave the
kidney. These are renal vein, renal artery, pelvis of
ureter. Other structures present in hilum are renal
lymphatics, nerves and perinephric fat.
4. Lateral border: It is convex, thick and lies on a more
posterior plane.
S E C T I O N-1
balance of body.
4. Kidneys also have an endocrine function and secrete
the following hormones:
a. Erythropoetin: It is secreted from the endothelium
of peritubular capillaries in response to hypoxia.
Erythropoetin stimulates hemopoeisis.
b. 1, 25-dihydroxycholecalciferol (calcitriol): It is
produced by the cells of PCT and it regulates
calcium metabolism.
c. Renin: It is secreted by JG cells and regulates
extracellular fluid volume and blood pressure.
URETERS
Ureters are thick walled tubes extending from the corres-
ponding kidney to the urinary bladder. They are two in
number and lie in relation to the posterior abdominal
wall (Fig. 13.4).
Length : 25 cm
Diameter : 3 mm
Parts of Ureter
There are three parts of ureter

1. Pelvis of ureter: It is formed in the hilum by union of

5. Anterior surface: It is convex, irregular and directed
major calyces. It is funnel shaped and continues with
forwards and laterally.
abdominal part of ureter at the level of lower end of
On right side it is related to right suprarenal gland,
the kidney.
second part of duodenum, liver and jejunum. On left
2. Abdominal part of ureter: It extends from lower end
side it is related to left suprarenal, spleen, stomach,
of the kidney to pelvic brim at bifurcation of common
pancreas and jejunum.
iliac artery.
6. Posterior surface: It is flat and is directed backwards 3. Pelvic part of ureter: It lies in pelvis and extends
and medially. It is completely non peritoneal. The from the pelvic brim to the entry of ureter in urinary
posterior surface of both the kidneys is related to bladder.
diaphragm with costodiaphragmatic recess above,
psoas major and quadratus lumborum muscles, Functions of ureters: Ureters primarily conduct urine
subcostal nerves and vessels, iliohypogastric and from the corresponding kidney to the bladder.
ilioinguinal nerves.
Each kidney is supplied by the renal artery which is a
branch of abdominal aorta. Each kidney is drained by a
renal vein which further drains into the inferior vena cava.
The left renal vein is longer than the right vein.
Functions of Kidneys
1. Kidneys are the main excretory organs of our body
that eliminate metabolic waste products like
ammonia, urea, uric acid, creatinine etc. by the
formation of urine.
Formation of urine: Kidneys receive 1.2 to 1.3 litres
of blood per minute and produce urine at the rate of
1 ml per minute. There are three processes involved
in urine formation namely, filtration, reabsorption
and secretion.
2. They play an important role in the regulation of extra
cellular fluid volume by controlling the water and
electrolyte balance Fig. 13.4: Parts of ureter

Fig. 13.5: Parts of urinary bladder
URINARY BLADDER
It is a muscular bag which acts as a reservoir of urine
(Fig. 13.5)
Position: It lies in pelvis in adult while in children it is an
abdomino-pelvic organ.
Shape: Ovoid when distended, tetrahedral when empty.
Capacity
Anatomical capacity : 1000 ml
Physiological capacity : 450 ml
Arterial supply of urinary bladder: Urinary bladder is
supplied by superior vesical artery, inferior vesical artery,
obturator artery, a branch from inferior gluteal artery and
in femaleuterine artery.
Venous drainage of urinary bladder: Venous drainage
is through vesical plexus of veins.
Lymphatic drainage of urinary bladder: Lymphatics
from bladder drain into external iliac group of lymph
nodes.
Nerve Supply of Urinary Bladder
1. Sympathetic supply: Preganglionic fibres are
derived from T11, T12, L1 and L2 segments of spinal
cord and relay in superior hypogastric plexus. Post
ganglionic fibres supply the body and neck of urinary
bladder. Sympathetic neurons stimulate the
sphincter vesicae and inhibit the detrusor muscle.
This is responsible for retention of urine. Painful
sensation is also carried by the sympathetic fibres.
2. Parasympathetic supply: Preganglionic fibres are
derived from lateral horn of S2, S3, S4 spinal segments
and form nervi erigentes. Post ganglionic fibres arise
form the bladder wall or parasympathetic ganglia
near the bladder. Parasympathetic is stimulator to
detrusor muscle and is responsible for micturition
(passing of urine). Sense of distension is carried by
parasympathetic fibres.
Presenting Parts (Fig. 13.5)
It presents the following parts when empty
1. Apex: It is directed forwards and upwards. The
urachus or median umbilical ligament is attached
to it.
2. Base: It is also called the postero-inferior surface.
3. Superior surface: It is triangular in shape and
covered with peritoneum.
4. Infero-lateral surfaces: There are two inferolateral
surfaces.
Urinary System 179
Fig. 13.6: Diagrammatic representation
of inner aspect of urinary bladder
5. Anterior border: It separates the inferolateral
surfaces, and extends from the apex to the neck of
bladder.
6. Posterior border: It separates the superior surface
C H A P T E R-13
from base of bladder.
7. Lateral border: Each lateral border separates the
inferolateral surface from superior surface.
8. Neck: Lowest point of the bladder from where
urethra begins is the neck of bladder. In case of male,
the neck is surrounded by prostate gland.
In distended bladder: Inferolateral surfaces become
anteroinferior surfaces. The anteroinferior surfaces are
nonperitoneal.
Inner Aspect of Bladder
On naked eye examination, the mucosa presents
with irregular folds, in an empty bladder, as it is
loosely attached to underlying muscular coat. These
folds flatten out as the bladder starts filling with
urine (Fig. 13.6).
Trigone: It is seen as a triangular area in the lower
part of base of bladder where the mucosa is adherent
to underlying muscular coat. Hence, it is smooth.
Base of trigone is formed by the interureteric ridge
which extends between the two openings of ureters
while the apex is directed downwards and leads to
the internal urethral meatus.
Bladder mucosa is derived from endoderm except
trigone of the bladder which developes from
mesoderm.
URETHRA
It is the distal most part of the urinary system that helps
to conduct urine from the bladder to the exterior.
Male Urethra
In males it is 18 to 20 cm long and extends from bladder
neck to tip of penis. It is S-shaped in flaccid penis while
J-shaped in erected penis (Fig. 13.7).
 180 Human Anatomy For Dental Students
Fig. 13.7: Male urethra
Parts of Male Urethra
1. Prostatic part of urethra (3 cm long). It is the part
which passes through the substance of prostate. It is
S E C T I O N-1
the widest and the most dialatable part.
2. Membranous part of urethra (1.5 to 2 cm long). It is
the part which lies in the deep perineal pouch and
is the narrowest.
3. Penile part of urethra (15 cm long). It is the part
which is present in the penis. It ends at the external
urethral meatus at the tip of glans penis.
The external urethral meatus is the narrowest part of
urethra and is in the form of a sagittal slit about 6 mm
long.
Female Urethra
In female, urethra is only 3.8 to 4 cm long (Fig. 13.8). It
extends from neck of bladder to the external urethral orifice
which lies in the vestibule. It is embedded in anterior
wall of vagina. Internally, the mucosa of urethra is folded
extensively and contains numerous mucus glands. It is
easily dilatable.
Blood supply of urethra: It is obtained from vessels
supplying prostate and penis.
Lymphatic drainage of urethra: Lymphatics from urethra
drain into internal and external iliac lymph nodes, deep
and superficial inguinal lymph nodes.
CLINICAL AND APPLIED ANATOMY
Kidneys move with respiration. The extent of
movement varies from 1.5 to 2.5 cm.
Renal angle: It is the angle between lateral border
of erector spinae muscle in the back and the 12th
rib. It is so named as the posterior surface of kidney
is related here. Retroperitoneal approach to kidney
in surgeries is via an incision from the renal angle.
Fig. 13.8: Female urethra
Pain of renal colic: It is a spasmodic pain, arising in
kidneys, usually due to presence of a stone (calculus)
in the pelvi-calyceal system.
The pain is referred from renal angle or the lumbar
region to the umbilicus and groin. This is because of
same segmental supply of kidney (via T10, T11, T12,
L1) and umbilicus (T10) and groin (L1) .
Pain of ureteric colic: This occurs due to spasm of
ureteric muscles, usually secondary to presence of a
calculus in ureter. Due to same segmental supply.
the pain is referred to groin and tip of penis in males.
Cystoscopy is the examination of interior of bladder
by a fiberoptic scope called cystoscope.
Highest centre of control of micturition is paracentral
lobule of cerebral hemisphere. Other centres are
detrusor centre in pons and sacral micturition centre
(S2 S3 S4): It is responsible for micturition reflex.
Incontinence of urine is the involuntary passage of
urine. It can be due to injury of bladder/urethral
wall, stress incontinence due to weakness of the
fascial support to bladder neck and bladder muscle
over activity.
Urinary Tract Infection (UTI): It can be upper urinary
tract or lower urinary tract infection.
Cystitis: It is infection of urinary bladder. Most
common site of UTI is the bladder. It is more
common in sexually active females. The
symptoms are due to inflamation of mucosa of
bladder. There is sensation of frequency and
urgency to pass urine, burning sensation while
passing urine, pain in lower abdomen after
passing urine and occasionally haematuria.
Pyelonephritis is infection of kidney which is
usually due to repeated lower urinary tract
infections.
Urethritis or infection of urethra is usually a
sexually transmitted condition due to infection
by Neisseria gonorrhea bacteria.
 Chapter
14
Endocrine System
INTRODUCTION
Functioning of cells, tissues and organs is controlled
primarily by two mechanisms to maintain internal
homeostasis.
1. Neural control, is mediated via stimulation of
nerves and action of neurotransmitters released at
synaptic ends.
2. Endocrine control, is mediated by hormones and
growth factors secreated by endocrine glands in the
body.
Endocrine Glands
Endocrine glands are collections of specialised cells with
secretory function which are grouped together but do
not have a duct. Hence, they are also called ductless
glands. They synthesize and secrete physiologically
active substances known as hormones directly into the
blood circulation.
Hormones
These are chemical compounds produced by endocrine
glands and secreted directly into circulation. They act
as chemical messengers. Hormones are secreted in small
quantities in response to a specific stimulation and act
on defined target cells, tissues or organs.
Structurally hormones are broadly classified into
three types:
1. Steriod hormones: Mineralocorticoids, glucocorti-
coids, sex hormones, 1, 25, dihydroxy cholecalci-
ferol.
2. Protein and polypeptide hormones: Anterior and
posterior pituitary hormones, hypothalamic horm-
ones, parathormone, calcitonin, insulin, glucagon,
gastrin, secretin, angiotensin.
3. Amino acid derivatives: Epinephrine, norepine-
phrine, thyroid hormones.
The hormones are transported in circulation either
bound to plasma proteins like albumin (steroid and
thyroid hormones) or lie free in plasma (protein
hormones).
Hormones act on the target cells via specific
receptors. The receptors may be present on cell surface
or may lie intracellularly. Generally, steroid hormones
cross plasma membrane of target cells by diffusion and
act on intracellular receptors while protein hormones
act on cell surface receptors.
Function of hormones is regulation of various
biochemical and metabolic reactions in the body. The
hormones act by affecting membrane permeability, gene
C H A P T E R-14
expression, activation of enzymes, activation of
tyrosinekinase system.
Regulation of secretion of hormones is very well
controlled. It is brought about by the following:
1. Negative feedback and positive feedback mecha-
nisms: Increase in circulating levels of a hormone
stimulates the organ and its higher centers to inhibit
further synthesis and release of the same hormone.
This is known as negative feedback. Positive
feedback is the reverse of this.
2. Neural control: The secretion of hormones is
influenced by external stimuli (e.g., taste and smell
stimulate secretion of GIT hormone) and internal
stimuli, e.g., stress and pain.
3. Autonomic hypothalamic control: This is respon-
sible for the circadian (day and night) rhythm of
secretion of various hormones. It controls the
diurnal, seasonal and developmental variation in
secretion of hormones.
The various endocrine glands are (Fig. 14.1)
1. Pituitary gland
2. Hypothalamus gland
3. Pineal gland
4. Thyroid gland
5. Parathyroid gland
6. Thymus gland
7. Adrenal gland
8. Pancreas: Islets of Langerhans
9. Ovary and testis
10. Other organs with endocrine functions are kidney,
mucosa of GIT, skin, placenta (during pregnancy).
 182 Human Anatomy For Dental Students

said to have an antigonadotrophic function that inhibits

gonadal development before puberty.

HYPOTHALAMUS
Hypothalamus lies in the ventral part of the dience-
phalon and consists of collection of nerve cells in a matrix
of neuroglial tissue (Fig. 14.2).

Extent
Dorsally : Hypothalamic sulcus, thalamus
Ventrally : Lamina terminalis
Superiorly : Lamina terminalis
Inferiorly : Upto the vertical plane just caudal to
the mamillary bodies
Medially : Ependymal lining of 3rd ventricle
Laterally : Upto the subthalamus and internal
capsule.

Nuclei of Hypothalamus
Hypothalamus is divided into lateral and medial areas
by a column of fornix, mamillo-thalamic tract and
S E C T I O N-1

fasciculus-retroflexus. The nuclei are arranged in four

regions:
1. Preoptic region: Preoptic nucleus: Lies in the
anterior wall of the 3rd ventricle, between the
supraoptic nucleus below and the anterior
commissure above.
Fig. 14.1: Endocrine system 2. Supra-optic region: It lies above the level of optic
chiasma and consists of
a. Ventromedial nucleus
Pitutiary gland (chapter 22), thyroid and parathyroid
b. Suprachiasmatic nucleus
gland (chapter 32) are described in head and neck.
c. Anterior nucleus
Thymus is described in lymphatic system (chapter 10).
d. Paraventricular nucleus
(Pancreas is described in digestive system (chapter 12)
3. Tuberal-infundibular region: Is the widest part
and ovary and testis are described in reproductive
which lies above the tuber cinereum and has the
system see (chapter 15).
following nuclei
a. Medial nucleus
PINEAL BODY b. Dorsomedial nucleus
Pineal gland or epiphysis cerebri is a conical, small c. Arcuate nucleus
organ attached to the roof of the third ventricle by a stalk d. Posterior hypothalamic nucleus
known as the pineal stalk It lies in a depression between e. Lateral hypothalamic nucleus
4. Mamillary region: Consists of the mamillary bodies
the two superior colliculi, below the splenium of corpus
with the following nuclei
callosum. It measures about 8 mm in length and 5 mm
a. Supraoptic nucleus
in width.
b. Lateral nucleus
It is made up of pinealocytes or parenchymal cells and
c. Intercalated nucleus
astrocyte like neuroglial cells. Pineal gland is a highly
vascular organ and contains fenestrated capillaries. Connections of Hypothalamus
Calcium granules get deposited in the gland after
1. The hypothalamus receives afferents from limbic
puberty.
system (hippocampus and amygdaloid nucleus)
Function: Pineal gland is a neuro-endocrine organ in midbrain, pons, retina, thalamus and basal ganglia
mammals. It is rich in melatonin and seretonin and is

Fig. 14.2: Nuclei of hypothalamus
2. The hypothalamus sends efferents to limbic system,
thalamus and cingulated gyrus in cerebrum,
reticular formation of midbrain which projects to
spinal motro neurons and posterior pituitary.
Functions of Hypothalamus
1. Neuro-endocrine control: It secretes following
hormones:
a. CRH: Corticotropin releasing hormone
b. GnRH: Gonadotrophin releasing hormone
c. Prolactin releasing hormone
d. Prolactin inhibitory hormone (identified as
neurotransmitter dopamine)
e. Growth hormone releasing hormone
f. TRH: Thyrotropin releasing hormone
g. ADH
h. Oxytocin
2. Regulates body temperature
3. Regulates circadian (day-night) rhythm of various
activity eg. sleep, appetite
4. Controls emotional behaviour, e.g., fear and anger
etc. It integrates autonomic motor and endocrinal
responses to various afferent stimuli.
5. Regulates various functions for body preservation
a. Hunger and satiety
b. Thirst
c. Sexual behaviour
6. Regulates autonomic nervous system activity.
a. Posterior and lateral parts of the hypothalamus
regulate the sympathetic activity.
Endocrine System 183
C H A P T E R-14
b. Preoptic and supraoptic areas are responsible
for parasympathetic activity.
PITUITARY GLAND
Endocrine Function of Pituitary Gland
Pituitary gland consists of an anterior lobe and a
posterior lobe connected by a small pars intermedia
(intermediary lobe). The anterior lobe has two types of
cells namely, chromophobes and chromophils. The exact
function of chromophobes (non staining cells) is not
known. Chromophils are the cells which produce
hormones.
a. Basophils: These consists of:
1. Gonadotropes: They secrete FSH (Follicular
stimulating hormone) and LH (Leuteinising
hormone).
2. Thyrotropes: They secrete thyroid stimulating
hormone (TSH). TSH stimulates growth and
vascular supply of thyroid gland. It increases
rate of thyroid hormone production.
3. Corticotropes: They secrete adreno corticotropic
hormone (ACTH). ACTH controls the growth
and secretion of zona fasciculata and zona
reticularis of adrenal gland.
b. Acidophils: These consists of:
1. Mammotropes: They secrete prolactin.
2. Somatotropes: Secrete growth hormone (GH).
The posterior lobe primarily has endings of axons from
supra-optic and paraventricular nuclei of hypothalamus
 184 Human Anatomy For Dental Students
and secretes hormones conducted from hypothalamus.
These are:
1. Vasopressin (ADH)
2. Oxytocin
The intermediate lobe is primarily rudimentary and
produces melanocyte stimulating hormone (MSH).
(For detail see head and neck section chapter no. 22)
THYROID GLAND
Functions of Thyroid Gland
1. It produces two thyroid hormones T3 and T4 which
are required for the normal growth and develop-
ment of the body. They also maintain the metabolic
rate of body.
2. It also produces calcitonin. This hormone has a role
in calcium metabolism.
(For detail see head and neck section chapter no. 32)
PARATHYROID GLAND
Function of Parathyroid Glands
They secrete parathormone which maintains the calcium
balance of body. Parathormone is secreted by the chief
S E C T I O N-1
cells of parathyroid gland. It is essential hormone for
life.
Actions of parathormone: The net effect of paratho-
rmone is increase in plasma Ca2+ and decrease in plasma
PO43 levels.
(For detail see head and neck section chapter no. 32)
PANCREAS
Endocrine Function of Pancreas
Pancreas contains ovoid collection of cells scattered
throughout its substance that are known as Islet of
Langerhans. There are about 1 to 2 million islets in
pancreas and they make upto 2% of its volume. There
Fig. 14.3: Suprarenal gland
are four distinct types of cells in the islets which secrete
four hormones:
1. cells (A cells): They form 20% of total cells and
secrete glucagon.
2. cells (B cells): They are the most abundant, 60%
of cells and they secrete insulin.
3. cells (D cells): These secrete somatostatin.
4. F cells: These secrete pancreatic polypeptide.
The a and b cells are innervated by parasympathetic
and sympathetic nerve endings. Each type of cell controls
secretion of other cells by paracrine control.
(For detail see chapter no. 12)
SUPRARENAL GLANDS (ADRENAL GLANDS)
Adrenal glands are a pair of endocrine glands, one each
situated in relation to the upper pole of kidney (Fig. 14.3).
They lie retroperitoneally on each side of vertebral
column in relation to posterior abdominal wall. They
are golden yellow in colour and weigh about 5 gm.
Shape: Right gland is triangular or pyramidal in shape.
Left suprarenal gland is semilunar in shape.
Dimensions:
Vertically : 3 cm
Breadth : 2 cm
Thickness : 1 cm
Right Suprarenal Gland
It is triangular or pyramidal in shape. It presents with
an apex which is directed above, and a base, directed
below. The base overlaps the upper pole of right kidney.
Near the apex on the anterior surface, lies the hilum
through which right suprarenal vein emerges in an
upward and forward direction. Posterior surface is

related to diaphragm in upper part and kidney in lower
part.
Left Suprarenal Gland
It is longer and semilunar in shape. The upper end is
narrow and is related to medial end of spleen. The lower
end is broad and is directed downward and medially. It
presents the hilum through which left suprarenal vein
passes.
Arterial supply of adrenal gland: Each gland is supplied
by the following arteries:
1. Superior suprarenal artery, branch of inferior
phrenic artery
2. Middle suprarenal artery, branch of abdominal
aorta
3. Inferior suprarenal artery, branch of renal artery
Venous drainage of adrenal gland: Right suprarenal
vein drains into inferior vena cava. Left suprarenal vein
drains into left renal vein.
Lymphatic drainage of adrenal gland: Lymphatic drains
into lateral aortic lymph nodes.
Nerve Supply of Adrenal Gland
1. Medulla is supplied by preganglionic sympathetic
fibres via coeliac plexus from T8 to L1.
2. Cortex is controlled by ACTH secreted by anterior
pituitary.
Endocrine Function of Adrenal Gland
1. Adrenal cortex is essential for life: It produces
steroid hormones which are:
a. Mineralocorticoids: Aldosterone and
deoxycorticosterone. It primarily helps to
maintain ECF volume.
b. Glucocorticoids: Cortisol, and corticosterone.
3. Adrenal androgens: Dehydroepiandrosterone
and androsteredione.
2. Adrenal medulla: It is not essential for life. Adrenal
medulla secrets catecholamines namely epineph-
rine, norepinephrine and dopamine.
CLINICAL AND APPLIED ANATOMY
PITUITARY
Hyperprolactinemia: Excess prolactin levels can be
caused by certain conditions other than pregnancy.
Pituitary tumors.
Drugs, which are dopamine antagonists, e.g.,
antipsychotic and antiepileptic drugs.
Hypothyroidism: This results in increase in levels
of TRH which stimulates secretion of prolactin.
In females, this leads to galactorrhea that is
expression of milk from breasts and cessation of
menstruation known as amenorrhea. Cessation of
Endocrine System 185
menstruation occurs due to inhibition of action of LH
and FSH leading to anovulation. It leads to lack of
libido and impotence in males and females.
Gigantism: This condition occurs due to excess
secretion of growth hormone during childhood or
growing years. It is mostly due to presence of a
pituitary tumor and leads to tall stature, large
hands and feet. Growth hormone has a facilitatory
action like prolactin and this causes gynaecomastia
and impotence in males.
Acromegaly: This condition occurs due to excess
secretion of growth hormone in adults (after
epiphyseal closure). It leads to enlargement and
widening of metacarpals, metatarsals and
mandible (there is protrusion of chin known as
prognathisn) with hypertrophy of soft tissues and
enlargement of heart, kidney, spleen, adrenals, etc.
Diabetes insipidus: It is a condition in which there
is marked deficiency of ADH due to diseases of
hypothalamus or pituitary or inability of kidneys
to respond to ADH. This leads to increase volume
of urine, polyuria and increase thirst, polydipsia.
C H A P T E R-14
Hypothyroidism: It is a condition which occurs
due to the deficiency of thyroid hormones in body.
Effects on body: BMR is low leading to cold
intolerance, weight gain. Memory is poor with
slow mentation, slow speech and physical
lethargy. Muscular weakness and cramps are
common. Constipation occurs due to slowing of
intestinal motility.
Crenitism: This condition results due to congenital
deficiency of thyroid hormones. It is characterised
by dwarfism, stunted growth, slow skeletal muscle
growth. Characteristic appearance is short height
with pot bellies, gross mental retardation,
deafmutism , coarse skin and scanty hair, poor
sexual development and other features of
hypothyroidism.
Hyperthyroidism: This condition is due to excess
circulating levels of thyroid hormones. It leads to
heat intolerance, increase heart rate, palpitations,
Anxiety, nervousness, sweating, weight loss, fine
tremors of outstretched hands, irritability,
insomnia. Increase in intestinal motility associated
with diarrhoea and hyperphagia (excess hunger).
Menstrual irregularity in the form of frequent
scanty periods may occur.
Diabetes mellitus (DM): It is a condition caused
by deficiency of insulin hormone.
Phaeochromocytoma: It is the tumor of chromaffin
(epinephrine and norepinephrine secreting) cells
which leads to excess hormone production.
Clinical features are hypertension, headache,
 186 Human Anatomy For Dental Students
sweating, weakness, blurred vision due to dilated
pupils of eye.
Hyperaldosteronism: It is due to excess aldos-
terone secretion. It is of two types namely:
Primary hyperaldosteronism (Conns
syndrome): It is due to excess mineralo-
corticoid secretion, usually due to presence of
an adrenal tumor. This leads to Na+ retension
causing hypertension, K+ depletion causing
muscular weakness, hypovolemic alkalosis
and tetany. Renin secretion is suppressed.
Secondary hyperaldostenonism: It is seen in
conditions that are associated with high renin
activity stimulated by low intravascular
volume. Examples of such conditions are
congestive heart failure, liver cirrhosis, nephro-
sis. There is peripheral edema and hyper-
tension. K+ levels are normal.
Cushings syndrome: It is a clinical condition
arising out of either:
Adrenal tumors producing glucocorticoids. It
is associated with low ACTH.
Increase ACTH secretion due to pituitary or
S E C T I O N-1
lung tumors.
Clinical effects
Thin skin, easy bruising, thinning of hair.
Poor muscle development.
Poor wound healing.
Redistribution of fat: Increase fat deposition in
abdominal wall, face and upper back (buffalo
hump).
Salt and water retention due to minerolo-
corticoid action leading to generalised edema,
facial edema is termed as moon facies.
Hyperglycemia, hypertension.
Osteoporosis due to protein metabolism, loss
of matrix and decrease Ca2+ uptake.
Addisons disease: Primary adrenocortical
insufficiency. There is destruction of adrenal
cortex by tumors or by infections like tuberculosis.
Deficiency of hormones causes hypotension,
anorexia, vomiting, diarrhea, decrease ability to
stand stress. It can lead to circulatory collapse
during stress.
Congenital adrenal hyperplasia: The primary
defect is deficiency in enzymes that convert
cholesterol to cortisol. Low levels of cortisol
stimulates ACTH secretion and this increases
adrenal activity. The net effect is excess production
of adrenal androgens. In males, excess androgens
leads to precocious puberty in boys. In females,
there is virilization with deepening of voice,
enlarged clitoris, growth of hair in male areas and
stoppage of menstruation.
 Chapter

15
Reproductive System
INRODUCTION 1. Mons pubis: It is a rounded, median cutaneous
Reproductive system is responsible for propogation of elevation in front of the symphysis pubis.
species for survival and existence of an organism. 2. Labia majora: Labia majora correspond to scrotum
in male. They are a pair of longitudinally placed,
Parts of female reproductive system
cutaneous elevations. Anteriorly, they continue
1. External genitalia: Female external genitalia is also
upwards as mons pubis. Posteriorly, they merge in
known as vulva. It includes (Fig. 15.1).
midline to form posterior comissure and continue
a. Mons pubis
with perineum.
b. Labia majora
3. Labia minora: These are a pair of thin, elongated,

C H A P T E R-15
c. Labia minora
cutaneous folds, present one on each side, on inner
d. Vestibule
aspect of labia majus. They converge anteriorly and
e. Clitoris
split to enclose the clitoris, forming a hood over it
f. Bulb of the vestibule
called prepuce.
g. Greater vestibular glands (Bartholins gland)
4. Vestibule: It is the area enclosed by labia minora.
h. Vaginal orifice
It presents anteriorly, a small opening of external
2. Internal genitalia: The structures lie in the pelvis
urinary meatus and a larger opening of vagina
and perineum. During pregnancy however, uterus
enlarges to become an abdominal organ. Internal below it.
genitalia consists of (Fig. 15.2) Hymen: It is a fold of membrane present in the
a. Uterus and cervix. vestibule. It covers the vaginal opening.
b. A pair of fallopian tubes 5. Clitoris: It corresponds to the penis of males,
c. Vagina embryologically.
d. Two ovaries 6. Bulb of the vestibule: These are a pair of elongated,
erectile tissue containing a rich plexus of veins
Parts of male reproductive system (Figs 15.3 and 15.4)
which embrace the sides of vaginal orifice.
It consists of the following parts:
7. Greater vestibular glands (Bartholins gland):
1. Penis
They are small pea size glands situated behind the
2. Scrotum
3. Testes bulb of vestibule and secrete mucous to keep the
4. Epididymis vulva moist.
5. Spermatic cord 8. Vaginal orifice
6. Ductus deferens Functions
7. Seminal vesicles
1. The external structures provide protection to the
8. Ejaculatory duct
vaginal canal from invasion by infections and from
9. Prostate gland
foreign bodies, specially in young girls.
First five form external genitalia of male.
2. The secretions of bulbourethral and paraurethral
glands help to lubricate the vulva.
EXTERNAL FEMALE GENITALIA
3. Erectile tissue of clitoris and labia minora help in
Female external genitalia is also known as vulva. It sexual arousal.
includes (Fig. 15.1).
S E C T I O N-1 188 Human Anatomy For Dental Students

Fig. 15.1: Female external genitalia

Fig. 15.2: Uterus, uterine tubes and ovaries


INTERNAL FEMALE GENITALIA
It consists of uterus, vagina, fallopian tubes and ovaries.
The structures lie in the pelvis and perineum. During
pregnancy however, uterus enlarges to become an
abdominal organ.
Uterus
It is a hollow, pyriform shaped, muscular organ of the
female genital tract. It lies in the pelvic cavity between
urinary bladder, anteriorly and rectum and sigmoid
colon, posteriorly (Fig. 15.2). The uterus presents with
body and cervix.
Dimensions (adults): Uterocervical length is 7.5 cm,
breadth is 5 cm, width is 2.5 cm. Weight of uterus is 50
to 80 gms.
Uterine body: It consists of upper expended part known
as fundus, a central body and a narrow lower constricted
part, the isthmus. The lumen of the body is known as
uterine cavity. The lateral angles or the cornu of the
uterus project outwards from the junction of fundus and
the body on each side and they present with uterine tube
and attachments of round ligament and ligament of
ovary
Cervix: Cervix of the uterus is cylindrical in shape. It
presents with a vaginal part that lies within the upper
end of vagina and a supra vaginal part which is present
above the level of vagina, below the isthmus. It is more
fixed than the body. Three pairs of ligments attach cervix
to pelvic wall namely Mackenrodts ligaments,
uterosacral ligaments and pubocervical ligaments.
Cervix is twice the length of body in children whereas
in adults the body is twice the length of cervix.
Function of uterus: After puberty uterus undergoes
cyclical changes known as menstrual cycle. These
changes prepare uterus to receive fertilized ovum and
nourish the embryo and maintain pregnancy till birth
of baby.
Uterine (Fallopian) Tubes
They are two in number, one originating on each side of
fundus of uterus. Each tube is situated in the medial
3/4th of the upper free margin of broad ligament of
uterus. Uterine tube extends first laterally then upwards,
backwards and then downwards (Fig. 15.2).
Each tube is 10 cm long and presents from medial to
lateral the following:
1. Uterine opening which communicates the
intramural part of uterine tube to lateral angle of
uterine cavity.
2. Intra mural part: It lies with in the uterine wall.
3. Isthmus: It is cord like with a thick wall.
4. Ampulla: It is the longest part and is thin walled.
5. Infundibulum: It is wide and trumpet like.
6. Abdominal opening: It is situated at the bottom of
infundibulum. This end is known as fimbriated end
Reproductive System 189
due to presence of fimbriae. It lies in relation to
ovary.
Functions of uterine (fallopian) tubes: They are the site
for receiving the ovum from ovary. Fertilization of ovum
occurs in the ampulla of the tubes. The secretions of
fallopian tubes provide nutrition to the fertilized ovum
and helps in its propulsion to the uterus.
Vagina
Vagina is a fibromuscular canal extending from the
vulva to uterus. It is the female copulatory organ. Vagina
lies between the urethra and bladder, in front and the
rectum and anal canal, behind. The vagina is directed
upwards and backwards from the vulva making an
angle of 45 with the uterus (Fig. 15.2).
Anterior wall is 8 cm while posterior wall is 10 cm
long. Upper end is wider, 5 cm and lower end is
narrower 2.5 cm. The lumen of vagina is circular at the
upper end and H-shaped in the rest of the length. This
is because the anterior and posterior walls are normally
in apposition.
Hymen: It is a thin annular fold of mucus membrane
present just above the vaginal opening in vestibule. In
C H A P T E R-15
sexually active women, especially after child birth the
hymen is torn and only tags of membrane are seen
known as carunculae myritiformis.
Fornices of vagina: The cervix protrudes into the upper
part of vagina and this results in formation of a circular
groove at the upper part of vagina or vault of vagina.
This is divided into four parts namely anterior fornix,
posterior fornix and two lateral fornices.
Functions of vagina: It forms an important passage from
uterus to exterior that helps in:
1. Birth of baby.
2. Flow of menstrual blood to exterior.
3. It acts as receptacle for the male copulatory organ,
penis, for deposition of sperm.
Ovaries
Ovaries are a pair of female reproductive glands situated
in the lesser pelvis, one on each side of the uterus. They
are almond in shape (Fig. 15.2).
Dimensions: Average dimensions of an ovary in adults
are 3 cm vertical, 1.5 cm anteroposterior and 1 cm
transverse.
Positions of ovary: In early fetal life, ovaries lie in lumbar
region near kidneys. In new born, ovaries are situated
above the pelvic brim. In nulliparous women, ovaries
lie in ovarian fossa below the pelvic brim. During
pregnancy, ovaries become abdominal structures after
14 weeks of gestation along with the uterus. After
childbirth (in multiparous women), ovaries get
displaced from ovarian fossa and usually lie in recto-
uterine pouch.
 190 Human Anatomy For Dental Students

Functions of ovaries: Ovaries are the store house of

female gametes or ova. They secrete two hormones
estrogen and progesterone.

MALE EXTERNAL GENITALIA

Penis (Figs 15.3 and 15.4)
It is the male organ to excrete urine out side the body
and to release the sperms in female genital tract. It is
made up of two parts namely,
1. Root of penis: It is situated in superficial perineal
pouch and consists of two crura and one bulb of
penis. Each crus is attached to the inner aspect of
everted ischio-pubic ramus. It is covered
superficially by ischiocavernosus muscle. The two
crura are approximated in mid line and continue
as corpora cavernosa. Deep artery of penis traverses
forward within the crus.
Bulb of penis is the expanded part and is attached
to the perineal membrane. Superficially, it is
covered by bulbo-spongiosus muscle. Bulb of penis
continues as the corpus spongiosum of penis.
S E C T I O N-1

Urethra enters through the upper surface of the bulb

after piercing the perineal membrane.
2. Body of penis: It is made up of a pair of corpora
Fig. 15.4: Ventral surface of penis showing different parts
cavernosa and a single corpus spongiosum
(Figs 15.3 and 15.4). Corpora cavernosa lie on the
dorsal surface and the corpus spongiosu, lies on the
ventral surface. Corpus spongiosus is traversed by
the spongy urethra. Traced in front it is expanded

Fig. 15.3: Male reproductive organs

 Reproductive System 191

Fig. 15.5: Layers of scrotum and covering of testis

to form glans penis covered with fold of skin 9. Processus vaginalis some times
known as prepuce. 10. Accessory suprarenal cortical tissues may be
present
Functions of Penis
1. It is a passage for urine to exterior. Epididymis
2. It is responsible for ejaculation of semen deposi-
tion in vagina. It is a comma shaped body made up of highly coiled
tubes, situated along the lateral part of the posterior
Scrotum border of testis (Figs 15.3 and 15.6). It has following parts:

C H A P T E R-15
1. Head is formed by coiling of efferent ductules from
It is a cutaneous pouch that contains testes, epididymis testis.
and lower part of spermatic cords (Fig. 15.5). 2. Body is also called middle part.
Layers of Scrotum (From Outside Inward) 3. Tail: It is the lower part which continues with vas
1. Skin deferens that ascends up on the medial aspect of
2. Dartos muscle epididymis.
3. External spermatic fascia Body and tail are made up of a single coiled
4. Cremastric muscle and fascia epididymal duct. The canal of epididymis is 20 feet long
5. Internal spermatic fascia when uncoiled.
6. Parietal layer of tunica vaginalis
Functions of epididymis: Maturation of sperms takes
Functions of Scrotum place in the epididymis.
1. Protect testes from external voilence
2. Helps in temperature regulation of testes Testes
Spermatic Cord Testes are the male reproductive glands. They lie in the
It is a tubular sheath, 7.5 cm in length and extends from scrotum suspended by spermatic cords. Left testis is
the deep inguinal ring, inguinal canal and external slightly lower than the right. They lie obliquely such that
inguinal ring to the upper posterior part of testis (Figs the upper pole is situated slightly laterally and forwards
15.3 and 15.6). (Figs 15.3, 15.5 and 15.6).
Dimensions (in adults): Length5 cm, breadth
Coverings of Spermatic Cord 2.5 cm, anteroposterior thickness3 cm. Each testis
1. External spermatic fascia. weighs 10 to 14 gms.
2. Cremasteric muscle and fascia. Coverings of testis (Fig. 15.5): Testis covered by three
3. Internal spermatic fascia.
layers, from outside inward these are tunica vaginalis,
Contents of Spermatic Cord tunica albuginea and tunica vasculosa.
1. Vas deferens
Functions of testes: The site of formation of sperms is
2. Pampiniform plexus
3. Testicular artery testes. The sperms are then transferred successively to
4. Artery to vas deferens epididymus, vas deferens, ejaculatory duct and penile
5. Cremasteric artery urethra. Testes also produce two hormones:
6. Lymphatics of testes and epididymis a. Testosterone
7. Genital branch of genitofemoral nerve b. Estrogen: In very small quantities.
8. Loose connective tissue
S E C T I O N-1 192 Human Anatomy For Dental Students
Fig. 15.6: Lateral section of testis and epididymis
MALE INTERNAL GENITALIA
Vas Deferens
It is also known as ductus deferens. It is a thick cord like
tubular structure, 45 cm long. It begins from the tail of
epididymis and ends at the base of prostate by joining
with duct of seminal vesicle to form the ejaculatory duct
(Figs 15.3 and 15.6).
Seminal Vesicles
These are a pair of pyramidal shaped organs which lie
in relation to base of the urinary bladder and ampulla
of rectum (Fig. 15.3). Each vesicle is 5 cm in length and 2
to 3 cm in breadth. When uncoiled it is about 10 to 15 cm
long. It presents the following parts:
1. Base is directed upwards
2. Apex points downward, towards the base of
prostate, joins with ductus deferens and forms
ejaculatory duct
Functions of seminal vesicles: They contribute about
60% of total semen volume. They secrete thick, sticky
fluid which is rich in:
1. Potassium, fructose, phosphorylcholine, citric acid
and ascorbic acid which are energy sources to
spermatozoa.
2. Hyaluronidase that lyses mucopolysaccharides and
help in penetration of cervical mucus.
3. Prostaglandins: These produce contractions in the
uterine musculature leading to movement of sperm
inside.
Ejaculatory Ducts (Fig. 15.3)
Each duct is formed by union of vas deferens and duct
of seminal vesicles. Each duct is 2 cm long and opens
into the prostatic urethra.
Prostate
It is a fibro-musculo-glandular organ and corresponds
in development with the paraurethral glands of female.
It is the accessory gland of male reproductive system
(Figs 15.3 and 15.7). It lies in lesser pelvis, below the neck
of bladder, behind the lower part of symphysis pubis
and in front of rectal ampulla. It resembles an inverted
cone. It has an apex, a base and anterior and posterior
surfaces and two infero lateral surfaces.
Dimensions: Average adult prostate weighs 8 gms. It is
2 cm thick anteroposteriorly, 3 cm vertically and 4 cm
transversely.
Anatomically prostate has three lobes, one median
lobe and two lateral lobes. The prostate is covered by
true capsule formed by the condensation of fibrous
stroma of the gland and false capsule derived from the
visceral layer of pelvic fascia. Space between the true
and false capsule is occupied by prostatic venous plexus.
Structures Passing Through Prostate
1. Prostatic urethra
2. Prostatic utricle
3. Ejaculatory duct

Fig. 15.7: Lobes of prostate and prostatic urethra
Functions of prostate gland: It contributes to 20% of total
semen volume. It secretes a thin, opalescent fluid which
is acidic and gives semen its characteristic fishy order.
The fluid contains calcium, ions like Na+, zinc, citric acid,
fibrinolysin and acid phosphatase.
CLINICAL AND APPLIED ANATOMY
VULVA AND VAGINA
Episiotomy: It is a planned surgical incision on the
posterior vaginal wall and perineum.
Structures cut: (From without inward)
1. Skin
2. Subcutaneous fat
3. Superficial perineal muscles
4. Bulbospongiosus muscle
5. Deep perineal muscles, in deep episiotomy
6. Fibres of levator ani, in deep episiotomy
7. Transverse perineal branches of pudendal
vessels and nerves.
8. Vaginal mucosa
Aim of episiotomy: To enlarge the introitus in
order to prevent stretching and rupture of perineal
muscles and vagina during delivery.
Indications
1. Tight introitus, e.g., in primigravida.
2. Difficult delivery, e.g., forceps application,
breech delivery.
Bartholin cyst: It is the enlargement of Bartholins
gland due to retention of its secretions. This occurs
after repeated infections which leads to blockage
of the duct of the gland. It is treated by excision.
Reproductive System 193
pH of vagina: It varies with age
In reproductive age group, it is 4.5 to 5.
C H A P T E R-15
In pre pubertal and post menopausal women
it is as high as 5 to 6.
Normal vaginal flora consists of Doderlins bacillus
which utilise glycogen in vaginal epithelium to
produce lactic acid. Thus, the pH of vagina is
normally acidic which helps to prevent invasion
by exogenous microorganisms.
UTERUS AND FALLOPIAN TUBES
Round ligaments and uterosacral ligaments are
responsible for anteflexion and anteversion of
uterus.
Prolapse of uterus: It is the clinical condition
characterised by descent of uterus and cevix with
or without the vaginal walls towards the vulva and
the exterior. The most common cause of prolapse
is weakness of Mackenrodts and utero-sacral
ligaments due to repeated deliveries or due to old
age.
Endometriosis: It is the presence of endometrial
tissue outside the endometrial lining of uterus. The
most common site of endometriosis is pelvic
peritoneum and ovaries. This condition is
associated with pelvic pain, painful menses and
heavy bleeding during periods.
Infection of uterine tube is known as salpingitis.
Pain is referred to umbilicus due to same spinal
segment involvement. Sympathetic preganglionic
fibres T10 to L2 supply the uterine tube and skin of
the umbilicus is supplied by T10 spinal segment.
 194 Human Anatomy For Dental Students
Ligation of fallopian tubes during sterilization is
done at junction of medial 1/3rd and lateral
2/3rd.
OVARY
At birth 200,000 follicles are present in each ovary
while at puberty, they to decrease to 40,000.
Anovulation: It is the absence of ovulation.
Ovary lies in the floor of ovarian fossa. Inflamma-
tion of ovary may lead to irritation of obturator
nerve which is present in the ovarian fossa.
Therefore, patient complains of pain on the medial
side of the thigh and knee joint.
MALE GENITALIA
Varicocele: It is the dilatation and tortuousity of
pampiniform plexus of veins of testis. It is more
common on the left side because the left testicular
vein drains into the left renal vein at a right angle.
Also, loaded sigmoid colon may compresses the
left testicular vein.
S E C T I O N-1
Descent of testes: Testes develop in the lumbar
region, they lie in the iliac fossa at 4th month of
intrauterine life. At 7 month they reach the deep
inguinal ring. In the 8th month of intrauterine life
testes traverse inguinal canal and superficial
inguinal ring and reach scrotum at birth or just after
birth. Factors responsible for descent of testis are
a. Contractions from below, produced by
gubernaculum of testis which is a musculo-
fibrous cord, attached inferiorly to scrotum and
superiorly to testis and adjacent peritoneum.
b. Differential growth of body wall.
c. Intra-abdominal pressure.
d. Male sex-hormones.
e. Maternal gonadotrophins.
f. Increased intra-abdominal temperature.
g. Normally developed testis.
Cryptorchidism: It is the arrest or incomplete
decent of testis.
Temperature of each testis is 2 to 3C lower than
the body temperature. This is important to facilitate
spermatogenesis. Following factors are responsible
for temperature regulation.
a. Pampiniform plexus of veins helps in tempera-
ture regulation by counter current principle.
This is the most important factor.
b. Scrotal skin contains numerous sweat glands
c. Superficial fascia of scrotum is replaced by
dartos muscle. Contraction of dartos muscle
helps in regulation of temperature in cold
weather.
d. Absence of deep fascia in scrotum.
Azospermia: It is absence of sperms in the semen.
Prostate undergoes a benign hypertrophy of its
tissue in old age which can compress the prostatic
urethra. It leads to urinary symptoms mainly,
difficulty in urination, frequency of urination,
recurrent infections and occasionally acute
retention of urine. It is treated by surgically
enucleating the gland.
Carcinoma prostate spread to vertebral column
due to retrograde venous drainage of prostate into
internal vertebral venous plexus through para
vertebral vein of Batson.
 Chapter
16
Skin and Its Appendages
INTRODUCTION
Skin is also known as integument or cutis. It is the outer
covering of the body. Skin acts as an interface between
the body and environment. It also covers the external
auditory meatus and lateral aspect of tympanic
membrane. It continues with the mucus membranes of
the oral, nasal and urogenital orifices.
Skin is classified as thin or hairy skin which covers
greater part of body and thick or hairless skin as present
on palms and soles.
STRUCTURE OF SKIN (Fig. 16.1)
Skin consists of two layers namely,
1. Epidermis: It is the superficial avascular layer of
skin.
2. Dermis: It is the deep layer of skin.
Epidermis
Epidermis is made up of keratinized stratified squamous
epithelium. Epidermis of skin has a property of self
repair and renewing. The principal cells of this
Fig. 16.1: Diagrammatic representation of various layers of skin
epithelium are called keratinocytes. It also has cells
known as non keratinocytes which are usually derived
from sites outside the skin and have migrated into it.
They are melanocytes, langherhans cells, derived from
bone marrow; lymphocytes, derived from circulation;
Merkel cells or clear cells, are the sensory receptors.
Epidermis is made up of cells arranged into five strata
(layers). From deep to superficial ,these layers are:
(Fig. 16.2)
1. Stratum basale: It consists of a single layer of
C H A P T E R-16
columnar to cuboidal shaped cells lying on a
basement membrane. These cells are continuously
dividing and provide for the cell population. This
layer also contains melanocytes.
2. Stratum spinosum (prickle cell layer): It contains
more mature keratinocytes. This layer is made up
of several layers of closely packed cells that contain
prominent bundles of keratin filaments in their
cytoplasm. On routine histological staining these
cells appear shrunk and give rise to a characteristic
spinous appearance.
3. Stratum granulosum: This layer consists of 3 to 4
layers of cells containing compact keratin filaments
and degenerating nuclei and organelles.
 196 Human Anatomy For Dental Students
4. Stratum lucidum: It is present only in thick skin,
e.g, over palms and soles. This layer contains
nuclear debris. On staining it appears as an ill
defined clear zone below the densely staining
cornified layer.
5. Stratum corneum: It is the most superficial layer
and consists of closely packed layers of flattened,
polyhedral corneocytes known as squames. The
cells lack nucleus and organelles. They contain
dense arrays of keratohyalin filaments embedded
in the cytoplasm.
Stratum basal, spinosum and granulosum are
together known as stratum malpighii. The
superficial cells are continuously shed and
replaced with the full cycle taking about 28 days.
Dermis
Dermis lies deep to the epidermis (Figs 16.1, 16.2). It is
made up of irregular, dense connective tissue composed
of collagen fibers, elastic fibers and ground substance
with blood vessels, lymphatics, nerves and the skin
appendages. Dermis gives passage to the neurovascular
bundle. It is made up of the following two layers:
1. Papillary layer: It is the superficial layer, lying
immediately deep to epidermis. It provides the
nutritional support to the overlying epidermis
S E C T I O N-1
which is avascular and provides passage for the free
nerve endings.
2. Reticular layer: It lies deep to the papillary layer
and has thick bundles of collagen fibres with deep
reticular plexuses of nerves and blood vessels.
Fig. 16.2: Layers of dermis and epidermis
APPENDAGES OF SKIN
Appendages of skin consist of pilosebaceous unit, nails
and sweat glands (Figs 16.1 and 16.3).
Pilosebaceous Unit
It consists of hair and its follicle with the associated
sebaceous gland, arrector pili muscle and sometimes
apocrine glands.
Hairs: They are keratinized filamentous structures. Hairs
are present all over the body except lips, palms, soles,
flexor surfaces of digits, umbilicus, nipples, areola of
female breast, glans penis, clitoris, labia minora and
inner aspect of labia majora. Hairs vary in length from 1
mm to 1 meter. Hairs can be curly or straight. Hair is
made up of hair shaft with the inner and outer root
sheaths.
Hair follicle: It is an invagination of the epidermis into
the dermis which contains hair. Hair follicles provide
for the outer root sheath of hair. Structure of hair follicle
varies with the stage of hair growth. Growth is cyclical
and consists of three phases namely, anagen phase,
active growing phase; catagen phase, hair growth ceases;
telogen phase, resting stage.
Hair bulb: It is the lowermost expanded part of the hair
follicle. The inner most end of follicular epithelium of
the bulb encloses the dermal papilla. Dermal papilla is
an invagination of a layer of mesenchymal cells of dermis
with a central core of capillaries. These cells are
responsible for the growth of hair follicle.

Sebaceous Glands
These are saccular structures present in the dermis,
related to the hair follicle and arrector pili muscles. The
gland is made up of clusters of acini (alveoli) which are
enclosed in a basal lamina and a thin dermal capsule
having a rich capillary network. The secretions of the
acini are conducted by a thin duct which opens at the
infundibulum of the hair follicle.
These glands secrete sebum which forms the major
part of skin surface lipid. The sebum provides a
protective covering over the epidermis and prevents
water loss from skin. It may also be inhibitory to invasion
by fungal and ectoparasites present on surface of skin.
Secretion of sebum is under the control of androgens
produced by testes and adrenals.
Meibomian glands of eyelids are a type of sebaceous
glands.
Sebaceous glands are absent in palms, soles and flexor
aspect of the digits.
Apocrine Glands
These are large glands of dermis and hypodermis. They
develop as outgrowths of hair follicle and discharge the
secretion into the hair canal. They are a subset of the
sweat glands. Apocrine glands are present in axilla,
perianal region, periumbilical region, prepuce and
scrotum (in male), mons pubis and labia minora (in
female).
The secretions of apocrine glands are mainly
produced after puberty and are controlled by local
androgen and adrenaline levels. These secretions are
responsible for the peculiar body odour.
Specialized subtypes of these glands are:
Ceruminous glands of external auditory meatus
Glands of Moll of eyelids.
Arrector Pili Muscle
It is made up of smooth muscle cells forming small
fasciculi. Arrector pili is attached to the bulb of hair
follicle and is directed obliquely and superficially
towards the papillary layer of dermis (Fig. 16.1).
Sebaceous gland lies in the angle between the muscle
and hair follicle. Contraction of muscle leads to erection
of hair and may be involved in the expression of
secretions from sebaceous glands. The muscle is absent
in areas of face, axilla, pubis, eyelashes, eyebrows,
nostrils and external auditory meatus.
Nails (Figs 16.3 and 16.4)
Nails are homologous to the stratum corneum of general
epidermis. They consist of anucleated keratin filled
squames. Nails have following five components:
1. Nail plate: It is a rectangular shaped plate bounded
by nail folds. It is composed of matrix protein and
mineral elements. Calcium is one of the main
minerals in the plate.
Nail plate is convex longitudinally and transversely.
Its thickness increases from the proximal part to
distal. The colour of nail plate is generally
Skin and Its Appendages 197
Fig. 16.3: Nail and its related structures
Fig. 16.4: Nail and its related structures
C H A P T E R-16
translucent pink. A cresentic white area is seen
emerging from under the proximal nail fold. This
is known as lunule.
2. Nail folds: The lateral margin on each side of the
nail plate is bounded by a lateral fold of skin called
lateral nail folds. Nail plate extends under this
proximal nail fold.
3. Matrix: Matrix is seen a wedge of cells in which
the deeper part of nail plate is embedded.
4. Nail bed: It extends from lunule to hyponychium
underneath the nail plate. Nail bed cells
differentiate and contribute to the nail plate.
Beneath the epithelium of nail bed is dermis, which
is anchored to the periosteum of phalanyx. The
dermis is richly vascularized and numerous sensory
nerve endings are present in it.
5. Hyponychium: It is an area of epidermis, which
extends from the nail bed to the distal groove. It
underlies the edges of nail plate. It provides defence
against invasion by microorganisms.
Sweat Glands
They are a type of unbranched tuboalveolar glands
and are situated deep in dermis or hypodermis. The
secretory part is arranged in a convoluted or coiled
form. It is drained by a thin, straight or slightly
helical duct which passes through the dermis and
epidermis and opens via a rounded aperture on the
surface of skin.
Sweat glands are numerous all over the body. They
are absent over lip margins, nail bed, nipples, glans
penis or clitorodis, labia minora ,and over the
tympanic membrane.
These glands secrete a clear, odourless hypotonic
fluid known as sweat which contains Na+,Cl, with
small amounts of K+, HCO3, urea, lactate, amino
 198 Human Anatomy For Dental Students
acids, immunoglobulins etc. Sweat has a role in
thermoregulation of body.
In palms and soles sweat increases the sensitivity
of skin and helps in proper grip.
Arterial Supply of Skin
Blood flow to skin is 10 times its nutritional require-
ments. Vascular supply of skin is derived from arteriolar
plexuses derived from cutaneous branches of vascular
trunks, from perforating branches of intramuscular
vasculature and vessels of deep fascia of the
corresponding area. They supply the dermis,
pilosebaceous unit and sweat glands.
Nerve supply of Skin
Skin is supplied by cutaneous branches of nerves of
corresponding dermatomes. On reaching the dermis,
these divide and branch extensively to form a deep
reticular plexus and a superficial papillary plexus.
Reticular plexus supplies sweat glands, hair follicles and
large arterioles. Nerve fibres from papillary plexus pass
horizontally and vertically and terminate either in
relation to encapsulated receptors or as free nerve
terminals reaching the basal lamina of epidermis.
S E C T I O N-1
Functions of Skin
1. It protects the underlying structures from mech-
anical, chemical, osmotic, thermal and photopic
injury, within limits.
2. It acts as an effective barrier against invasion of
microbial organisms.
3. It is a major sense organ. It is richly supplied by
sensory receptors and nerve endings for pain, touch,
temperature, pressure and pleasurable stimuli.
4. It helps in regulation of body temperature by
vascular mechanism and sweating.
5. It acts as an endocrine organ as it helps in the
formation of vitamin D and also secretes certain
cytokines and growth factors.
6. It helps in mounting a primary immune response.
7. It helps in excretion of substances like ions of Na+,
Cl, H+, water and even urea in sweat.
8. It is not an actual absorptive surface but it can
absorb certain drugs when administered as trans-
dermal patches, e.g., hormonal patches, diclofenac
patches.
9. It is involved in socio-sexual communication
especially, facial skin helps in emotional signals.
10. Melanin present in skin helps protect against ultra-
violet rays and also damage by free radicals.
11. The texture, elasticity and structure of skin is an
important indicator of status of health of an
individual. Change in color or appearance of the
skin, loss of sensations can help in identifying
certain clinical conditions. Skin biopsy helps in
clinching the clinical diagnosis in certain disease
conditions.
12. Skin is important in preventing water loss from
body.
CLINICAL AND APPLIED ANATOMY
Dermatome is the part of skin supplied by a nerve
from single spinal segment. Knowledge of the
dermatomal supply of various parts provides clues
in clinical conditions to determine origin of
referred pain
Excessive shedding of superficial layers of
epidermis is seen in seborrhic dermatitis. It usually
occurs in areas bearing hair and is also known as
dandruff. It is usually caused by fungal infection
of superior layer of skin.
Comedone/Acne: This occurs due to blockage of
the ducts of sebaceous glands due to hyper-
keratinization (usually due to hormonal or external
environment changes). There is retention of sebum
which results in formation of small papules known
as comedone. Infection of these leads to acne.
Wound healing: Destruction of an area of skin due
to injury brings about complex and orderly
processes that result in repair and regeneration of
the area. This is known as healing. The various
stages of healing are described as:
Stage of inflammation: The wound is filled
with blood clot. Within 24 hours of injury,
neutrophils appear in the margins of wound
that are responsible for phagcytosis of clot and
debris in the wound. There is thickening of cut
edges of epidermis due to increase mitotic
activity. By day three neutrophils are replaced
by macrophages which faster the process of
phagocytosis. Fibroblasts appear in the margins
and start laying down collagen fibers.
Stage of proliferation: Granulation tissue fills
up the wound. It is a specialized tissue consist-
ing of proliferating new small blood vessels and
proliferating fibroblasts. It provides the area
with new vascular supply. The epidermal cells
proliferate and regain normal thickness and
differentiation and they cover the wound. The
collagen fibers form bridges across the wound,
under the epithelium.
Stage of maturation: There is continued
accumulation of collagen and proliferation of
fibroblasts during 2nd week and it gradually
replaces the granulation tissue. The inflamma-
tion settles down by end of one month. The
bridging of wound is complete with scar forma-
tion and gets covered by the intact epidermis.
The dermal appendages that are destroyed are
lost permanently.
Fingerprinting: It is the science of studying
papillary ridges (PR). PR are surface projections of
epidermis that occur secondary to underlying
dermal papillae and are seen in areas of palms,
soles and flexion surfaces of digits. Each individual
has a specific pattern of this papillary ridges which
are arranged in arches, loops and whorls. These
are not affected by aging and are unique to an
individual. Study of patterns of papillary ridges in
the form of their prints is dermatoglyphics. This is
of considerable use in forensic medicine.
Chapter
17 Review of General and
Systemic Anatomy
GENERAL ANATOMY
Q. What is anatomical position and its importance?
Ans. Anatomical position: Body is erect, the eyes face
forward, and arms are kept by the side with
palms facing forward. The legs are kept together
with feet directed forwards.
Importance of anatomical position: All
structures of our body are described in relation
to this position, irrespective to any body posture
in space.
Q. Define lithotomy position?
Ans. Person lies supine with hips and knees
semiflexed, thighs abducted and feet strapped.
Q. What are functions of cell membrane or plasma
membrane?
Ans. Functions of plasma membrane
1. Maintains the shape of a cell.
2. It is selectively permeable to Na+, K+, Ca++, Cl
and HCO3 through special channels.
3. Amino acids, proteins, nucleic precursors pass
through channels in the membrane, either
actively or passively.
4. Lipid soluble substances pass through cell
membrane.
5. Various receptors are present on the cell
membrane.
6. It aids in recognition of identical cells with
the help of cell coat which is specific to those
cells.
7. It helps in endocytosis and exocytosis.
Q. What are the types of intercellular junctions?
Ans. Intercellular and extracellular matrix junctions
are (Fig. 2.5):
1. Macula adherens (desmosome): Inter-
cellular gap of 25 nm bridged by filaments
2. Zonula adherens: Intercellular gap of 20 nm
filled by adhesive non-stainable material,
there are no filaments. These junctions are
found in the apical region of epithelial,
endothelial and mesothelial cells.
3. Zonula occludens (tight junctions): There is
no intercellular gap and the membranes of
adjacent cells come in close contact.
4. Gap junction: Intercellular gap of 3 nm
traversed by numerous dense beats arranged
in a hexagonal array.
5. Fascia adherens: It is similar to zonula
adherens. It is present between smooth muscle
cells and intercalated discs of cardiac muscle
cells.
6. Hemidesmosomes: They are known as
anchoring junctions between bases of
C H A P T E R-17
epithelial cells and basal lamina.
Q. Enumerate different types of epithelium.
Ans. Various types of epithelium are:
1. Simple squamous epithelium
2. Simple columnar epithelium
3. Simple cuboidal epithelium
4. Stratified squamous epithelium
5. Stratified columnar epithelium
6. Stratified cuboidal epithelium
7. Pseudostratified columnar epithelium
8. Transitional epithelium
Q. Where do you find simple squamous
epithelium?
Ans. Simple squamous epithelium is present at the
following sites (Fig. 3.1):
1. Blood vessels 2. Alveoli
3. Bowmans capsule 4. Peritoneum
5. Pleura
Q. Enumerate the sites where simple cuboidal
epithelium is present?
Ans. Simple cuboidal epithelium is found at the
following sites (Fig. 3.2):
1. Thyroid follicles
2. Small ducts of digestive glands
3. Germinal epithelium of ovary
4. Retinal pigment epithelium
5. Respiratory bronchiole
Q. Enumerate the sites where simple columnar
epithelium is present?
Ans. Simple columnar epithelium is present at the
following sites (Fig. 3.3):
1. Uterine tube and uterus
2. Small bronchi and bronchioles
 200 Human Anatomy For Dental Students

3. Tympanic cavities histocytes, plasma cells, mast cells, pigment

4. Auditory tube cells , lymphocytes and monocytes.
5. Epididymis
Q. What are the functions of connective tissue?
6. Ependyma of spinal cord
Ans. Functions of connective tissue are:
7. Gall bladder
1. Binds together various structures.
8. Gastrointestinal tract (Stomach, duodenum,
2. Facilitates passage of neurovascular bundle.
jejunum, ileum, colon, rectum)
3. In the form of deep fascia, connective tissue
Q. Where do you find pseudostratified ciliated keeps the muscles and tendons in position,
columnar epithelium gives origin to muscles and forms different
Ans. Pseudostratified ciliated columnar epithelium is functional compartment of muscles.
present in (Fig. 3.4) 4. In the form of ligaments, bind the bones.
1. Trachea 5. Attaches muscle to the bone with the help of
2. Bronchi tendons and facilitates a concentrated pull.
3. Ductus deferens 6. Facilitates venous return in lower limb with
4. Male urethra the help of deep fascia.
7. Helps in wound repair due to the presence of
Q. Where do you find non-keratinized stratified
fibroblasts.
squamous epithelium
Ans. Non-keratinized stratified squamous epithelium Q. Define bursa.
is present at the following sites (Fig. 3.5): Ans. It is a sac of synovial membrane supported by
1. Oral cavity dense irregular connective tissue. It helps to
2. Tongue reduce friction. Hence, it is found at those places
3. Tonsils where two structures which move relative to each
S E C T I O N-1

4. Pharynx other in tight apposition. Bursae present at

5. Esophagus different places are:
6. Vagina 1. Subcutanous bursaBetween skin and bone.
7. External urethral orifice 2. Submuscular bursaBetween muscle and
8. Cornea bone.
9. Conjunctiva 3. Subfascial bursaBetween fascia and bone.
4. Interligamentous bursaThe bursa between
Q. Enumerate the sites where stratified cuboidal two ligaments.
epithelium is present?
Ans. Stratified cuboidal epithelium is present at (Fig. 3.7): Q. What is adventitious bursa?
1. Ducts of sweat glands and mammary gland Ans. Adventitious bursa develops over bony parts
2. Seminiferous tubules which are subjected to much friction or pressure.
3. Ovarian follicles It develops due to physiological reasons and is
not present normally, e.g., Tailors ankle, Porters
Q. Where do you find stratified columnar shoulder, Weavers bottom.
epithelium?
Ans. Stratified columnar epithelium is found at the Q. Name the types of bones in the body?
following sites (Fig. 3.8): Ans. According to shape, ossification and presence of
1. Fornix of conjunctiva cavity, bones are classified as follows:
2. Anal mucous membrane 1. Long bone 2. Short bone
3. Urethra 3. Flat bone 4. Irregular bone
5. Pneumatic bone 6. Sesamoid bone
Q. Where do you find transitional epithelium? 7. Accessory bone
Ans. Transitional epithelium is present at the
following sites (Fig. 3.9): Q. Give examples of pneumatic bones.
1. Pelvis of kidney 2. Ureter Ans. Maxilla, sphenoid, ethmoid and squamous part
3. Urinary bladder 4. Urethra of frontal bone.
Q. Enumerate cells present in connective tissue. Q. What is a sesamoid bone
Ans. Two types of cells are present in connective Ans. These bones develop in the tendon of a muscle.
tissues They share the load of the tendon and change
1. Resident cells namely, fibroblasts, adipocytes the direction of pull of the tendon. Periosteum is
and mesenchymal stem cells absent in these bones. Examples, patella, pisi-
2. Migrant cells: These are derived from blood form, fabella.
circulation and consist of macrophages or

Q. What is arterial supply of a long bone?
Ans. A long bone is supplied by 4 sets of arteries
namely (Fig. 5.10):
1. Nutrient artery
2. Metaphyseal arteries
3. Epiphyseal arteries
4. Periosteal arteries
Q. What is the composition of a bone?
Ans. Bone is made up of 40% organic component and
60% inorganic component.
Organic component consists of type I collagen
fibres with osteoblasts, osteoclasts and osteo-
cytes.
Inorganic component contains calcium
hydroxyapatite crystals Ca++ (H3O)2 (PO4)6 (OH)2
with small amounts of magnesium, sodium and
carbonate.
Q. What are characteristic features of cartilage?
Ans. Characteristic features of cartilage are
1. Cartilage is avascular. It receives its nutrition
through diffusion from the nearest capillaries.
2. Cartilage has no nerves. Hence it is insensitive
to pain.
3. Cartilage is surrounded by perichondrium.
4. Cartilage grows by appositional as well as
interstitial method of growth.
5. Cartilage has low antigenicity due to lack of
lymphatics, homogeneous transplantation of
cartilage is possible without much risk of
rejection.
Q. What are different types of cartilages and their
distribution?
Ans. Different types of cartilages:
1. Hyaline cartilage (Fig. 5.14)
Distribution: Articular cartilage, thyroid
cartilage, cricoid cartilage, lower part of
arytenoid cartilage, tracheal rings, costal
cartilages, bronchial cartilages, nasal
cartilage.
2. Elastic cartilage (Fig. 5.15)
Distribution: Pinna of external ear, epiglottis,
corniculate and cuneiform cartilages, apex of
arytenoid cartilage, auditory tube, external
auditory meatus.
3. White fibro-cartilage (Fig. 5.16)
Distribution: Intervertebral disc, interpubic
disc, menisci of knee joint, articular disc of
temporaomandibular, sternoclavicular and
inferior radioulnar joints, labra of glenoid and
acetabulum.
Q. What are characteristics of skeletal muscle?
Ans. Characteristics of skeletal muscle are
1. It is the most abundant muscle in the body
and is attached to the skeletal frame work.
Review of General and Systemic Anatomy 201
2. It is supplied by spinal nerves. It is under
voluntary control except muscles of pharynx
and diaphragm.
3. Skeletal muscle fibres respond quickly to
stimuli, undergo rapid contraction and get
fatigued easily.
4. Skeletal musculature helps in adjusting the
individual to his external environment.
5. Highest control of muscle activity is the
cerebral cortex.
6. Histological sections of muscle fibres show
cylindrical multi-nucleated fibres with cross
striations seen under microscope.
Q. What are characteristics of smooth muscle?
Ans. Characteristics of smooth muscle are:
1. Smooth muscles surround the various viscera.
2. They are supplied by autonomic nervous
system. They are less dependent on neuronal
control.
3. They respond slowly to stimuli with a
sustained contraction, do not fatigue easily.
4. They help in regulating internal environment.
C H A P T E R-17
5. Histological sections of muscle fibres show
closely packed spindle shaped fibres with
single central nucleus. Cross striations are not
seen under microscope.
Q. What are characteristics of cardiac muscle?
Ans. Characteristics of cardiac muscle are
1. Cardiac muscle forms the myocardium of
heart.
2. Cardiac muscle is supplied by autonomic
nervous system and has involuntary control.
3. Automatic and rhythmic contractions are seen
in cardiac muscle. Nervous control is only to
maintain the rhythm of cardiac muscle.
4. Histological sections show interconnected
cylindrical fibers joined by intercalated discs
with fine striations.
5. The fibres of cardiac muscle function as a
single mass, i.e., syncytium.
Q. What are different types of fibrous joint?
Ans. Types of fibrous joints:
1. Sutures (Fig. 5.17)
2. Syndesmosis (Fig. 5.18)
3. Gomphosis (Fig. 5.19)
Q. Give examples of secondary cartilaginous
joints.
Ans. Manubriosternal joint, symphysis pubis,
intervertebral disc.
Q. What are different types of synovial joint?
Ans. Different types of synovial joints are
1. Plane joint, e.g. Acromio-clavicular joint.
2. Uniaxial joint
Hinge joint, e.g. Elbow joint.
 202 Human Anatomy For Dental Students
Pivot joint, e.g. Superior radioulnar joint.
Condylar joint, e.g. Knee joint.
3. Biaxial joint
Ellipsoid joint, e.g. Wrist joint.
Saddle joint, e.g. Ist carpo-metacarpal joint.
4. Polyaxial joint
Ball and socket joint, e.g. shoulder joint.
Q. What is Hiltons law?
Ans. Hiltons law states that, nerve supplying a joint
also supplies the muscles acting on the joint and
the skin over the joint.
Q. What is collateral circulation?
Ans. When an anastomotic channel enlarges to
provide an alternative route for circulation of
blood following the interruption of flow in the
primary artery it is known as collateral
circulation. Collateral circulation develops
rapidly in young people.
Q. How many spinal nerves are there in the body?
Ans. There are 31 pairs of spinal nerves. These are:
1. 8 Cervical spinal nerves
2. 12 Thoracic spinal nerves
3. 5 Lumbar spinal nerves
S E C T I O N-1
4. 5 Sacral spinal nerves
5. 1 Coccygeal spinal nerve
Q. Enumerate the different layers of epidermis of
skin?
Ans. Epidermis is divided into five layers. From deep
to superficial, these are:
1. Stratum basale
2. Stratum spinosum
3. Stratum granulosum
4. Stratum lucidum
5. Stratum corneum
Q. What is the largest round cell in the human
body?
Ans. Ovum, its size is 120-140.
Q. Enumerate the endocrine organs in the body?
Ans. Important endocrine glands in the body are
(Fig. 14.1):
1. Pituitary gland (hypophysis-cerebri)
2. Pineal gland (epiphysis cerebri)
3. Thyroid glands
4. Parathyroid glands
5. Adrenals
6. Islets of Langerhans (pancreas)
7. Ovaries, in females
8. Testes, in males
9. Placenta, during pregnancy
Q. What is anthropometry?
Ans. It is the study of variations in the dimensions
and bodily proportions of various bones in
different races and of variations with age and
sex in a single race.
Q. Why is symphysis menti is not a true secondary
cartilagenous joint?
Ans. The fusion of two halves of the mandible takes
place at the age of 3 years. Therefore, it behaves
like a primary cartilaginous joint.
Q. What is the function of articular disc?
Ans. Articular disc performs the following functions:
1. It divides the joint cavity into two, this
increases the range of movement.
2. It acts as shock absorber.
3. It deepens the joint cavity.
Q. Where does the nerve supply of a joint lie?
Ans. Nerve supply of a joint lies in the capsule of the
joint and its ligaments. Articular cartilage is
insensitive.
Q. What is Wolffs law?
Ans. Wolffs law states that osteogenesis is directly
proportional to stress and strain.
Q. Enumerate the unpaired bones in the body?
Ans. Unpaired bones are:
1. Frontal 2. Occipital
3. Sphenoid 4. Ethmoid
5. Vomer 6. Mandible
7. Hyoid 8. Vertebrae
9. Sternum 10. Sacrum
11. Coccyx
Q. What is a dermatome?
Ans. It is the part of the skin supplied by a single spinal
segment.
Q. What is law of union of epiphysis?
Ans. It states that the epiphyseal centre which appears
first, unites last and epiphyseal centre which
appears last unite first.
Q. Define aponeurosis?
Ans. It is a regular dense connective tissue associated
with the attachment of muscles. It is made up of
densely arranged collagen fibres.
Q. Name the areas of body which do not bear any
hairs.
Ans. These are following:
1. Palms
2. Soles
3. Dorsal surfaces of distal phalanges
4. Umbilicus
5. Glans penis
6. Inner surface of the prepuce
7. Inner surfaces of the labia majora
8. Labia minora
9. Surfaces of the eye-lids
10. Exposed margins of the lips
Q. What are end arteries? Enumerate them?
Ans. End arteries are the arteries which do not have
any anastomosis. Following are the end arteries:
 Review of General and Systemic Anatomy 203

1. Central artery of the retina. It is considered as 12. Veins, less than 2 mm in diameter
an absolute end artery
Q. How does the lymph node enlarge? What is the
2. Central branches of cerebral arteries
effect?
3. Splenic artery
Ans. The cells of lymph node are responsible for
4. Vasa-recta of the small gut
filtering bacteria or antigens and induce
5. Coronary arteries (anatomically they are not
inflammation or cell-mediated immune reaction,
end-arteries although functionally they
either of which can produce swelling of the node.
behave like end-arteries)
Hence, the involved node gets enlarged. When
6. Appendicular artery
nodes are swollen by inflammation or blocked
7. Supraduodenal artery of Wilky
by metastatic cells, edema occurs.
8. Metaphyseal arteries
9. Arcuate arteries of the kidney Q. Enumerate the tissues and organs devoid of
lymphatics?
Q. What are the areas in the body devoid of
Ans. Organs devoid of lymphatics are:
capillaries?
1. Central nervous system
Ans. Following are the areas devoid of capillaries:
2. Bone marrow
1. Epidermis of the skin
3. Eye ball
2. Hair
4. Intralobular portion of the liver
3. Nails
5. Internal ear
4. Cornea of the eye
6. Red pulp of spleen
5. Lens
7. Fetal-placenta
6. Articular hyaline cartilages
8. Areas devoid of capillaries
Q. Where do you find arterio-venous anastomosis

C H A P T E R-17
Q. What is the function of neuron?
in the body?
Ans. Neuron is the structural and functional unit of
Ans. Following are the sites of arterio-venous
nervous system and is responsible for
anastomosis:
conduction, reception, integration, association,
1. Tip of nose 2. Lips
interpretation, transformation and analysis of
3. Eye-lids 4. Lobule of ear
impulses.
5. Finger tips 6. Nail-beds
Q. What are the different type of fibres in
Q. Which arteries are formed by union of other
peripheral nerve?
arteries?
Ans. Peripheral nerve carries the following fibres
Ans. Following arteries are formed by fusion of other
1. Sensory
two arteries:
2. Motor
1. Basilar artery, due to union of vertebral arteries
3. Preganglionic autonomic
2. Anterior spinal artery, due to fusion of anterior
4. Postganglionic autonomic
spinal branches of vertebral arteries
3. Azygos arteries of the vagina due to Q. Where do you find the pseudoganglia in relation
anastomosis between the branches of uterine to nerves?
and vaginal arteries. Ans. Psendoganglia are present with following nerves.
1. Nerve to teres minor muscle
Q. Which large size artery is made up of only
2. Posterior interosseous nerve
endothelium and where is it present?
3. Median nerve at wrist
Ans. Internal carotid artery in the cavernous sinus.
4. Lateral terminal branch of deep peroneal
Q. Enumerate the valveless veins? nerve
Ans. Following veins are valveless:
Q. What is the neurotransmitter of sympathetic
1. Superior venacava and inferior venacava
nervous system?
2. Pulmonary veins
Ans. Noradrenaline is the neurotransmitter of
3. Portal vein
sympathetic nervous system except at the nerve
4. Hepatic veins
endings for sweat glands and blood vessels of
5. Renal veins
muscles where there are cholinergic neurons and
6. Uterine veins
neurotransmitter is acetylcholine.
7. Ovarian veins
8. Cerebral veins Q. What is the neurotransmitter of parasympa-
9. Spinal veins thetic nervous system?
10. Veins of spongy tissue of bone Ans. Acetylcholine is the neurotransmitter of
11. Umbilical veins parasympathetic nervous system.
 204 Human Anatomy For Dental Students
SYSTEMIC ANATOMY
Q. What is skeletal system?
Ans. Skeletal system is composed of skeleton made
up of bones which provide the basic structure to
the body (Fig. 5.1).
Q. What is axial skeleton?
Ans. It consists of skull, vertebral column, thoracic
cage and hyoid bone.
Q. What is appendicular skeleton?
Ans. It consists of bones of upper and lower limbs
Bones forming upper limb skeleton are clavicle,
scapula, humerus, radius, ulna, 8 carpal bones:
scaphoid, lunate, triquetral, pisiform, trapezium,
trapezoid, capitate, hamate, 5 metacarpals and
14 phalanges.
Bones forming lower limb skeleton: ilium,
ischium, pubis, femur, patella, tibia, fibula, 8
tarsal bones: talus, calcaneum, navicular, cuboid
and three cuneiform bones 5 metatarsals, 14
phalanges.
Q. What are the functions of skeleton?
S E C T I O N-1
Ans. 1. Skeleton forms the structural framework of the
body.
2. It supports the body.
3. It transmits the weight of the body.
4. Bones and joints act as a biochemical levers
on which muscles act to produce motion.
5. Skeleton of head and vertebral column protect
the vital organs namely brain and spinal
cord.
6. Skeletal frame work of thoracic cage (ribs and
sternum) provides for the respiratory
movements and protects the heart and lungs.
7. Bones serve as a reservoir of ions (Ca++, PO4,
CO3) in the mineral homeostasis of the body.
8. Bone marrow in adults is the source of red
blood cells, granular white blood cells and
platelets.
9. Cartilage is a precursor for bone formation.
Most of the bones are laid down on cartilage.
It also provides structural support in areas
like ear, larynx and trachea where rigidity is
not require.
Q. What is muscular system?
Ans. It consists of muscles and tendons
Functions of muscular system:
1. Responsible for movement of skeleton and
various hollow viscera of the body.
2. Is the site of heat production in body.
Q. What are the types of muscles present in human
body?
Ans. Muscle are divided into three types based on their
location in relation to various body parts and on
the differences in microscopic structure.
1. Skeletal muscle
2. Smooth muscle
3. Cardiac muscle
Q. What are the parts of respiratory system?
Ans. It consists of the following parts (Fig. 11.1):
1. Upper respiratory tract: Nose and paranasal
sinuses, pharynx, larynx, trachea with two
principal bronchi
2. Lower respiratory tract consisting of broncho-
pulmonary tree on each side with two lungs
enclosed in pleura.
Musculo-skeletal framework of thorax
enclosing the lungs and pleura is made up of
thoracic cage, intercostal muscles and
diaphragm.
Q. Name the muscles of inspiration?
Ans. 1. External intercostal muscles
2. Diaphragm
3. Accessory muscles: Erector spinae, scalene
group of muscles, sternocleidomastoid,
pectoralis major, serratus anterior, quadratus
lumborum.
Q. Name the muscles of expiration?
Ans. Expiration is passive and occurs due to recoil of
lungs. In forced expiration following muscles are
involved:
1. Anterior abdominal wall muscles namely,
rectus abdominis, internal oblique and
transverse abdominis
2. Internal intercostal muscles
Q. What are the components of lymphatic system?
Ans. (Fig. 10.1)
1. Lymph and lymph vessels namely, lymph
capillaries, lymph vessels proper and terminal
lymph ducts (trunks)
2. Lymphoid tissue and lymphoid organs
a. Primary lymphatic follicles
b. Lymph nodes
c. Spleen
d. Thymus
e. Bone marrow
f. Mucosa associated lymphoid tissue
Q. What are the parts of excretory system?
Ans. The excretory function of the body is primarily
carried out by a pair of kidneys. Kidneys are
responsible for the filtration of blood and removal
of waste substances like urea, creatinine, uric acid
and others from the body. The filtrate undergoes
a process of reabsorption and secretion which
results in the formation of urine. The urine is
 Review of General and Systemic Anatomy 205

carried from the kidneys to the urinary bladder arteries, dorsal metatarsal arteries etc.
by the ureters and is expelled to exterior during 4. Arterioles and capillaries
micturition through urethra. Kidneys, ureters, 5. Large veins: Superior vena cava, Inferior vena
urinary bladder and urethra form the urinary cava.
system. This system helps in regulating the solute 6. Medium and small size veins
and water content of the body there by, regulating 7. Venules
the composition and volume of extracellular
Q. Enumerate components of endocrine system?
fluid.
Ans. (Fig. 14.1)
The other excretory organs of the body are skin
1. Pituitary gland
(produces sweat), GIT (excretes faeces),
2. Hypothalamus
respiratory tract (excretes CO2).
3. Pineal gland
Q. Name the parts of male reproductive system. 4. Thyroid gland
Ans. It consists of the following parts (Fig. 15.3): 5. Parathyroid gland
1. Penis 6. Thymus gland
2. Scrotum 7. Adrenal gland
3. Testes 8. Islets of Langerhans
4. Epididymis 9. Ovary and testis
5. Spermatic cord 10. Other organs with endocrine functions are
6. Ductus deferens kidneys, mucosa of GIT, skin, placenta
7. Seminal vesicles (during pregnancy).
8. Ejaculatory duct
Q. Name the parts of digestive system?
9. Prostate gland
Ans. (Fig. 12.1)

First five form external genitalia of male.
Q. Name the parts of female reproductive system.
Ans. The female reproductive system consists of:
1. External genitalia (Fig 15.1): Female external
genitalia is also known as vulva. It includes.
a. Mons pubis
b. Labia majora
c. Labia minora
d. Vestibule
e. Hymen
f. Clitoris
g. Bulb of the vestibule
h. Greater vestibular glands (Bartholins
gland)
i. Vaginal orifice
Q. Name the parts of brain?
2. Internal genitalia (Fig. 15.2)
Ans. Brain is divided into three parts namely (Figs 7.2
a. Uterus and cervix
b. A pair of fallopian tubes
c. Vagina
d. Two ovaries
Q. Name the parts of cardiovasulcar system?
Ans. Cardiovascular system is made up of heart and
blood vessels (Fig. 8.17).
Q. What is the extent of spinal cistern? Mention its
Blood vessels are classified into
1. Large arteries, e.g., aorta, common carotid
Ans. The spinal cistern extends from L1 to S2 vertebral
arteries, external and internal carotid arteries,
arteries of upper limb like axillary arteries,
common iliac arteries, external and internal
iliac arteries, etc.
2. Medium and small arteries: brachial arteries,
radial arteries, ulnar arteries, anterior tibial
arteries, posterior tibial arteries, dorsalis pedis
C H A P T E R-17
1. Oral cavity
2. Pharynx
3. Oesophagus
4. Stomach
5. Small intestine: Duodenum, jejunum, ileum.
6. Large intestine: Caecum, appendix, ascending
colon, transverse colon, descending colon,
sigmoid colon, rectum and anal canal.
It is associated with various organs that help in
digestion and absorption of food. These are
1. Three pairs of salivary glands: Parotid,
submandibular and sublingual glands.
2. Liver and biliary tract
3. Pancreas
and 7.3):
1. Forebrain, made up of two cerebral
hemispheres
2. Midbrain, consisting of cerebral peduncles
3. Hindbrain, consisting of pons, medulla and
cerebellum
applied importance.
level. CSF is drawn during lumbar puncture
through the spinal cistern.
Q. Name the vessels involved in subdural, subara-
chnoid, extradural and intracerebral haemor-
rhages?
 206 Human Anatomy For Dental Students
Ans.
Site of haemorrhage Vessels involved
Subdural Superficial cerebral veins
Subarachnoid Arteries (usually in circle of Willis)
Extradural Middle meningeal vein and artery
Intracerebral Central branches of middle cerebral arteries
Q. What is the surface area of choroid plexus?
Ans. 150300 sq.cm.
Q. Name the structures which form the blood brain
barrier?
Ans. Following structures form the blood brain barrier
1. Non-fenestrated endothelium of capillaries.
2. Basement membrane of endothelium.
3. Perivascular feet and cell bodies of astrocytes.
4. 200 A intercellular space between astrocytes
and neurons.
Q. What forms the blood CSF barrier?
Ans. Blood CSF barrier is formed by:
1. Fenestrated capillary endothelium.
S E C T I O N-1
2. Incomplete sheath of pial stroma.
3. Continuous simple cuboidal epithelial
ependyma with apical tight junctions resting
on a basement membrane.
Q. What constitutes the brain CSF barrier?
Ans. Brain CSF barrier is formed by
1. Extra choroidal ependymal cells with gap
junctions.
2. Basement membrane of cells.
3. Subependymal glial membrane.
Q. Which is the first cranial nerve to be compressed
in raised intracranial tension and why?
Ans. 6th cranial nerve (abduscent nerve) is the first
and most common cranial nerve to be damaged
by raised intracranial tension because it has an
elongated course in the subtentorial compart-
ment of brain.
Q. What is the anatomical basis of headache after
a lumbar puncture?
Ans. Due to aspiration of CSF during lumbar puncture
there may be slight stretching of the nerve endings
in duramater that is perceived as headache in
some patients. It usually lasts for 624 hours by
which time the CSF regains its original volume.
Q. How many fibres are there in each pyramidal
tract?
Ans. 1 million fibres.
Q. Which lower motor neurons are activated by
the corticospinal tract in the spinal cord?
Common cause
Shearing forces of head injury
Rupture of aneurysm
Fracture of skull
Hypertension
Ans. and motor neurons are activated simulta-
neously by the fibers of corticospinal tract.
Q. When does myelination of the corticospinal tract
start?
Ans. Myelination of corticospinal tract starts at 3 years
of age and completes by puberty.
Q. What type of paralysis is seen when the
corticospinal tract is damaged?
Ans. Upper motor neuron type of paralysis occur due
to lesions of corticospinal tract. It is character-
ized by
1. Spastic paralysis
2. Hyper reflexia: Exaggerated tendon reflex
3. Hyper tonia: Increased muscle tone
4. Babinskis extensor response is positive.
Isolated lesions of corticospinal tract occur rarely
and generally they are associated with lesions of
extrapyramidal tracts also.
If corticospinal tract is involved above the
pyramidal decussation in medulla then
contralateral side will be affected. Below
pyramidal decussation, same side of the body
will be affected.
Q. What is positive Babinski sign?
Ans. Positive Babinski sign is when the lateral aspect
of the sole is scratched and it leads to dorsiflexion
of great toe and fanning out of other toes
Babinski sign is positive in infants and
poisoning besides pyramindal tract lesions.
In normal individuals scratching of sole leads to
dorsiflexion of all toes.
Q. What are the effects of compression of the
dorsal root of spinal nerve?
Ans. The manifestations of dorsal root compression
are
1. Sharp pain over the affected dermatome
2. Segmental cutaneous vasodilatation due to
reflex autonomic response.
3. Sometimes parasthesia may be the manifesta-
tion.
Q. Enumerate the sensations that are lost in a
complete lesion of the dorsal root of spinal
nerve.
 Review of General and Systemic Anatomy 207

Ans. Ipsilateral segmental loss of following sensations 2. Hypertonia

occur 3. Hyper reflexia due to reduction of inhibitory
1. Loss of pain, touch, temperature and pressure influences upon the gamma motor neurons.
sense 4. Spasticity of the muscles
2. Loss of conscious proprioception
Q. What is anterior spinal artery syndrome?
3. Loss of unconscious proprioception
Ans. Anterior spinal artery or trunk supplies the
4. Loss of sensations from viscera
anterior 2/3rd of the cross section of the spinal
5. Loss of reflex actions
cord. Occlusion of anterior spinal artery leads to
Q. What will be the effect of a complete lesion of following manifestations.
the posterior column of white funiculus? Manifestations at the site of lesion
Ans. There will be a loss of the following sensation at
Part of cord involved Manifestation
and below the level of lesion
1. Loss of position sense a. Motor Anterior grey column Flaccid paralysis
2. Loss of vibratory sense with atrophy.
3. Loss of discriminative touch b. Sensory Spinothalamic tracts Loss of pain and
temperatue
A common cause of lesion of the posterior white
sensations
column is tabes dorsalis. Patient will present as bilaterally.
a case of sensory ataxia. Rombergs sign is
positive.
Manifestations below the level of lesion
Q. What is lower motor neuron?
Ans. A lower motor neuron consists of axons of ventral Site of involvement Manifestation

C H A P T E R-17
horn cells that supply a motor end plate. It of cord
involves alpha and gamma motor neurons and a. Motor Pyramidal tract Spastic paralysis.
preganglionic autonomic fibres in the b. Sensory Spinothalamic tract Loss of sensation
thoracolumbar and sacral region. Following are of pain and
temperature on
the characteristic features of lower motor neuron
both sides.
paralysis (LMN)
Q. What is a lower motor neuron paralysis? Q. How many areas are classified by Brodman in
Ans. 1. Segmental paralysis of voluntary and reflex the cerebral cortex?
movements Ans. Brodmanns classification divides the cerebral
2. Loss or diminished muscle tone due to loss of cortex into 52 areas.
stretch reflex. This is called as atonia or
Q. What will be the effect of lesion of area no. 4 or
hypotonia
motor area?
3. Muscle paralysed is flaccid
Ans. Initially there will be flaccid paralysis of
4. Segmental loss of reflexes Both superficial
contralateral side. But generally there is no
and deep tendon reflexes are lost
isolated lesion of area 4. It is usually associated
5. Fasciculations after few weeks
with lesion of area no. 6 and 8. In such cases
6. Atrophy or wasting of affected muscles
there is an upper motor neuron paralysis.
7. If autonomic fibres are involved the
corresponding area of skin becomes cyanotic Q. What is the effect of lesion of prefrontal cortex?
and dry. There is lysis of bones and joints. Ans. It is generally seen due to a tumor of frontal lobe
Disturbances in function of the rectum and where patient presents with the following
urinary bladder are also present. 1. Lack of self responsibility
2. Vulgarity in speech
Q. What is upper motor neuron?
3. Clownish behavior
Ans. Fibres of pyramidal tract (descending tracts above
4. Feeling of euphoria
the ventral horn cells) are known as upper motor
neurons. Q. What will be the effect of lesion of area no. 40.
Ans. Astereognosis and tactile aphasia.
Q. What is upper motor neuron paralysis?
Ans. Following are the manifestations of upper motor Q. What is word blindness?
neuron paralysis (UMN) Ans. When patient is unable to recognise the written
1. Loss or impairment of voluntary movements words even when written by the patient himself.
of the affected part
 208 Human Anatomy For Dental Students

This is known as word blindness. It is seen in Centre Function

lesion of area no. 39.
Q. What will be the effect of lesion of area no. 22?
Ans. In the lesion of area no. 22, patient will develop
sensory aphasia or word deafness. Patient
cannot interpretate words spoken by himself or
others.
Q. What are speech centres? How does speech
develop in a child?
Ans. Following are the four speech centres
interconnected with each other. They help in the
development of speech in a child.
Area no. 39, 40 and 22 are interconnected with
each other. The child starts learning speech with
the help of these areas. Area no. 22 is further
connected to the area no. 45, 44 with the help of
arcuate fasciculus. Area 45, 44 is the motor speech
area that controls the movement of muscles
involved in all three components of speech.
S E C T I O N-1
1. Area no. 22 Comprehend spoken language and
recognise familiar sound and words.
2. Area no. 39 Recognise the object by sight and store
visual images.
3. Area no. 40 Recognise the object by touch and
proprioception
4. Area no. 45, 44 It is the motor speech area which controls
the movement of lips, tongue, larynx,
pharynx and palate.
Q. What will be the effect of lesion of area no. 45,
44?
Ans. This will lead to loss of fluency of speech or motor
aphasia.
Q. What is the effect of lesion of area no. 22 or
Wernickes area?
Ans. This leads to sensory aphasia. Fluency of the
speech is maintained but person speaks
nonsense words in between.
 Section-2: Head and Neck
18. Osteology of Head and Neck ..................................... 211-256
19. Scalp and Face .............................................................. 257-270
20. Eye and Orbit ................................................................ 271-300
21. Dura Mater, Intra Cranial Venous Sinuses ............... 301-308
22. Pituitary Gland ............................................................. 309-312
23. Temporal and Infratemporal Regions ....................... 313-328
24. Parotid and Submandibular Regions ........................ 329-338
25. Neck and Its Triangles ................................................. 339-364
26. Back of Neck and The Back ........................................ 365-370
27. Oral Cavity .................................................................... 371-388
28. Nose and Paranasal Sinuses ....................................... 389-398
29. Pharynx .......................................................................... 399-410
30. Larynx ............................................................................ 411-422
31. Ear................................................................................... 423-434
32. Cervical Viscera and Deep Muscles of Neck ............ 435-442
33. Lymphoid Tissue and Joints of Head and Neck...... 443-448
34. Surface Anatomy of Head and Neck......................... 449-460
35. Review of Head and Neck .......................................... 461-482
 Chapter
18
Osteology of Head and Neck
Skeletal framework of head and neck consists of skull,
cervical vertebrae and hyoid bone.
SKULL
Skull forms the skeleton of head and provides:
1. A case for the brain
2. Cavities for organs of special sensation (sight,
hearing, equilibration, smell and taste)
3. Openings for the passage of air and food
4. Jaws with sockets for teeth used during mastication.
The term cranium is used for skull without mandible.
Parts of the Skull
The skull is made up of 22 bones plus 6 ear ossicles. It
can be studied in two parts namely:
1. Neurocranium (calvaria/brain-box)
2. Facial skeleton.
Neurocranium: It is also known as calvaria. It is made
up of 8 bones, 2 paired and 4 single bones. These are:
1. Paired bones: Parietal and temporal.
2. Unpaired bones: Frontal, occipital, sphenoid and
ethmoid.
Facial skeleton: It consists of 14 bones, 6 paired and 2
unpaired bones.
1. Paired bones: Maxilla, zygomatic, nasal, lacrimal,
palatine and inferior nasal concha.
2. Unpaired bones: Mandible and vomer.
Bones forming the skull (except ear ossicles) are flat
bones made up of two flat plates of compact bone with
a central marrow cavity lined by a thin strip of cancellous
bone. The two plates may be fused, as in vomer and
pterygoid bones.
The skull bones are joined to each other with the help
of fibrous joints known as sutures. The joint between
base of sphenoid and occipital bone is primary
cartilaginous joint while the joints between occipital
condyles and first cervical vertebra, temporal bone and
mandible and between the ear ossicles are synovial
joints.
Anatomical Position of Skull
Skull is placed in such a way that the dome of skull
is upwards with orbital cavities directed forwards.
The lower margins of the orbits and upper margins
of external acoustic meatuses should be in the same
C H A P T E R-18
horizontal plane (Frankfurts plane).
External Features of the Skull
The exterior of the skull is studied in five different views:
1. Superior view or norma verticalis
2. Posterior view or norma occipitalis
3. Anterior view or norma frontalis
4. Lateral view or norma lateralis
5. Inferior view or norma basalis.
NORMA VERTICALIS: SUPERIOR ASPECT OF
SKULL (Fig. 18.1)
When the skull is viewed from above, it appears oval,
being wider posteriorly than anteriorly. Four bones can
be identified on this aspect. These are:
1. Squamous part of frontal bone, anteriorly.
2. Two parietal bones, one on each side.
3. Squamous part of occipital bone, posteriorly.
The bones are united by three sutures:
1. Coronal suture: It lies between the posterior margin
of frontal bone and anterior margins of the two
parietal bones.
2. Sagittal suture: It is present in the midline between
the two parietal bones.
3. Lambdoid suture: It is present between the
posterior margins of parietal bones and superior
margin of occipital bone.
 212 Human Anatomy For Dental Students

6. Temporal lines: A pair of temporal lines, one

superior and one inferior are seen. They are present
antero posteriorly on lateral side of each parietal
emenience. They are better described in norma
lateralis (Figs 18.6 and 18.7).

NORMA OCCIPITALIS: POSTERIOR ASPECT OF

THE SKULL (Fig. 18.2)
The back of skull is composed of posterior part of parietal
bones, occipital bone and mastoid part of temporal
bones:
They are located as follows:
1. Parietal bones: The two lie superiorly, one on each
side of midline.
2. Occipital bone: It lies inferiorly.
3. Mastoid part of temporal bones: These are present
infero-laterally, one on each side.
Sutures which unite these bones are:
1. Lambdoid suture: It is present between the occipital
bone and the two parietal bones.
2. Occipitomastoid suture: It is present, between the
occipital bone and the mastoid part of temporal
S E C T I O N-2

bone (Fig. 18.7).

3. Parietomastoid suture: It lies on each side between
the parietal bone and the mastoid part of temporal
bone (Fig. 18.7).

Anatomical Features
Fig. 18.1: Norma verticalis
POINT TO REMEMBER
Metopic suture: It is the suture between the two halves
of frontal bone. It may be seen in 3 to 8% cases.
1. Lambda (Described above).
2. External occipital protuberance: It is a median bony
projection seen midway between the lambda and
the foramen magnum. The most prominent point
of the prominence is called inion (Fig. 18.34).
3. Superior nuchal lines: These are curved bony
ridges passing laterally, on each side, from the
external occipital protuberance. In some cases a
curved, faint bony ridge is seen 1 cm above each of

Anatomical Features
1. Bregma: It is the point at which the coronal and
sagittal sutures meet. It is the site of anterior
fontanelle in new born skull.
2. Parietal eminence: It is the area of maximum
convexity of parietal bone, seen on each side.
3. Vertex: It is the highest point of the skull. It lies on
the sagittal suture, near its middle and is situated a
few centimeters behind the bregma.
4. Lambda: Point at which the sagittal and lambdoid
sutures meet is named as lambda (Figs 18.1 and 18.2).
5. Parietal foramen: A small foramen is seen in each
parietal bone near the sagittal suture, 3 to 4 cm in
front of lambda. Fig. 18.2: Norma occipitalis

Fig. 18.3: Norma frontalis
the superior nuchal lines. These are called highest
or supreme nuchal lines (Fig. 18.34).
4. External occipital crest: Is a median, vertical ridge
passing vertically downwards from the external
occipital protuberance to the posterior margin of
foramen magnum (Fig. 18.34).
5. Inferior nuchal lines: These are curved bony ridges
passing parallel to and below the superior nuchal
lines, laterally on each side from the middle of
external occipital crest.
NORMA FRONTALIS: ANTERIOR ASPECT OF THE
SKULL (Fig. 18.3)
When viewed from front, the skull appears oval in shape,
being wider above and narrow below. It presents with
the following bones:
Osteology of Head and Neck 213
C H A P T E R-18
1. Frontal bone, forms the forehead.
2. Right and left nasal bones, form the bridge of nose.
3. Right and left maxillae, form the upper jaw.
4. Right and left zygomatic bones, form the malar
prominences.
5. Mandible, forms the lower jaw.
Anatomical Features
1. Forehead: It is formed by the frontal bones. On each
side of median plane, the frontal bone articulates
with the nasal bone at the root of nose.
2. Frontal prominence: It is a low, rounded elevation
seen above each of the supraciliary arch.
 214 Human Anatomy For Dental Students
3. Supraciliary arches: These are rounded bony
elevations forming an arch above each of the
superior orbital margins.
4. Glabella: It is a median elevation between the
supraciliary arches.
5. Orbits: These are two bony cavities in which the
eyes are located. The orbit is described in chapter 31.
When viewed from front each orbit presents with
superior, lateral, inferior and medial margins.
a. The supraorbital margin is formed by the
frontal bone. At the junction of its lateral 2/3rd
and medial 1/3rd, there is a notch called
supraorbital notch (or foramen in some skulls),
through which passes the supraorbital nerve
and vessels. Medial to the notch, the margin is
crossed by supratrochlear nerve and vessels.
b. The lateral orbital margin is formed by the
zygomatic and frontal bones.
c. The infra-orbital margin is formed by the
zygomatic bone laterally and the maxilla
medially.Below this margin the anterior surface
of body of maxilla presents an opening for the
S E C T I O N-2
passage of infraorbital nerve and vessels known
as infraorbital foramen.
d. Medial orbital margin is ill-defined as
compared to other margins. It is formed by the
frontal bone above and the lacrimal crest of the
maxilla below.
6. Bony external nose: Is formed by the nasal bones
above and the maxillae laterally.
7. Anterior nasal aperture: It is a piriform shaped
aperture seen in the centre of norma frontalis. It is
bounded by nasal bones above and maxillary bones
laterally and inferiorly. The aperture is seen to be
divided into 2 parts by the bony nasal septum.
Inferior conchae can be seen projecting from lateral
wall of nose.
8. Root of nose: It is a slightly depressed area seen
above the nasal bones where they meet the frontal
bone at the frontonasal sutures.
9. Nasion: It is a median point at the root of nose
where the internasal and frontonasal sutures meet.
10. Prominence of the cheek: It is formed by the body
of zygomatic bone. It is situated on the lower lateral
side of orbit and rests on the maxilla.
11. Anterior surface of maxilla: It forms the central part
of facial skeleton on each side of anterior nasal
aperture. It extends upwards and articulates with
frontal bone (via frontal process) and extends
laterally to articulate with zygomatic bone (via
zygomatic process). An intermaxillary suture can
be identified in the midline below the anterior nasal
aperture, between the two maxillae. It presents the
following features on each side.
a. Nasal notch, medially.
b. Infraorbital foramen, 1 cm below the infraorbital
margin.
c. Incisive fossa above the incisor teeth (Fig. 18.27).
d. Canine fossa lateral to canine eminence
produced by the root of canine tooth.
12. Anterior nasal spine: It is a sharp bony projection
at the upper end of intermaxillary suture seen
projecting from the lower boundary of the piriform
aperture in the median plane.
13. Upper jaw: It is formed by the alveolar processes
of the two maxillae and bears the upper teeth.
14. Lower jaw: The lower jaw is formed by mandible.
The upper border, also called alveolar arch of
mandible, carries the lower teeth.
15. Anterior surface of body of mandible: It forms the
lowest part of facial skeletal and presents with the
following features:
a. Symphysis menti: It is a median bony ridge
representing the joining of the two halves of
mandible.
b. Mental protuberance: It is a triangular elevation
at the lower end of symphysis menti. It is
responsible for the promience of chin.
c. Mental point (gnathion): It is the mid point of
base of mandible.
d. Mental foramen: A foramen is seen on each
side, below the interval between two premolar
teeth.
e. Oblique line on body of mandible: It extends
between the mental protuberance and lower end
of anterior margin of ramus of mandible
(Fig. 18.19).
The supraorbital, infraorbital and mental foramens
lie in the same vertical plane.
Muscle Attachment on the Bones of Norma
Frontalis are shown in Fig. 18.4
NORMA LATERALIS: LATERAL ASPECT OF THE
SKULL (Figs 18.5 to 18.7)
The lateral aspect of skull presents with the following
bones:
1. Above: Nasal, frontal, parietal and occipital bones.
2. In middle: Maxilla, zygomatic, sphenoid and
temporal bones.
3. Below: Body and ramus of mandible.
The bones articulate to form following sutures:
1. Coronal suture
2. Parieto-squamosal suture, between parietal bone
and squamous part of temporal bone.
3. Parietomastoid suture, between parietal bone and
mastoid part of temporal bone.
4. Occipitomastoid suture, between occipital bone
and mastoid part of temporal bone.
5. Lambdoid suture (Described on page no. 211, Fig.
18.2).
 Osteology of Head and Neck 215

C H A P T E R-18
Fig. 18.4: Norma frontalis showing muscle attachments

Fig. 18.5: Norma lateralis

S E C T I O N-2 216 Human Anatomy For Dental Students

Fig. 18.6: Norma lateralis

Fig. 18.7: Norma lateralis (diagrammatic representation)

Anatomical Features frontal bone and arches backwards and upwards

over the parietal bone. The superior temporal line
1. Temporal lines: These are two in number, one fades when traced backwards but the inferior
superior and one inferior temporal line. Each begins temporal line continues downwards and forwards
at the posterior border of zygomatic process of the to become continuous with the suprameatal crest.

2. Zygomatic arch: A horizontal bar of bone formed
by the union of temporal process of zygomatic bone
and zygomatic process of temporal bone is seen in
centre anteriorly. The bones join at zygomatico-
temporal suture. Traced anteriorly, the prominent
body of zygomatic bone is seen. It joins with the
zygomatic process of frontal bone at fronto-
zygomatic suture above and with zygomatic
process of maxillary bone at zygomatico maxillary
suture in front.
3. Temporal fossa: It is the area bounded above and
posteriorly by the temporal line and below by the
zygomatic arch and frontal process of zygomatic
bone.
4. Pterion: It is the region in the anterior part of
temporal fossa where the 4 bones forming floor of
temporal fossa meet. These bones are frontal,
parietal, squamous part of temporal and greater
wing of sphenoid bones. They meet to form an H-
shaped suture known as pterion. It is situated
roughly 4 cm above the midpoint of the zygomatic
arch.
5. Infratemporal fossa: It is the region on the side of
skull below the zygomatic arch which is bounded
medially by the lateral pterygoid plate and laterally
by the ramus of mandible.
6. Lateral or external surface of ramus of mandible:
The ramus projects upwards from posterior part of
body of mandible. It presents with two processes
on the superior border namely, coronoid process
anteriorly and condylar process posteriorly. The
superior surface of condylar process articulates with
the mandibular fossa of temporal bone to form the
temporomandibular joint.
7. External acoustic meatus: It is the external aperture
of bony ear canal. It is seen just below the posterior
root of the zygomatic process of temporal bone.
8. Suprameatal triangle (triangle of McEven): It is a
small depression present postero-superior to the
external auditory meatus. It is bounded by
a. Suprameatal crest, superiorly.
b. Posterosuperior margin of external acoustic
meatus, anteriorly.
c. A vertical tangent to the posterior margin of the
meatus, posteriorly.
The aditus-ad-antrum lies 12 mm deep to this
triangle in adults.
9. Tympanic plate of temporal bone: It is a thin plate
of bone forming the anterior and inferior wall of
external acoustic meatus.
10. Mastoid process: It is a conical process seen
extending down from the mastoid part of temporal
bone, behind the external acoustic meatus.
Osteology of Head and Neck 217
11. Styloid process: It is a thin long bony process of
temporal bone lying anteromedial to the mastoid
process. Its base is partly ensheathed by the
tympanic plate. It is directed downwards forwards
and slightly medially.
12. Asterion: It is the meeting point of parietomastoid,
occipitomastoid and lambdoid sutures. In an infant
it is the site of posterolateral (mastoid) fontanelle
(Fig. 18.7).
CLINICAL AND APPLIED ANATOMY
Clinical importance of suprameatal triangle:
Severe mastoiditis, needing surgical intervention,
is treated by approaching the mastoid antrum via
the supra meatal triangle. Careful anatomical
delineationis important as it is related to the facial
nerve posteriorly and the sigmoid sinus anteriorly.
Clinical significance of pterion: Inner aspect of
the pterion is related to middle meningeal vessels.
C H A P T E R-18
In cases of an extradural haematoma due to head
injury, where there is injury to middle meningeal
vessels, a burr hole is drilled in the region of pterion
for evacuation of blood to release the pressure.
NORMA BASALIS: INFERIOR ASPECT OF SKULL
(Figs 18.8 to 18.10)
Norma basalis or inferior surface of cranium extends
from alveolar arch in front to the superior nuchal lines
behind. It is studied in three parts namely, anterior,
middle and posterior.
Anterior part is formed by the alveolar arch and hard
palate. The middle part extends from posterior margin
of hard palate to anterior margin of foramen magnum
and the posterior part lies behind a transverse line
passing through the anterior margin of the foramen
magnum.
Anatomical Features in the Anterior Part of Norma
Basalist
1. Alveolar arch: It is present anteriorly and is formed
by the two alveolar processes of maxillae. It bears
sockets for the roots of upper teeth.
2. Hard palate: It is formed by the palatine processes
of maxillae (3/4th) in front and by horizontal plates
of palatine bones behind (1/4th). It presents the
following features:
a. Incisive fossa: A deep fossa is present anteriorly
in the median plane behind the incisor teeth.
S E C T I O N-2 218 Human Anatomy For Dental Students
Fig. 18.8: Norma basalis
Two (right and left) incisive foramina pierce the
wall of the fossa.
b. Greater palatine foramen: One foramen is
present on each side in the postero-lateral corner
of hard palate, medial to last molar tooth. The
lesser palatine foramina lie behind it.
c. Posterior nasal spine: It is a conical bony
projection seen in the median plane on the sharp
free posterior border of palate.
Anatomical Features in the Middle Part of Norma
Basalis
It is occupied by body and greater wing of sphenoid,
basilar part of occipital bone and temporal bone.
The median area presents
1. Posterior border of vomer: It separates the two
posterior nasal apertures.
2. A broad bar of bone, formed by the fusion of the
body of sphenoid and basilar part of the occipital
bone. It is marked in the median plane by
pharyngeal tubercle a little in front of the foramen
magnum.
The lateral area presents on each side
3. Pterygoid process: This projects downwards from
the sphenoid bone behind last molar tooth. It
divides into medial and lateral pterygoid plates
which are separated from each other by pterygoid
fossa. Each plate has a free posterior border. The
upper end of posterior border of medial pterygoid
plate encloses a triangular depression called
scaphoid fossa, and the lower end bears a hook like
process called pterygoid hamulus. Lateral
pterygoid plate forms the medial boundary of infra-
temporal fossa and continues with infratemporal
surface of greater wing of sphenoid.
4. Infratemporal or lateral surface of the greater wing
of sphenoid. It lies lateral to pterygoid process and
presents with
a. Four margins
Anterior margin, forms the posterior margin
of inferior orbital fissure.
Anterolateral margin, forms the infra-
temporal crest. It separates the infratemporal
surface from temporal surface of greater wing
of sphenoid.

Fig. 18.9: Norma basalis
Postero-lateral margin, articulates with the
squamous part of temporal at sphenosqua-
mosal suture.
Posteromedial margin, articulates with
petrous temporal bone.
b. Four foramina: All the foramina are located
along the posteromedial margin of infra-
temporal surface of greater wing of sphenoid.
These are:
Foramen spinosum, a small circular foramen
at the base of spine of sphenoid.
Foramen ovale, a large oval foramen antero-
lateral to the upper end of the posterior
border of the lateral pterygoid plate.
Emissary sphenoidal foramen (foramen of
Vesalius), a small foramen sometimes present
between the foramen ovale and the scaphoid
fossa.
Osteology of Head and Neck 219
C H A P T E R-18
Canaliculus innominatus, is a very small
foramen present between the foramen ovale
and foramen spinosum.
c. Spine of sphenoid: It is a small conical bony
projection from the posterior most point of
infratemporal surface of greater wing of
sphenoid between its posterolateral and
postero-medial margins. Two nerves are related
to this spine:
Auriculotemporal nerve on the lateral aspect.
Chordatympani on the medial aspect.
5. Sulcus tubae: It is a groove seen between the
posterolateral margin of the greater wing of
sphenoid and petrous temporal bone. It lodges the
cartilaginous part of the auditory tube.
6. Inferior surface of the petrous temporal bone: It
is triangular in shape with apex directed antero-
medially. It presents the following features:
 220 Human Anatomy For Dental Students
a. Foramen lacerum: Apex of pterous temporal
bone forms the posterior boundary of foramen
lacerum which is completed by greater wing of
sphenoid bone and basilar part of occipital bone.
b. Carotid canal: It is a circular foramen which lies
in posteior part of petrous temporal bone.
7. Tympanic part of temporal bone: This lies lateral
to the petrous part and joins with the squamous
part above at the squamotympanic suture.
8. Squamous part of temporal bone: It presents with
the following features:
a. Zygomatic process: Each process consists of 2
roots, one anterior and one posterior.
b. Mandibular fossa: It is a gentle depression
behind the anterior root. Anterior part is formed
S E C T I O N-2
Fig. 18.10: Norma basalis showing muscle attachment
by squamous temporal bone and it articulates
with condylar process of mandible. Posterior
part of fossa is formed by tympanic part of
temporal bone and is non-articular.
9. Tegmen tympani: Thin plate of bone which arises
from anterior surface of petrous temporal part, is
seen to divide the squamotympanic suture into two
parts petrotympanic and petrosquamous.
Anatomical Features in the Posterior Part of Norma
Basalis
It is formed mostly by occipital bone and part of temporal
bones on each side:

Median area presents the following structures from
before backwards:
1. Foramen magnum: It is an oval, large foramen in
the occipital bone, behind basi occiput.
2. External occipital crest: It is a midline bony ridge
extending from foramen magnum to external
occipital protuberance.
3. External occipital protuberance (described on page
no. 342).
The lateral area presents on each side:
4. Occipital condyle: It is an oval condylar process
present on each side of foramen magnum.
5. Hypoglossal canal: It is located antero-superior to
each occipital condyle.
6. Condylar fossa: It is a small depression located just
behind each occipital condyle. Sometimes it is
perforated by a canal called the condylar canal.
7. Jugular process of occipital bone: It extends
laterally from the occipital condyle and joins the
petrous part of temporal bone and forms the
posterior boundary of jugular foramen.
8. Jugular foramen: It is a large elongated foramen at
the posterior end of the petro-occipital suture. Its
anterior wall is hollowed out to form the jugular
fossa.
9. Squamous part of occipital bone: It forms a large
part of this part of norma basalis. It presents with
the superior and inferior nuchal lines on each side
of external occipital protuberance.
Fig. 18.11A: Internal surface of vault of skull
Osteology of Head and Neck 221
10. Petrous temporal bone: The posterior part of
inferior surface presents with.
a. Tympanic canaliculus: Opens on the thin edge
of bone between jugular fossa and the lower end
of the carotid canal.
b. Jugular surface for jugular process of occipital
bone.
11. Styloid process: It is a thin bony process seen
projecting between the petrous and tympanic part
in the posterior aspect.
12. The stylomastoid foramen: It is situated posterior
to the root of styloid process.
13. Mastoid process
Muscle Attachments on Norma Basalis are shown
in Fig. 18.10
INTERNAL STRUCTURE OF SKULL (Figs
18.11 and 18.13)
Internal surface of skull can be further studied as internal
feature of vault of skull and base of skull.
C H A P T E R-18
INTERNAL SURFACE OF VAULT OF SKULL
(Fig. 18.11A)
Vault of skull is formed by frontal parietal and occipital
bones which join at coronal, sagittal and lambdoid
sutures. It is concave and presents with furrows which
are the markings of various cranial arteries associated
with it.
 222 Human Anatomy For Dental Students
Anatomical Features of Vault of Skull
1. Frontal crest: In median plane, anteriorly a bony
crest is seen which is known as frontal crest. The
posterior end presents a groove for the anterior end
of sagittal sulcus.
2. Sagittal sulcus: A longitudinal sulcus is present
along the entire length of sagittal suture which
lodges the sagittal sinus.
3. Granular foveolae: These are irregular depressions
on each side of sagittal sulcus. They denote the
impressions of arachnoid granulations.
4. Parietal foramina: A parietal foramen is present on
each side of sagittal sulcus, 3 to 4 cm anterior to
lambda.
5. Groove for middle meningeal artery: A groove is
seen on either side, parallel to and behind the
coronal suture. It lodges the middle meningeal
vessels.
S E C T I O N-2
Fig. 18.11B: Internal surface of base of skull
INTERNAL SURFACE OF THE BASE OF SKULL
The internal surface of the base of the skull is divided
into anterior, middle and posterior cranial fossae.
Anterior Cranial Fossa (Figs 18.11B, 18.11C and 18.12)
It is formed by lower part of squamous part of frontal
bone, orbital plates of frontal bone with intervening
cribriform plate of ethmoid bone, superior surface of
body of sphenoid and lesser wing of sphenoid bone. It
is limited posteriorly by
1. Free border of lesser wing of sphenoid on each side.
2. Anterior border of sulcus chiasmaticus in the
median region.
The junction between these two is marked by
anterior clinoid processes.
Anatomical Features
Median region presents from before backwards
1. Frontal crest: It is a vertical, median bony crest on
inner aspect of frontal bone. Falx cerebri get
attached to it.
 Osteology of Head and Neck 223

2. Foramen caecum: A small foramen is seen at inferior 4. Cribriform plate of ethmoid bone: On each side
end of fontal crest at its junction with crista galli. of crista galli lies cribriform plate of ethmoid which
3. Crista galli: It is a bony crest formed by perpendi- separates the anterior cranial fossa from nasal
cular plate of ethmoid bone. cavity. It possesses a number of foramina that

C H A P T E R-18
Fig. 18.11C: Internal surface of base of skull (Diagramatic representation)

Fig. 18.12: Enlarged view of internal surface of anterior and middle cranial fossae
 224 Human Anatomy For Dental Students
provide passage for olfactory nerves. A nasal slit,
is present one on either side of crista galli. Anterior
and posterior ethmoidal canals are present along
the lateral border of crista galli.
5. Jugum sphenoidale, superior surface of anterior
part of the body of sphenoid.
Lateral region on each side presents with:
6. Orbital plate of the frontal bone: It separates the
anterior cranial fossa from the orbit and supports
the frontal lobe of the brain. It shows impressions
of sulci and gyri.
7. Upper surface of lesser wing of sphenoid bone: It
lies posterior to frontal bone.
Middle Cranial Fossa (Figs 18.11B, 18.11C and 18.12)
Middle cranial fossa is bounded by:
Anteriorly: free border of lesser wing of sphenoid,
anterior border of sulcus chiasmaticus.
Posteriorly: Superior border of petrous temporal
bone, upper border of dorsum sellae.
Laterally (anteroposteriorly): Greater wing of sphe-
noid, squamous part of temporal bones with part of
S E C T I O N-2
parietal bone.
Anatomical Features
The median region from before backwards presents
with
1. Sulcus chiasmaticus: It leads on each side into optic
canal which leads into the orbit. Interanterior
cerebral artery lies in it.
2. Sella turcica: It is a saddle shaped structure which
consists of
a. Hypophyseal fossa: It is a hollow area on upper
surface of body of sphenoid. It lodges the
pituitary gland.
b. Tuberculum sellae: It forms the anterior
boundary of the fossa. The lateral ends of
tuberculum sellae bear middle clinoid processes.
c. Dorsum sellae: It forms the posterior boundary
of the fossa. The lateral ends of dorsum sellae
bear posterior clinoid processes.
3. Carotid groove: It is a groove present on either side
of dorsum sellae which lodges the internal carotid
artery.
The lateral area is deep and lodges the temporal lobes
of the brain. It presents on either side:
4. Cranial surface of greater wing of sphenoid. It
shows 4 foramina arranged in a roughly semi-
circular array, along the postero medial margin.
a. Foramen spinosum, is located at the posterior
tip of the greater wing. A groove for middle
meningeal vessels is seen leading forwards from
the foramen spinosum.
b Foramen ovale, is located just in front of
foramen spinosum.
c. Foramen rotundum, is present in front of
foramen ovale, lateral to carotid sulcus.
d. Superior orbital fissure, lies anterior to foramen
rotundum. It lies along the anterior border,
under the over-hanging shelf of the lesser wing
of sphenoid.
5. Anterior surface of petrous temporal bone which
presents with:
a. Foramen lacerum: It lies at the posterior end of
the carotid groove, postero-medial to the
foramen ovale. It is bounded posteriorly by the
apex of petrous temporal bone.
b. Trigeminal impression: It is a small depression
seen posterior to foramen lacerum, near the apex
of petrous temporal. It lodges the trigeminal
ganglion.
c. Hiatus and groove for greater petrosal nerve:
It is seen lateral to the foramen lacerum.
d. Hiatus and groove for lesser petrosal nerve: It
lies further laterally and leads to foramen ovale
or canaliculus innominatus.
e. Arcuate eminence: It is a small eminence
produced by anterior semicircular canal of inner
ear. It is located at the middle of anterior surface
of petrous temporal bone.
f. Tegmen tympani: It is a thin plate of bone
anterolateral to the arcuate eminence. It forms
the roof of middle ear (tympanic cavity).
6. Inner surface of squamous part of temporal bone:
This lies lateral to greater wing of sphenoid and
petrous temporal bone. It is grooved by the middle
meningeal artery. Petrosquamosal suture is present
between the two parts of temporal bone.
Posterior Cranial Fossa (Figs 18.11B and 18.13)
Posterior cranial fossa is deepest and is formed mainly
by occipital bone supplemented by body of sphenoid
bone anteriorly and petromastoid part of temporal bone.
It is bounded by
1. Anteriorly, dorsum sellae and adjoining part of
body of sphenoid and basilar part of occipital bone.
2. Laterally, posterior surface of petrous temporal and
mastoid part of temporal bone alongwith squamous
part of occipital bone.
3. Posteriorly squamous part of occipital bone.
It lodges the hind brain.
Anatomical Features
The median area presents
1. Clivus: It is a sloping surface, present in front of
foramen magnum. It is formed by the fusion of

Fig. 18.13: Posterior cranial fossa
posterior part of the body of sphenoid with the
basilar part of the occipital bone. It is separated
laterally on each side from the petrous temporal
bone by a petro-occipital fissure which ends
posteriorly at jugular foramen.
2. Foramen magnum: It is the largest foramen of skull
and lies in the floor of posterior cranial fossa. It is
bounded in front by basi-occiput, posteriorly by
squamous part of the occipital bone, and on each
side by condylar part of the occipital bone.
3. Hypoglossal canal: It is a shallow groove with
foramen present on each side of anterior part of
foramen magnum.
4. Internal occipital crest: A vertical bony ridge
running downwards from the internal occipital
protuberance to the foramen magnum. Near the
foramen it splits to enclose a shallow depression
called vermian fossa.
5. Internal occipital protuberance: It is located
opposite the external occipital protuberance.
Lateral area on each side consists of
6. Inner surface of squamous part of occipital bone: It
presents with
a. Grooves for transverse sinuses: These run
laterally on each side from the internal occipital
protuberance to the mastoid angle of the parietal
bone where they become continuous with the
grooves for sigmoid sinuses.
b. Anterior to the grooves, the squamous part of
occipital bone is hollow to accomodate the
cerebellar hemispheres.
7. Jugular foramen: It is a large, irregular foramen at
the posterior end of petro-occipital fissure. Lateral
to foramen magnum.
8. Posterior surface of petrous temporal bone. This
presents with:
a. Superior border of petrous temporal: It presents
a groove for superior petrosal sinus.
Osteology of Head and Neck 225
b. Anteroinferior border of petrous temporal
presents a groove for inferior petrosal sinus.
c. A groove made by the sigmoid sinus is seen at
posteior end of the surface.
d. Internal acoustic meatus: It is present above and
anterior to the jugular foramen.
C H A P T E R-18
e Aqueduct of vestibule: It is a slit like opening
behind the meatus for saccule and ductus
endolymphaticus.
9. Mastoid part of temporal bone: It presents a deep
groove for the sigmoid sinus.
CLINICAL AND APPLIED ANATOMY
Fracture of anterior cranial fossa leads to damage
to the cribriform plate of ethmoid can cause
bleeding and/or drainage of cerebrospinal fluid
(CSF) from the nose. Leaking of CSF is known as
rhinorrhoea.
The usual line of fracture in injury of middle cranial
fossa passes downwards from the parietal
tuberosity along the squamous part of temporal
bone and internally into the petrous temporal bone.
It can cause:
a. Bleeding or drainage of CSF from ear.
b. Bleeding through nose.
c. Vertigo due to involvement of semicircular
canals.
The features usually studied in the interpretation
of X-ray skull:
From clinical point of view, one should know what
structures in the calvarium leave markings that are
seen normally on an X-ray skull so that one can
distinguish them from fractures. These structures
are
a. Sutures: Do not forget occasional presence of
metopic suture between two halves of the
frontal bone.
 226 Human Anatomy For Dental Students
b. Middle meningeal vessels: Their shadows are
clearly seen in the lateral view of X-ray skull.
c. Pineal gland: Near the centre of brain. It may
contain small calcareous granules called
corpora arenaceae or brain-sand which are
radio-opaque. The position of pineal gland is
helpful to recognize the displacements of the
brain.
d. Auricle of the ear: It casts a semicircular
shadow on a lateral view of X-ray skull.
Remember it is often identified as a semicircular
canal by the students.
e. Emissary foramina: These are also seen on X-
ray skull. One is usually found in the parietal
bone and one in the temporal bone behind the
external auditory meatus.
STRUCTURES PASSING THROUGH VARIOUS
FORAMINA, CANALS AND FISSURES OF THE
SKULL
The skull presents about 85 normal foramina, canals
and fissures which provide passage to various nerves
S E C T I O N-2
and vessels. The important ones have been named
below with the structures passing through.
Foramina in the Internal Surface of Base of Skull
(Figs 18.11B, 18.11C, 18.12 and 18.13)
Foramen caecum: Emissary vein: From the nasal
mucosa to the anterior end of superior sagittal sinus.
Foramina in the cribriform plate of the ethmoid
1. Olfactory nerves: Surrounded by leptomeninges
(pia and arachnoid maters) from olfactory
epithelium of the nasal cavity to the olfactory bulb.
They are 15 to 20 in number on each side.
2. Nervi-terminalis: If present, is seen one on either
side. It is also called as O pair or the 13th pair of
cranial nerve.
Anterior Ethmoidal Foramen
1. Anterior ethmoidal nerve, branch of nasociliary
nerve.
2. Anterior ethmoidal artery, branch of ophthalmic
artery
3. Anterior ethmoidal vein, tributary of ophthalmic
vein.
Posterior Ethmoidal Foramen
1. Posterior ethmoidal nerve, branch of nasociliary
nerve.
2. Posterior ethmoidal artery, branch of ophthalmic
artery.
3. Posterior ethmoidal vein, tributary of ophthalmic
vein.
Optic Foramen (Canal)
1. Optic nerve: It passes from the optic disc along
with its sheath of meninges, i.e., duramater,
arachnoidmater and piamater in the optic canal to
open on lateral end of sulcus chiasmaticus.
2. Ophthalmic artery: Branch of cerebral part of
internal carotid artery. It lies inferolateral to optic
nerve.
3. Sympathetic plexus: This plexus consists of post
ganglionic sympathetic nerve fibres derived from
the superior cervical sympathetic ganglion and it
surrounds the ophthalmic artery.
Superior Orbital Fissure
This fissure is divided into three parts by means of
the common tendinous ring of Zinn.
1. Structures passing through the part within the
common tendinous ring
a. Superior and inferior divisions of oculomotor
nerve.
b. Nasociliary nerve: It lies between the two
divisions of oculomotor nerve.
c. Abducent nerve: It lies posterior to the
nasociliary nerve.
d. Sympathetic root of the ciliary ganglion.
2. Structures passing through the part above the
common tendinous ring
a. Trochlear nerve
b. Frontal nerve
c. Lacrimal nerve
d. Lacrimal artery
e. Superior ophthalmic vein
f. Recurrent meningeal branch of lacrimal artery.
3. Structures passing through the part below the
common tendinous ring
Inferior ophthalmic vein
Foramen Rotundum
1. Maxillary nerve, 2nd division of the trigeminal
nerve.
2. Emissary vein.
Foramen Ovale (Pnemonic: MALE)
1. Mandibular nerve, 3rd division of trigeminal nerve.
2. Accessory middle meningeal artery, branch of 1st
part of maxillary artery.
3. Lesser petrosal nerve
4. Emissary vein: Connecting pterygoid venous
plexus to the cavernous sinus.
Foramen Spinosum
1. Middle meningeal artery, branch from 1st part of
maxillary artery.
2. Nervus spinosus, branch from the undivided trunk
of mandibular nerve.
3. Middle meningeal vein.

Foramen Lacerum
1. Meningeal branch of ascending pharyngeal artery
2. Emissary vein: From cavernous sinus to
pharyngeal venous plexus.
The anterior part of foramen lacerum lodges
the internal carotid artery along with the
sympathetic plexus around it.
Greater petrosal nerve joins the deep pertrosal
nerve to form the nerve of the pterygoid canal
(Vidians nerve) which passes through the
pterygoid canal. The posterior orifice of the
pterygoid canal lies in the lower part of the
anterior wall of the foramen lacerum.
Carotid Canal
1. Internal carotid artery.
2. Sympathetic plexus: Sympathetic fibres derived
from the superior cervical sympathetic ganglion
surround the artery. This plexus consists of
postganglionic fibres.
3. Emissary vein: It connects the pharyngeal venous
plexus to the cavernous sinus.
Internal Auditory Meatus
1. Facial nerve
2. Vestibulo-cochlear nerve
3. Nervus intermedius
4. Internal auditory (labyrinthine) vessels: Internal
auditory artery is a branch of basilar artery.
Jugular Foramen
It may be divided into 3 compartments: anterior,
middle and posterior
1. Anterior compartment: Inferior petrosal sinus,
tributary of internal jugular vein.
2. Middle compartment (In the antero-posterior
direction)
a. Glossopharyngeal nerve
b. Vagus nerve
c. Accessory nerve
10th and 11th cranial nerves are surrounded in a
common sheath of duramater.
3. Posterior compartment
Sigmoid sinus: It continues as the superior bulb
of internal jugular vein.
Hypoglossal (Anterior Condylar) Canal
1. Hypoglossal nerve.
2. Meningeal branch of ascending pharyngeal artery.
3. Emissary vein connecting the deep veins of the
neck to the transverse sinus.
Posterior Condylar Canal (Sometimes present)
Emissary vein, connecting the sub-occipital venous
plexus to the sigmoid sinus.
Osteology of Head and Neck 227
Foramen Magnum
It is divided into a small anterior and a large posterior
compartment by means of the alar ligaments of axis
(2nd cervical) vertebra.
1. Anterior compartment
a. Apical ligament of dens.
b. Upper longitudinal band of cruciform ligament.
c. Membrana tectoria: A continuation of posterior
longitudinal ligament of the vertebral bodies.
d. Process of dens: Sometimes.
2. Posterior compartment
a. Medulla oblongata along with its meninges, i.e.,
dura, arachnoid and pia-mater.
b. Right and left posterior spinal arteries.
c. Anterior spinal artery.
d. Communicating veins between: internal
vertebral venous plexus and basilar veins.
e. Right and left vertebral arteries (4th part).
f. Sympathetic plexus around the vertebral
arteries. This plexus consists of post-ganglionic
sympathetic fibres derived from the inferior
cervical sympathetic ganglion.
C H A P T E R-18
g. Right and left spinal roots of accessory nerves.
h. Tonsils of cerebellum: These project on each
side of the medulla oblongata.
Foramina In the External Surface of Base of
skull (Norma Basalis) (Figs 18.8 and 18.9)
Incisive Foramina
1. Lateral incisive foramina: Two in number, right
and left, are present in the lateral wall of the
incisive fossa. Each leads into the floor of the nasal
cavity through the incisive canal.
a. Greater palatine vessels
b. Naso-palatine nerve: Only when the median
foramina are absent
2. Median incisive formina: Two in number, one
present in the anterior and another in the posterior
wall of the incisive fossa.
a. Left naso-palatine nerve: Passes through a
foramen present in the anterior wall of the
incisive fossa.
b. Right naso-palatine nerve: Passes through a
foramen present in the posterior wall of the
incisive fossa from nasal cavity to hard palate.
Greater Palatine Foramen
1. Greater palatine nerves.
2. Greater palatine vessels.
Squamo-tympanic fissure: It is divided into two parts
by a down-turned part of tegmen tympani, a part of
petrous temporal bone.
 228 Human Anatomy For Dental Students

a. Petro-tympanic fissure Spheno-palatine foramen

1. Chorda tympani nerve, branch of facial nerve. 1. Naso-palatine nerve
2. Anterior tympanic artery, branch of 1st part of 2. Spheno-palatine vessels
the maxillary artery. Greater palatine canal
3. Anterior ligament of the malleus. 1. Anterior, middle and posterior palatine nerves.
b. Petro-squamous fissure 2. Greater palatine vessels.
No structure passes through it. 3. Lesser palatine vessels.
Palato-vaginal canal
1. Pharyngeal nerve, branch from pterygopalatine Foramina in the Norma Verticalis (Fig. 18.1)
ganglion.
2. Pharyngeal artery, branch of 3rd part of maxillary Parietal Foramen
artery. Emissary vein: Connecting superficial veins of the
Vomero-vaginal canal: If present, it provides passage scalp to the superior sagittal sinus.
to
1. Pharyngeal nerve Foramina in the Norma Frontalis (Fig. 18.3)
2. Pharyngeal artery
Supra-orbital foramen (usually it is a notch).
Pterygoid Canal 1. Supra-orbital nerve: A branch of frontal nerve
1. Nerve of pterygoid canal (Vidians nerve). which in turn is a branch of ophthalmic division
2. Vessels of the pterygoid canal. of trigeminal nerve.
2. Frontal diploic vein.
Tympanic Canaliculus Infra-orbital foramen
S E C T I O N-2

1. Infra-orbital nerve: Continuation of maxillary

Located on a bony crest present between the carotid
canal and jugular fossa. It provides passage to the
tympanic branch of glossopharyngeal nerve
(Jacobsons nerve).
Mastoid Canaliculus (Arnolds canal)
Present in the lateral wall of jugular fossa. It provides
passage to auricular branch of vagus nerve
(Aldermans nerve/Arnolds nerve).
Stylomastoid Foramen
1. 7th cranial (facial) nerve
2. Stylomastoid artery: A branch of posterior
auricular artery.
Foramina in the Norma Lateralis (Figs 18.5 to 18.7)
Zygomatico-temporal Foramen
1. Zygomatico-temporal nerve
2. Zygomatico-temporal artery
Pterygo-maxillary Fissure
1. 3rd part of the maxillary artery: From infra-
temporal fossa to the pterygopalatine fossa.
2. Maxillary nerve: 2nd division of the trigeminal
nerve.
Inferior Orbital Fissure
1. Maxillary nerve.
2. Infraorbital vessels.
3. Zygomatic nerve.
4. Vein connecting inferior ophthalmic vein with
pterygoid venous plexus.
nerve.
2. Infra-orbital artery: Branch of maxillary artery.
3. Infra-orbital vein
Foramina in the Mandible
Mandibular Foramen (Fig. 18.21) (inferior dental
foramen)
1. Inferior alveolar nerve: A branch of the posterior
division the mandibular nerve.
2. Inferior alveolar artery: A branch from the 1st part
of the maxillary artery.
3. Inferior alveolar vein
Mental Foramen (Figs 18.19 and 18.23)
1. Mental nerve: A branch of inferior alveolar nerve.
2. Mental artery: A branch of inferior alveolar artery.
3. Inferior alveolar vein.
NEWBORN SKULL (Figs 18.14 to 18.18)
The striking feature of a newborn skull is the relatively
large size of the cranium as compared to the facial
skeleton which is small and consists of a collection of
tiny bones clustered on the anterior end of the cranium.
The mandible and maxilla are not fully developed as
there are no teeth. The sinuses are also underdeveloped.
The bony part of external ear is not developed. It is thus
important to remember that the tympanic membrane is
nearer to the surface. Mastoid process is also absent and
thus the facial nerve behind styloid process is also
superficial.
 Osteology of Head and Neck 229

Fig. 18.14: New born skull (anterior aspect) Fig. 18.15: New born skull (lateral aspect) Fig. 18.16: New born skull (superior
aspect)

C H A P T E R-18
Fig. 18.17: New born skull (lateral aspect)

a. Permit some overlapping of the skull bones

(moulding) during child birth
b. Permit growth of brain in infancy.
Number of fontanelles: There are six fontanelles, one
situated at each angle of the parietal bone.
1. Median fontanelle: These are two in number
namely,
a. Anterior fontanelle: It is rhomboid in shape and
is present at the meeting point of sagittal,
Fig. 18.18: New born skull (superior aspect) coronal and metopic sutures. It closes by 18 to
24 months of age.
b. Posterior fontanelle: It is triangular in shape
Fontanelles
and lies at junction of sagittal and lamboid
The skull at birth is partly ossified and gaps or fontanelles sutures. It closes by 4 to 6 months of age.
exist between the various bones. These are filled in by a 2. Lateral fontanelles: These are 4 in number
membranous structure.The fontanelles serve two a. Two anterolateral fontanelles or sphenoidal
important purposes: fontanelles. These are situated at sphenoidal
 230 Human Anatomy For Dental Students
angle of parietal bone, where coronal suture
meets the greater wing of sphenoid bone.
b. Two posterolateral fontanelles or mastoid
fontanelles.These are situated at mastoid angle
of parietal bone where it meets the mastoid part
of temporal bone.
CLINICAL AND APPLIED ANATOMY
The clinical importance of anterior fontanelle is due
to the fact that it is easily palpated in newborns.
a. A bulging and tense anterior fontanelle is
suggestive of increased intracranial tension.
b. A depressed fontanelle is a sign of dehydration
in newborn.
c. The superior sagittal sinus lies below this
fontanelle.
d. During labour the position of anterior fontanelle
helps to identify the position of fetal head in
the maternal pelvis.
Craniosynostosis: It is the premature fusion of
sutures of skull bones. It results in increased intra-
cranial pressure, asymmetrical growth of facial
S E C T I O N-2
skeleton and poor development of brain.
INDIVIDUAL SKULL BONES
MANDIBLE (Figs 18.19 to 18.23)
Mandible or lower jaw is the largest and the strongest
bone of the face.
Fig. 18.19: Mandible
Anatomical Features
It consists of three parts
1. Body
2. Pair of rami
Body
The body of mandible is horse shoe shaped. It presents
with two surfaces and two borders.
Two surfaces are:
1. External surface: It presents with the following
features:
Symphysis menti: It is a faint appearing vertical,
ridge in the midline on the external surface. It
marks the line of fusion of the two halves of
mandible. The symphysis menti expands below
into a triangular elevation termed the mental
protuberance. The base of the elevation is
limited on each side by the mental tubercles.
On either side of upper end of the protuberance,
below the incisor teeth, is present the incisive
fossa.
A faint ridge (oblique ridge) extends obliquely
from each of the mental tubercle to the
corresponding anterior border of ramus of
mandible. This is also called as oblique line.
A foramen opens in the middle of the body,
above the oblique ridge, vertically below the
premolars. This is the mental foramen and it
transmits the mental vessels and nerve.
 Osteology of Head and Neck 231

C H A P T E R-18
Fig. 18.20: Alveolar border of mandible

Fig. 18.21: Internal surface of mandible

Structures related to the external surface of
mandible, at the junction of body with anterior
border of ramus, below the oblique line are:
i. Facial artery
ii. Facial vein, crosses over the artery
iii. Marginal mandibular branch of facial nerve,
is superficial to both vessels.
2. Internal surface (Fig. 18.21)
Inner aspect of symphysis menti presents with
2 pairs of tubercles in its lower part, one upper
pair and one lower pair, called the genial
tubercles or mental spines.
An oblique line is seen on either side of inner
aspect body of mandible which extends
downwards and forwards from the lower
margin of posterior end of 3rd molar towards
the symphysis menti. This is the mylohyoid
line. It is clearly defined in the upper half.
This line divides the inner surface into two parts:
a. Upper part: It presents with a triangular fossa
seen in its anterior part which is called
sublingual fossa. It is related to the
sublingual gland. Above this the surface is
covered by oral mucosa till the 3rd molar.
 232 Human Anatomy For Dental Students
b. Lower part: It presents with a gentle
concavity known as submandibular fossa.
The lateral surface of superficial part of the
submandibular gland rest on this fossa. Loop
of facial artery is related to the bone between
it and the gland.
Lower end of mylohyoid groove is seen behind
the mylohyoid line at its posterior end. It
contains mylohyoid vessels and nerves.
Two borders are:
1. Upper border: It is also known as alveolar border
(Fig. 18.20). It bears sockets for the teeth of lower
jaw, 8 on each side of midline. The depth and shape
of the sockets depends on the type of tooth. The
sockets for incisors, canines and premolar are single
with the socket for canine teeth being the deepest.
The sockets for molar teeth are wide and are divided
into two parts by a bony septa.
2. Lower border: It is also known as base of mandible.
It extends posterolaterally from the centre to the
ramus of mandible on each side. It presents with a
digastric fossa for digastric muscle on each side of
midline. Behind the fossa, the border is thick and
S E C T I O N-2
rounded and continues with the lower border of
ramus beyond the 3rd molar tooth.
Attachments on Body of Mandible (Fig. 18.23)
1. Oblique line on external surface
Origin of buccinator from posterior superior
part below the three molar teeth.
Origin of depressor anguli oris in the middle,
anterior to buccinator.
Origin of depressor labii inferioris from the
anterior end of the line.
2. Incisive fossa: Origin of mentalis muscle.
3. Mylohyoid line
Origin of mylohyoid muscle.
The deep layer of investing layer of cervical
fascia is attached to it.
4. Superior genial tubercle or mental spines: Origin
of genioglossus muscle.
5. Inferior genial tubercle or mental spines: Origin
of geniohyoid muscle.
6. Base
Origin of anterior belly of digastric muscle from
a fossa on inner surface of the base, lateral to
symphysis menti.
Insertion of platysma on outer surface of base.
The superficial layer of investing layer of
cervical fascia is attached deep to platysma.
Ramus of Mandible (Figs 18.19 and 18.22)
One ramus is attached on either side of the body. It is
more or less a quadilateral plate of bone and presents
with two surfaces and four borders.
Fig. 18.22: Ramus of mandible
Two surfaces:
1. Lateral surface: It is overlapped posteriorly by the
parotid gland in upper part.
2. Medial surface
In the middle of the surface a mandibular
foramen is present. This provides passage for
the inferior alveolar vessels and nerve.
A thin, bony projection named lingula is seen
arising from the anteromedial margin of the
foramen.
Above the foramen, maxillary artery winds
around the ramus.
Below the foramen, a groove is seen extending
downwards upto upper part of the mylohyoid
line. This is the mylohyoid groove that lodges
mylohyoid vessels and nerve.
Four borders
1. Superior border
It is thin and presents with an anterior and a
posterior process which are separated by a
mandibular notch (incisure). The masseteric
nerve and vessels pass over this notch. The two
processes are:
a. Coronoid process: It is a triangular projection
from the anterior end of superior border. Its
anterior border is continuous with the
anterior border of ramus below while the
posterior border continues with the
mandibular notch. Medial surface presents
a temporal ridge.
b. Condylar process: It is an expanded
projection from the posterosuperior aspect of
ramus of mandible. It has a head which
articulates with the anterior part of the
mandibular fossa on temporal bone to form
the temporo-mandibular joint. The neck is a
constricted portion which connects the head
to the ramus of mandible. Auriculotemporal
nerve winds around the medial aspect of
neck.

Fig. 18.23: Attachments and structures related to mandible
2. Inferior border: It continues with the base of
mandible.
3. Posterior border: It is thick, rounded and joins the
inferior border at an angle. It is overlapped by the
parotid gland.
4. Anterior border: It continues superiorly with
coronoid process.
Attachments on Ramus of Mandible (Fig. 18.23)
1. The entire lateral surface of ramus except
posterosuperior part provides insertion to masseter
muscle.
2. Temporalis muscle is inserted into the apex, medial
surface of coronoid process and anterior border of
ramus.
3. Lateral pterygoid muscle is inserted into pterygoid
fovea.
4. Medial pterygoid muscle is inserted on the medial
surface of ramus below and behind mylohyoid
groove.
5. Lingula gives attachment to sphenomandibular
ligament.
Angle of Mandible (Fig. 18.19)
It is the meeting point of posterior and inferior
borders of mandible. It is also named the gonion.
It measures 110 to 115 in adults. In newborn and
old people the angle is higher, upto 140.
Mandibular Canal
It extends from the mandibular foramen, within the
bone, forwards and downwards and divides into
Osteology of Head and Neck 233
C H A P T E R-18
mental and incisive canals between the 1st and 2nd
premolar teeth.
It transmits the inferior alveolar vessels and nerve
which supply the roots of teeth of lower jaw.
Nerves Related to the Mandible
1. Lingual nerve: It runs on the inner surface of the
body close to the medial side of the root of the third
molar tooth.
2. Inferior alveolar nerve: Enters the mandibular
foramen and passes through the mandibular canal.
3. Mylohyoid nerve: Runs in the mylohyoid groove.
4. Mental nerve: It comes out of the mental foramen.
5. Nerve to masseter: Passes over the mandibular
notch.
6. Auriculotemporal nerve: It winds around the
medial surface of neck of the condylar process.
Changes in Mandible with Age
1. In new born: The body of mandible is small and in
two halves united by a fibrous symphysis menti.
The ramus is small and the coronoid process is more
prominent.
2. In children: There is fusion of symphysis menti by
age of three years. The body grows in height, length
and width. The ramus increases in size with
development of condylar process.
3. In adult: The adult mandible has been described
above.
4. In old age: The alveolar border gets resorbed due
to loss of teeth and height of the bone decreases.
 234 Human Anatomy For Dental Students

Position of Mental Foramen with Age

At birth: It is present below the sockets for the
deciduous molar teeth near the lower border of
mandible.
In adult: As the mandible grows, the foramen
gradually moves upwards and opens midway
between the upper and lower borders.
In old age: It lies close to alveolar border due to
absorption of the alveolar border.

Differences Between Male and Female Mandibles

Features Male mandible Female mandible
1. Size Larger and thicker Smaller and thinner
2. Height of Greater Lesser Fig. 18.24: Lateral view of left maxilla
of the body
3. Angle of Everted Inverted
mandible Anatomical Features
4. Chin Quadrilateral Rounded
5. Inferior Irregular Smooth
Each maxilla consists of a body and four processes.
border of
body of Body
mandible
S E C T I O N-2

It is pyramidal in shape and contains a cavity called the

6. Condyles Larger Smaller
maxillary air sinus within its substance. The body
presents four surfaces.
Anatomical Position of Mandible 1. Nasal surface (Medial surface)
1. Convex surface of body of mandible faces forwards It forms the base of body of maxilla and is a
with ramus of mandible on each side. part of the lateral wall of nasal cavity.
2. Alveolar arch with teeth is directed superiorly. In its upper part is present a large, irrigular
3. Inferior border or base is smooth. maxillary hiatus leading into the maxillary
4. Mandibular foramen and mylohyoid groove on sinus. In the articulated skull this hiatus is
ramus of mandible face medially. reduced into a smaller semilunar opening by the
following bones:
MAXILLA (Figs 18.24 to 18.26) a. Uncinate process of ethmoid, from above.
The maxilla is an irregular pyramidal shaped bone. The hiatus semilunaris is divided into two
One maxilla is present on either side of the midline and by the uncinate process of ethmoid bone. The
the two together form the upper jaw. anteroinferior hole is covered by mucus

Fig. 18.25: Lateral and medial view of right maxilla


membrane and the posterosuperior hole
forms the middle meatus under cover of
middle concha of ethmoid bone.
b. Descending process of lacrimal bone. It is
present anteriorly.
c. Inferior concha: It overlies the hiatus
inferiorly and articulates with the conchal
crest present in front of the nasolacrimal
groove of maxilla.
d. Maxillary process of perpendicular plate of
palatine bone.
Smooth area below and in front of the hiatus
forms a part of the inferior meatus.
A nasolacrimal groove is present anterior to the
hiatus which is converted to the nasolacrimal
canal by articulation with lacrimal bone.
The rough area on the nasal surface behind the
hiatus articulates with the perpendicular plate
of palatine bone.
Posterior border is rough and bears a groove
known as greater palatine groove which is
converted to the greater palatine canal by the
perpendicular plate of palatine bone. It provides
passage for greater palatine vessels and nerves.
2. Orbital surface
It is the superior surface and forms the floor
of orbital cavity.
It is triangular in shape with an anterior, a
posterior and a medial border.
The anterior border is sharp and forms the lower
margin of orbit known as infraorbital margin.
It continues medially with the lacrimal crest of
frontal process of the bone.
The posterior border is rounded and forms the
anteromedial boundary of inferior orbital
fissure. In the centre it presents an infra orbital
groove that runs anteriorly and passes into the
bone as the infraorbital canal. It provides a
passage for the infraorbital vessels and nerves.
Medial border presents the lacrimal notch at the
anterior end. It articulates anteroposteriorly
with lacrimal bone, orbital plate of ethmoid bone
and orbital process of palatine bone respectively.
3. Anterior surface
It is directed forwards and laterally and forms
part of norma frontalis.
Infraorbital foramen is present 1cm. below the
infraorbital margin. It lies in line with the canine
fossa and represents the external opening of
infra orbital canal containing the corresponding
vessels and nerve.
The lateral limit presents a ridge which
separates it from the posterior surface.
Medially, it presents a deep nasal notch that ends
Osteology of Head and Neck 235
below as a projection and joints the same of the
opposite maxilla to form the anterior nasal spine.
Below the level of spine and above the alveolar
process, the anterior surface shows a pro-
minence over the root of canine tooth. On either
side of this prominence is present a fossa, the
incisive fossa medially and the canine fossa
laterally.
4. Posterior surface (Infratemporal surface)
This surface faces backwards and laterally. It
forms the anterior boundary of infratemporal
fossa.
It is separated from the anterior surface by a
vertical ridge at level of 1st molar tooth going
upto the zygomatic process. This is called the
jugal crest.
At its upper end is a groove for maxillary nerve.
This continues upwards into orbital surface as
the infraorbital groove.
In the centre, there are 1 to 2 foramina for the
passage of posterior superior alveolar vessels
and nerve.
Behind the 3rd molar tooth it presents the
C H A P T E R-18
maxillary tuberosity which articulates with the
pyramidal process of palatine bone.
Four Processes
1. Frontal process
It is a thick truncated upward projection from
the body.
Tip of the frontal process articulates with the
frontal bone.
It articulates with nasal bone along the anterior
border.
It articulates with lacrimal bone along the
posterior border.
The lateral surface is divided into an anterior
and a posterior part by a vertical, anterior
lacrimal crest. Anterior part is smooth while the
posterior part is grooved and forms the lacrimal
fossa when it articulates with the lacrimal bone.
This lodges the lacrimal sac.
The medial surface presents with the ethmoidal
crest, below the apex, which articulates with the
middle concha of ethmoid bone.
2. Zygomatic process: It is a short, pyramidal process
that projects laterally from the junction of anterior,
posterior and orbital surfaces of the body. It
articulates with the maxillary process of zygomatic
bone.
3. Alveolar process: It is an arch like projection and
extends inferiorly from the body. The alveolar
process of both sides join in midline to form the
alveolar arch (upper jaw). It carries the sockets for
 236 Human Anatomy For Dental Students
root of upper teeth. The depth and shape of the
sockets depends on the type of tooth. The canine
socket is the deepest while the sockets for molar
teeth are wide. A single socket present for the
incisors, canine and second premolar. The socket
for first premolar is divided into two and for the
molar teeth is divided into three parts by bony
septae.
4. Palatine process
It is a horizontal shelf of bone projecting
medially from the junction of nasal surface of
body and alveolar process.
The palatine processes of both sides meet in
midline and form anterior 3/4th of hard palate.
Posteriorly, it articulates with the horizontal part
of palatine bone.
Superior surface of the process is smooth and
forms the floor of nasal cavity. In the midline, it
presents with a nasal crest that articulates with
vomer bone.
Inferior surface of the process is concave. Behind
the incisor teeth it presents an incisive fossa on
either side.
S E C T I O N-2
The greater palatine vessels and nerves run in
their respective grooves present on the inferior
surface of palate along the posterolateral aspect.
Maxillary Sinus (Antrum of Highmore)
This is the largest paranasal air sinus. It is present in the
body of maxilla, one on either side of the nasal cavity. It
drains into the hiatus semilunaris of the middle meatus
in the posterior part.
Measurements
Vertical : 3.5 cm
Transverse : 2.5 cm
Antero-posterior : 3.25cm
Fig. 18.26: Muscle attachment on maxilla
Parts of Maxillary Sinus
Maxillary sinus is pyramidal in shape. It has the
following parts:
1. Roof: It is formed by floor of the orbit.
2. Floor: It is small and is formed by the alveolar
process of the maxilla. It lies about 1.25 cm below
the floor of the nasal cavity. This level corresponds
to the level of ala of nose.
3. Base: It is formed by the nasal surface of body of
maxilla. It presents with the opening or ostium of
the sinus in its upper part which communicates
with the middle meatus.
In the disarticulated skull the medial surface of
body of maxilla presents a large opening, the
maxillary hiatus. The hiatus is reduced in size by
the following bones when all the skull bones are
articulated.
a. Uncinate process of ethmoid, from above.
b. Descending process of lacrimal bone, from
above.
c. Ethmoidal process of inferior nasal concha, from
below.
d. Perpendicular plate of palatine from behind.
4. Apex: The apex of maxillary sinus extends into the
zygomatic process of maxilla.
5. Anterior wall: It is related to infraorbital plexus of
nerves. Within this wall runs the anterior superior
alveolar nerve in a bony canal called the canalis
sinuosus.
6. Posterior wall: It forms the anterior boundary of
infratemporal fossa. It is pierced by the posterior
superior alveolar nerves.
Attachments on Maxilla (Fig. 18.26)
1. Anterior Surface of Body
a. Depressor septi muscle is attached to the incisive
fossa.

b. Nasalis muscle is attached superolateral to the
fossa.
c. Orbicularis oris muscle is attached to the
alveolar border below the fossa.
d. Levator anguli oris is attached to the lateral side
of canine fossa.
e. Levator labii superioris is attached above the
infraorbital foramen.
2. Infratemporal surface of body: Few fibers of
medial pterygoid muscle are attached to the lateral
margin of maxillary tuberosity.
3. Orbital surface of body: Inferior oblique muscle of
eye ball arises from a small depression lateral to
lacrimal notch, at the anteromedial angle of the
orbital surface.
4. Frontal process: Orbicularis occuli and levator labii
superioris alaeque nasai are attached to the smooth
area anterior to the lacrimal crest.
5. Alveolar process: Buccinator muscle originates
from alveolar process above the first to the third
molar tooth.
Anatomical Position of Maxilla
1. Largest frontal process should face upwards.
2. Body presents a nasal notch anteriorly.
3. Alveolar process with socket for teeth faces
downwards.
Fig. 18.27: Left temporal bone (external view)
Osteology of Head and Neck 237
4. A large irregular opening, the maxillary hiatus faces
medially.
TEMPORAL BONES (Figs 18.27 and 18.28)
A pair of temporal bones are situated one on each side
of the skull extending to its base.
Anatomical Features
It consists of following four basic parts:
1. Squamous part
2. Petro-mastoid part: For the sake of convenience of
description the petromastoid part is generally
divided into two parts.
a. Mastoid part
b. Petrous part
3. Tympanic part
4. Styloid process
C H A P T E R-18
Squamous Part
It is a thin, transparent, shell like plate of bone which
projects upwards to form the side of skull. It articulates
above with parietal bone and anteroinferiorly with
sphenoid bone. It presents with:
Fig. 18.28: Left temporal bone upside down (internal view)
 238 Human Anatomy For Dental Students
1. External (temporal) surface
It forms the floor of temporal fossa and is
grooved in its centre by the middle temporal
artery.
Posteriorly, it presents a supramastoid crest. The
squamous part extends up to 1.5 cm below it
where it joins the mastoid part.
Anterior to the crest, it forms the roof and upper
posterior wall of external acoustic meatus.
2. Internal surface: It lies in contact with the temporal
lobe of the brain. It is grooved by the anterior and
posterior branches of middle meningeal artery.
Lower border is fused with petrous part.
3. Zygomatic process
This projects laterally and forwards from the
lower part of the temporal surface and joins the
temporal process of the zygomatic bone to form
the zygomatic arch.
The base of process is triangular with an anterior
and a posterior root. The two roots meet at the
S E C T I O N-2
tubercle of the root of zygoma.
The anterior root is otherwise called articular
eminence and the posterior root continues
behind with the supramastoid crest.
4. Mandibular fossa: It is a shallow fossa formed by
squamous part of temporal bone anteriorly and
tympanic part of temporal bone posteriorly. The
two parts are joined at squamotympanic fissure.
The anterior part of fossa is articular and forms the
temporomandibular joint with the condylar head
of mandible. It is limited anteriorly by the articular
eminence on anterior root of zygomatic process.
Mastoid Part
It lies below and behind the squamous part.
It articulates with the parietal bone, at mastoid
angle, above and the occipital bone below. A
mastoid foramen may be present at the occipito-
mastoid suture.
The external surface is rough and convex. It extends
below as a conical shaped bony process known as
mastoid process. This encloses the mastoid air cells.
On the medial surface of the mastoid process there
is a notch called mastoid or digastric notch for
attachment of the posterior belly of digastric muscle.
The inner surface is concave and presents a deep
groove for the sigmoid sinus.
Tympanic Part
It is a thin, triangular curved plate of bone which
extends below the squamous part in front of the
mastoid part.
The posterior concave surface forms the floor and
anterior wall of the external auditory meatus.
The anterior surface forms the non-articular part
of the mandibular fossa and is related to posterior
part of the parotid gland.
It meets the squamous part at the squamo-tympanic
fissure superiorly while inferiorly it splits to enclose
the root of styloid process.
Petrous Part (Figs 18.11B and 18.28)
It is shaped as a three dimentional pyramid and is
wedged between the occipital and sphenoid bones
at the base of skull. It is the hardest (rock like) part
of the temporal bone and contains inside it the
internal ear, middle ear and mastoid antrum which
it safely protects. It also contains canals for the
internal carotid artery and facial nerve.
It consists of base, apex, 3 surfaces and 3 borders.
1. Base is fused with lower border of inner surface
of the squamous part.
2. Apex is directed anteromedially and forms the
posterolateral wall of the foramen lacerum.
3. Anterior border is fused with squamous part
and at medial end articulates with greater wing
of sphenoid bone. Posterior border joins the
occipital bone to form a gutter for the inferior
petrosal sinus. Superior border lies between
anterior and posterior surfaces and has a groove
for superior petrosal sinus.
4. Anterior surface forms the posterior part of the
middle cranial fossa. It presents with:
Trigeminal depression for the trigeminal
ganglion near the apex.
Arcuate eminence due to bulging of anterior
semicircular canal.
Tegmen tympani, a plate of bone which
forms the roof of tympanic cavity, mastoid
antrum and auditory tube. It passes down to
divide the squamotympanic fissure.
5. Posterior surface forms the anterior part of floor
of posterior cranial fossa. It presents the internal
acoustic meatus situated in line with the lateral
end of the external meatus.
6. Inferior surface is seen at the base of skull. It lies
between the greater wing of sphenoid and the

basilar part of the occipital bone. It presents the
lower opening of the carotid canal and the jugular
fossa for superior bulb of internal jugular vein
(Fig. 18.8).
Styloid Process (Fig. 18.27)
It is a slender bony projection of about 1inch length.
It extends downwards and forwards from the
under surface of the tympanic plate to appear at
base of skull.
It is crossed externally by the facial nerve.
Stylomastoid foramen is present behind the base
of styloid process for the passage of facial nerve.
Attachments on Temporal Bone (Figs 18.10 and
23.5 to 23.8)
1. Temporalis muscle is attached to a large part of
external surface of squamous part of temporal bone.
2. Temporalis fascia is attached to supramastoid crest
and superior border of zygomatic process.
3. Temporomandibular ligament is attached to the
tubercle at junction of anterior and posterior roots
of zygomatic process.
4. Few fibres of masseter originate from inferior
border and medial surface of zygomatic process.
5. Occipital belly of occipitofrontalis and auricular
posterior muscles are attached to the external
surface of mastoid part of temporal bone.
6. Sternocleidomastoid is attached to tip of mastoid
process.
7. Digastric muscle: is attached to digastric notch on
medial surface of mastoid process.
Fig. 18.29: Left parietal bone (external view)
Osteology of Head and Neck 239
PARIETAL BONES (Figs 18.29 and 18.30)
These are a pair of curved, plate like bones which form
a major portion of the vault of skull.
Anatomical Features
Each parietal bone is quadrilateral in shape and presents
with two surfaces and four borders:
Two surfaces
1. External surface (Fig. 18.29)
It is smooth, convex and presents an elevation
called parietal tuber or tuberosity near its centre.
Below the parietal tuberosity, it presents two
curved lines running anteroposteriorly called
superior and inferior temporal lines.
A parietal emissary foramen is situated close to
the posterior part of the superior border (Fig 18.1).
2. Internal surface (Fig. 18.30).
It is concave and overlies the parietal lobe of
the cerebral hemisphere.
Sagittal sulcus: one half of sagittal sulcus is
C H A P T E R-18
present along the superior border of each bone.
It lodges the superior sagittal sinus.
Granular pits known as granular foveolae are
seen by the side of sagittal sulcus. These lodge
the arachnoid granulations.
A narrow, deep groove is present at the antero
inferior angle which lodges the anterior branch
of the middle meningeal artery.
Grooves formed by impression of branches of
middle meningeal artery run upwards from the
middle of the lower border.
 240 Human Anatomy For Dental Students

Fig. 18.30: Left parietal bone (internal view)

A transverse sulcus is present across the postero- Body

inferior angle which lodges the transverse sinus.
It presents three surfaces and five borders.
Four borders
1. Orbital surface (Superior surface): It is concave and
S E C T I O N-2

1. Superior border: It is serrated and articulates with

forms a part of the lateral wall of the orbit. It has a
the opposite parietal bone, forms sagittal suture.
zygomatico-orbital foramen which transmits the
2. Inferior border: It articulates with the following zygomatic nerve and vessels.
bones, anteroposteriorly: 2. Lateral surface (Facial surface): It is subcutaneous
a. Greater wing of sphenoid bone. and is convex and directed forwards. It presents a
b. Upper part of squamous temporal bone. zygomatico-facial foramen through which comes
c. Mastoid part of temporal bone.
out the zygomatico-facial nerve.
3. Anterior border articulates with frontal bone, forms
3. Temporal surface (Posteromedial surface): It is
corresponding part of coronal suture.
directed backwards and its posterior part forms a
4. Posterior border articulates with squamous part of
part of the anterior wall of temporal fossa. It
occipital bone, forms lambdoid suture.
presents a rough area anteriorly which articulates
Four Angles with the zygomatic process of maxilla. Zygomatico-
1. Antero-inferior angle: It corresponds to pterion.
2. Antero-superior angle: It corresponds to the bregma.
3. Postero-inferior angle: It corresponds to the asterion.
4. Postero-superior angle: It corresponds to the
lambda.

Attachments of Parietal Bone

(Figs 18.10, 19.6 and 23.5)
1. Temporal fascia is attached to the superior temporal
line.
2. Temporalis muscle is attached to the inferior
tempral line.

ZYGOMATIC BONES (Fig. 18.31)

The zygomatic bones form the prominence of the cheeks.

Anatomical Features
Each zygomatic bone consists of three parts, a body and
two processes. Fig. 18.31: Right Zygomatic bone (external view)

temporal foramen is present anteriorly. It transmits
the zygomatico-temporal nerve.
4. Borders: Anterosuperior or orbital margin forms
the lateral half of inferior margin of orbit. Antero
inferior or maxillary margin articulates with
maxilla. Postero inferior margin is rough and
provides attachment to masseter muscle. Postero
medial or sphenoidal margin articulates with
greater wing of sphenoid. Postero superior border
is smooth and runs between back of frontal process
to upper border of zygomatic arch.
Two Processes
1. Frontal process (Figs 18.6, 18.7 and 18.31): It is a
thick upward projection that forms a part of the
lateral wall of orbit. It articulates above with the
zygomatic process of the frontal bone and
posteriorly with orbital surface of greater wing of
sphenoid.
2. Temporal process (Figs 18.6 and 18.7 and 18.31): It
extends backwards from the junction of posterior
aspect of lateral and temporal surfaces and joins
the zygomatic process of the temporal bone to form
the zygomatic arch.
FRONTAL BONE (Figs 18.32 and 18.33)
The frontal bone is located in the region of forehead.
It is shaped like a shell.
Anatomical Features
It presents with the following parts:
1. Squamous part
Fig. 18.32: Frontal bone (internal view)
Osteology of Head and Neck 241
2. Nasal part
3. Two orbital plates
4. Two zygomatic processes
5. Frontal air sinuses
1. Squamous part
It is the larger, upper part placed vertically. It
forms the forehead.
Inferiorly, on each side the squamous part
continues with the orbital plate. The junction of
these two forms the supra-orbital margin. A
supraorbital notch is present at the junction of
medial 1/3rd and lateral 2/3rd of the margin.
The squamous part presents with external and
internal surfaces.
The external surface, above each supra-orbital
margin, presents a curved elevation called
supraciliary arch. The medial end of the two
supraciliary arches meet in centre to form a
rounded prominence called glabella. Above each
supraciliary arch, in the middle, the external
surface displays an elevation called the frontal
tuber or eminence.
C H A P T E R-18
The internal surface is deeply concave. It
presents a median bony ridge called frontal crest
in its lower part. This continues above with the
sagittal sulcus which lodges the superior sagittal
sinus. The crest and margins of the sulcus give
attachment to falx cerebri.
The squamous part of frontal bone articulates
above and posteriorly with the two parietal
bones along the parietal margin forming coronal
suture. Inferiorly on each side it articulates with
greater wing of sphenoid bone.
 242 Human Anatomy For Dental Students
Fig. 18.33: Frontal bone (external view)
2. Nasal part
It is the portion of bone which projects
downwards from the squamous part, in the
midline, between the right and left supraorbital
S E C T I O N-2
margins.
It presents with a nasal notch, inferiorly which
articulates with the two nasal bones in centre
and the frontal processes of maxilla and the
lacrimal bones on either side.
3. Orbital plates
These form the lower horizontal part of the
frontal bone. They consist of 2 thin, triangular
plates of bone, each extending backwards and
horizontally from the lower end of squamous
part, on either side of the midline.
The 2 plates are separated from each other
medially by a U-shaped notch that articulates
with the cribriform plate of ethmoid bone.
The upper surface forms part of the anterior
cranial fossa and lodges the frontal lobe.
The lower surface is smooth and forms most of
the roof of orbit. On its lateral end, just behind
the supra orbital margin, is present the lacrimal
fossa for the lacrimal gland.
Each plate articulates posteriorly with the lesser
wing of sphenoid.
4. Zygomatic process: It is a very short process arising
from each side of the bone which extends
downwards and laterally from the lateral end of
the supraorbital margin. It articulates with the
frontal process of the zygomatic bone. From the
posterior margin of each zygomatic process a
temporal line curves upwards and backwards and
when traced further splits into superior and inferior
temporal lines which continue over the parietal
bones.
5. Frontal sinuses: These are air filled spaces
extending from each side of nasal part of the bone
into the substance of the bone. In adults they are
large, irregular and lie along the medial border of
orbital plates. They extend up into the squamous
part till the supraciliary arches.
OCCIPITAL BONE (Figs 18.34 and 18.35)
Occipital bone occupies the posterior part of skull. It is
characterized by the presence of a large foramen called
foramen magnum, in the mid line.
Anatomical Features
It consists of following four parts:
1. Squamous part: An expanded plate above and
behind the foramen magnum.
2. Two condylar parts situated externally, one on each
side of foramen magnum.
3. Basilar part: This projects forwards and upwards
in front of the foramen magnum.
Squamous Part
It presents two surfaces and two pairs of borders and 3
angles.
1. External surface: It is convex and shows following
features:
External occipital protuberance: It is a median
elevation at the point of maximum convexity of
the bone. The most prominent point of this
protuberance is called as inion.
 Osteology of Head and Neck 243

External occipital crest: It is a median bony crest
running downwards from external occipital
protuberance to the foramen magnum.
Two superior nuchal lines: These are curved
bony prominences present on each side. Each
line curves laterally with its convexity upwards
from the external occipital protuberance.
Two inferior nuchal lines: One inferior nuchal
line is present one on each side below the
superior nuchal line. Each line curves laterally
from the middle of the external occipital crest.
Highest nuchal lines: These are also known as
supreme nuchal lines and may be present over
the superior nuchal lines.

C H A P T E R-18
Fig. 18.34: Occipital bone (external surface)

Fig. 18.35: Occipital bone (internal surface)

 244 Human Anatomy For Dental Students
2. Internal surface: Itis concave and shows the
following features:
Internal occipital protuberance: It is a bony
elevation seen in the centre.
A number of lines radiate from the internal
occipital protuberance
a. Sagittal sulcus: It is a median sulcus that runs
upwards from the internal proruberance
towards the superior angle of the bone. It
lodges the superior sagittal sinus.
b. Transverse sulcus: A sulcus is seen on each
side running transversely from internal
occipital protuberance towards the lateral
angle. It lodges the transverse sinus.
c. Internal occipital crest: It is a bony crest in
median plane which runs downwards from
the internal occipital protuberance towards
the foramen magnum. Near the foramen
magnum it splits to form a triangular depre-
ssio called vermian fossa related to the vermis
of cerebellum.
These lines divide the internal surface into 4
S E C T I O N-2
fossae. The two upper fossae are related to
occipital lobes of brain while the two lower
fossae accommodate the cerebellar hemi-
spheres.
3. Superolateral borders (parietal margin): On either
side they articulate with posterior border of parietal
bone (lambdoid suture).
4. Inferolateral borders (mastoid margin): On either
side these articulate with mastoid part of temporal
bone (occipitomastoid suture).
5. Superior angle: It is the meeting point of the 2
superolateral borders. It corresponds to the lambda,
(posterior fontanelle).
6. Lateral angles: The superolateral and inferolateral
borders on each side meet at an angle known as
the lateral angle. It corresponds to the posterolateral
fontanelle.
Condylar Part
Each condylar part is divided into medial and lateral
parts
1. Medial part
It bears oval shaped occipital condyles and is
known as proper condylar part. These occupy
the area along the anterior half of border of
formen magnum and converge in front to the
basiocciput. They articulate with atlas vertebra
on each side inferiorly.
Hypoglossal canal transmitting the hypoglossal
nerve lies above and medial to the occipital
condyle on each side.
A depression is present just behind each
condyle. It is named as condylar fossa. Some-
times, it presents a foramen in its floor called
posterior condylar canal.
The inner superior surface of the condylar part
presents a bony projection, the jugular tubercle.
2. Lateral part
It is a quadrilateral plate projecting laterally
from the posterior half of the occipital condyle
which is called the jugular process. It articulates
with petrous temporal bone.
The anterior margin of jugular process presents
a concave jugular notch which forms jugular
foramen with a similar notch on the petrous
temporal bone.
Basilar Part (Basi-occiput)
It is a wide bar of bone which extends in front of
the foramen magnum and articulates with the body
of sphenoid to form the basi-sphenoid joint (a
primary cartilaginous joint).
The upper surface of the basi-sphenoid presents a
shallow gutter which slopes downwards and
backwards from basisphenoid to the foramen
magnum. It is called as clivus. It is related to the
lower pons and medulla of the brain.
The inferior surface of the basilar part presents a
pharyngeal tubercle in the median plane about 1 cm
in front of the foramen magnum. This gives rise to
the upper end of pharyngeal raphae.
Attachment on Occipital Bone (Fig. 18.10)
1. Epicranial aponeurosis is attached to medial half
of highest nuchal lines.
2. Occipital part of occipito frontalis muscle is attached
to lateral half of highest nuchal lines.
3. Trapezius muscle originates from medial 1/3rd of
superior nuchal line and external occipital
protuberance.
4. Rectus capitis major and minor are respectively
attached to the lateral and medial half of inferior
nuchal line and the corresponding area of bone
below it.
5. Semispinalis capitis is attached to medial area
between superior and inferior nuchal line.
6. Obliqus superior is attached to lateral area between
superior and inferior nuchal line.
7. Splenius capitis is attached along a line just below
superior nuchal line in lateral 1/3rd.
 Osteology of Head and Neck 245

8. Sternocleidomastoid muscle is attached to lateral Anatomical Features

half of superior nuchal line. It consists of the following seven parts:
9. Rectus capitis lateral is attached to jugular process
1. Body, in the centre
of condylar part.
2. Two lesser wings
10. Rectus capitis anterior is attached to basiliar part
infront of condylar part. 3. Two greater wings
11. Longus capitis is attached on lateral side of 4. Two pterygoid processes
pharyngeal tubercle.
Body
SPHENOID BONE (Figs 18.36, 18.37 and 18.11B and C) It is cuboidal in shape with six surfaces and contains a
The sphenoid is an unpaired irregularly shaped bone pair of sphenoidal air sinuses.
situated at the base of skull. Its structure resembles a 1. Superior surface: It presents the following features
bat with spreadout wings. from before backwards:

C H A P T E R-18
Fig. 18.36: Sphenoid bone (anterior view)

Fig. 18.37: Sphenoid bone (posterior view)

 246 Human Anatomy For Dental Students
Ethmoidal spine: It is present as an anterior
triangular projection between the two lesser
wings and articulates with the cribriform plate
of ethmoid.
Jugum sphenoidale: It is a flattened plate of
bone behind the ethmoidal spine.
Sulcus chiasmaticus: It is a shallow transverse
groove which leads on each side to the optic
canal.
Tuberculum sellae: An horizontal elevation
forming the posterior limit of sulcus chiasma-
ticus. On each side it presents the middle clinoid
processes.
Hypophyseal fossa: This is a deep depression
behind the tuberculum which lodges the
hypophysis cerebri.
Dorsum sellae: Square plate of bone which
projects upwards behind the fossa. It presents a
conical projection on each side called the
posterior clinoid processes. It slopes downward
and backwards and joins with basi-occiput.
Sella turcica: is the collective name given to
S E C T I O N-2
tuberculum sellae, hypophyseal fossa and
dorsum sellae. It resembles a Turkish saddle.
2. Inferior surface: It presents with
Sphenoidal rostrum: A median ridge projecting
downwards which articulates with the groove
between the alae of vomer.
Sphenoidal conchae: These are thin, curved
triangular plates of bone present antero-
inferiorly to the body and join in the centre to
the rostrum. They articulate with the corres-
ponding ala of vomer.
Vaginal processes: Small triangular bony
shelves which project downwards and medially,
one from each lateral end of the inferior surface
at its junction with base of medial pterygoid
plate.
3. Anterior surface
Sphenoidal crest: It is a vertical, median bony
ridge which articulates with the posterior border
of the perpendicular plate of ethmoid to form a
part of the nasal septum. On each side of
sphenoid crest, lies the opening of sphenoidal
air sinuses.
Upper vertical part of sphenoidal conchae: One
concha lies on each side of the crest. Sphenoidal
foramen is present medially in its lower part.
4. Posterior surface: It is quadrilateral in shape and
articulates by a plate of hyaline cartilage with the
basi-occiput.
5. Lateral surfaces
On each side, the lateral surface joins with the
greater wing of sphenoid, laterally and
pterygoid process, inferiorly.
The lateral surface in upper part presents a
groove called carotid sulcus, produced by the
internal carotid artery on each side of the
hypophyseal fossa.
Lesser Wings
A triangular plate of bone is attached to the upper
part of body of sphenoid on either side anteriorly.
The base is formed by 2 roots arising from the body
and the apex is directed laterally. This forms the
lesser wings.
Optic canal is formed in between the two roots and
body of sphenoid. It transmits the optic nerve and
ophthalmic artery of that side.
Anteriorly, it articulates with the orbital plate of
frontal bone. The posterior border is free and has a
medial prominence the anterior clinoid process.
Superiorly, it forms part of anterior cranial fossa
and inferiorly the roof of orbit.
Greater Wings
One greater wing spans out laterally from each side
of the body. It presents with three surfaces:
a. Upper or cerebral surface is concave and forms
part of the middle cranial fossa. It presents three
foramina along its postero medial margin
namely, foramen rotundum, foramen ovale and
foramen spinosum.
b. Lateral or temporal surface: It is divided into
temporal and infratemporal surfaces by an
infratemporal crest. It presents with the external
opening of foramen ovale and foramen
spinosum. A spinous projection is seen behind
the foramen spinosum and is called the spine
of sphenoid.
c. Anterior or orbital surface: It lies anteriorly and
forms the posterior part of lateral wall of the
orbit. It articulates above with frontal bone and
laterally with zygomatic bone. Medial margin
forms the inferolateral margin of superior orbital
fissure and inferior margin forms the postero
lateral margin of inferior orbital fissure.
The greater wing articulates above with frontal
bone and on lateral ends with sphenoidal angle of
parietal bone. Posteriorly, the margins are wedged
between the petrous and squamous part of
temporal bone, seen clearly in the base of skull.
 Osteology of Head and Neck 247

Pterygoid Processes Anatomical Features

Each pterygoid process projects downwards from
the junction between the body and greater wings
of the sphenoid.
It consists of two laminae called medial and lateral
pterygoid plates. They are fused anteriorly while
posteriorly they are separated by the pterygoid
fossa.
The anterior surface of the root of the pterygoid
process forms the posterior wall of the pterygopala-
tine fossa. The foramen rotundum and anterior
pterygoid canal open into the pterygopalatine fossa
through this surface.
Lateral pterygoid plate is quadrilateral: It presents
with anterior and posterior margins; lateral and
medial surfaces. The lateral surface forms medial
wall of intratemporal fossa and medial surface
forms wall of pterygoid fossa. The anterior margin
in upper part forms the posterior boundary of
pterygo-maxillary fissure and articulates with
perpendicular plate of palatine bone in lower half.
It consists of two parts namely, cribriform plate and bony
labyrinths.
1. Cribriform plate
It is a central horizontal plate which fills the
ethmoidal notch between the two orbital plates
of frontal bone and separates the nasal cavities
from the anterior cranial fossa.
It forms the roof and part of lateral wall of nasal
cavity.
It has a number of pores which transmit the
olfactory nerve filaments from the olfactory
epithelium of nasal cavity to the olfactory bulb
of the brain.
Crista galli: It is a triangular shaped median
crest arising from the upper surface of the
cribriform plate. It resembles the crest on the
head of gallus domesticus (cocks comb-the red
growth of flesh on top of the head of a cock). It
gives attachment to the anterior end of falx
cerebri along its posterior border.
A quadrilateral perpendicular plate of bone

C H A P T E R-18
Posterior margin is free.
projects downwards from the inferior surface
The medial pterygoid plate: It is more elongated. of the cribriform plate in midline. It forms the
It also presents with anterior and posterior margins; upper part of nasal septum and is lodged
lateral and medial surfaces. The posterior margin
is free and presents in its lower part a hook-like
process called pterygoid hamulus while the anterior
margin articulates with perpendicular plate of
palatine bone in lower half. Medial surface forms a
part of the lateral wall of nasal cavity. Lateral
surface forms the medial surface of pterygoid fossa.

Attachments of Sphenoid Bone (Fig. 18.10)

1. Temporalis muscle is attach to temporal surface of
greater wing of sphenoid.
2. Lateral pterygoid muscle is attached to infra
temporal surface of greater wing and lateral surface Fig. 18.38: Ethmoid bone (superior view)
of lateral pterygoid plate.
3. Sphenomandibular ligament is attached to spine of
sphenoid.
4. Medial pterygoid muscle is attached to medial
surface of lateral pterygoid plate.
5. Pterygomandibular raphe is attached to pterygoid
hamulus.
6. Pharyngobasilar facia is attached to posterior
margin of medial pterygoid plate.

ETHMOID BONE (Figs 18.38 and 18.39)

The ethmoid is a single, irregular, cuboidal shaped bone
located between the two orbital cavities, superiorly. Fig. 18.39: Ethmoid bone (inferior view)
 248 Human Anatomy For Dental Students
between the nasal crest of frontal bone and 2
nasal bones in front, the sphenoidal crest behind
and the vomer posteroinferiorly. Inferiorly it is
attached to the septal cartilage.
2. Bony labyrinths
These are cuboidal shaped boxes filled with air
cells which extend downwards, one on each
side, from the lateral border of the cribriform
plate.
Each labyrinth articulates anteriorly with the
lacrimal and maxillary bones and posteriorly
with the palatine bone.
The medial surface or nasal plate forms the
lateral wall of nasal cavity. It consists of 2 curved
shelf like projections called conchae, a large
middle conchae and a smaller posterosuperiorly
placed superior conchae.
The uncinate process projects below the middle
conchae from upper part of the middle meatus.
The lateral surface (orbital plate) forms the
medial wall of orbit.
The narrow lower surface between the medial
and lateral surfaces articulates with body of
S E C T I O N-2
maxilla.
The air cells contained in it are divided into 3
groups namely anterior, middle and posterior.
PALATINE BONES
There are two palatine bones. Each palatine bone is
lodged between the maxilla in front and pterygoid
process of sphenoid behind.
Anatomical Features
It is an L-shaped bone with a perpendicular and a
horizontal plate.
Perpendicular Plate
It is a vertical plate of bone with 2 surfaces and 4
borders. The lateral surface articulates in the middle
with the medial side of maxilla behind the hiatus.
It bears a groove for greater palatine vessels and
nerve corresponding to that on the maxilla.
The medial surface forms a part of the lateral wall
of nose and bears 2 crests that divide it into 3 fossae.
The upper ethmoidal crest articulates with the
middle concha and lower conchal crest articulates
with the inferior concha.
Posteriorly, it articulates with medial pterygoid
plate.
It presents with three processes:
1. Orbital process: It is an expanded pyramidal
projection from the superior border. The base
of orbital process forms a part of the floor of
orbit.
2. Sphenoidal process: Also arises from the
superior border, behind the orbital process. The
two processes are separated by a sphenopalatine
notch which is converted to a foramen by the
sphenoid bone in articulated skull.
3. Pyramidal process: It is present inferiorly and
arises from the junction of the vertical and
horizontal plates of palatine bone. It passes
postero-laterally and provides attachment to
medial pterygoid muscle.
Horizontal Plate
It is a quadrilateral plate of bone extending medially
from the inferior border of perpendicular plate.
The upper surface is concave and forms the
posterior part of floor of nasal cavity while the lower
surface forms the posterior part of the hard palate.
The two plates from each side join in the centre.
Anteriorly, they articulate with the corresponding
palatine processes of maxilla while their posterior
border is free.
VOMER (Figs 18.8 and 18.9)
It is a thin, quadrilateral plate of bone which is placed
vertically. It forms the postero-inferior part of nasal
septum. Vomer consists of four borders and two lateral
surfaces.
Superior border: It is grooved and articulates with
the sphenoidal rostrum.
Inferior border: It articulates with the median nasal
crest of bony palate.
Anterior border: Is the longest and slopes
downwards and forwards. In its upper part, it
articulates with the perpendicular plate of ethmoid
and in its lower part with the septal cartilage.
Posterior border: It is free and separates the two
posterior nasal apertures.
Lateral surface of vomer: On each side it is covered
with mucous membrane. A groove for the naso-
palatine nerve and vessels is seen inferior to the
anterior margin.
NASAL BONES (Fig. 18.3)
These are a pair of triangular bones with a wide
apex. They form the bridge of the nose.
Each bone has an outer convex and an inner
concave surface.
The apex of each nasal bone articulates with the
frontal bone above.

Its base continues below with the lateral nasal
cartilage.
Lateral border articulates with frontal process of
maxilla.
Medial border meets the lacrimal bone of opposite
side.
LACRIMAL BONES (Figs 18.3, 20.5 and 20.6)
These are thin plates of bones situated on the medial
aspect of the orbit.
Anteriorly, each articulates with the frontal process
of maxilla, posteriorly with orbital plate of ethmoid,
superiorly with frontal bone and inferiorly with
orbital surface of maxilla.
The lateral surface bears a posterior lacrimal crest.
Anteriorly, to the crest is a groove which forms the
lacrimal fossa.
Posteriorly, it forms the medial wall of orbit.
Medially, it overlaps over the labyrinth of the
ethmoid bone.
INFERIOR NASAL CONCHAE (Fig. 28.5)
These are a pair of curved bones, lying in an
anteroposterior direction, on the lateral wall of nasal
cavity.
The superior border articulates with the conchal
crest on maxilla anteriorly and the perpendicular
plate of palatine bone posteriorly. It presents with
three processes, lacrimal, maxillary and ethmoidal.
Inferior border is curved and free.
Medially it is convex while laterally it is concave
and forms the medial wall of inferior meatus.
HYOID BONE (Figs 18.40 and 18.41)
This U-shaped bone is located in the anterior aspect of
the neck between the base of mandible and the larynx.
It lies at the level of third cervical vertebra. It does not
articulate with any other bone but, is suspended from
the styloid processes of temporal bones on each side by
stylohyoid ligaments.
Fig. 18.40: Hyoid bone (anterio-superior view)
Osteology of Head and Neck 249
Anatomical Features
Hyoid bone consists of the following five parts:
1. A body
2. A pair of greater cornu (also called horns)
3. A pair of lesser cornu.
Body
It is elongated and quadrilateral in shape. The body
presents two surfaces, anterior and posterior and
two lateral extremities.
The anterior surface is convex and faces forwards
and upwards. Its upper part is crossed by a
transverse line or ridge. In many cases a vertical
median ridge divides the body into two lateral
halves.
The posterior surface is smooth and concave. It faces
backwards and downwards. The posterior surface
of hyoid is separated from the epiglottis by the
thyrohyoid membrane; a bursa intervenes between
the bone and the membrane.
The lateral extremities of the body on each side are
C H A P T E R-18
continuous with the greater cornu. In early life the
body is connected with the greater cornu by a
cartilage, but later in life it ossifies and unites to
form a single bone.
Greater Cornu
Each greater cornu is a horizontally flattened, thin
shelf of bone which projects backwards and slightly
upwards from the side of the body of hyoid bone.
Each cornu has an upper and a lower surface. They
diminish in size from before backwards.
Each cornu ends posteriorly in a tubercle.
When the neck is relaxed, the two greater cornu
can be gripped in vivo between the index finger
and the thumb and then the hyoid bone can be
moved from side to side.
Lesser Cornu
Each lesser cornu is a small conical bony projection that
is attached at the junction of the body and greater cornu.
Fig. 18.41: Hyoid bone (posterio-inferior view)
 250 Human Anatomy For Dental Students
Attachments on Hyoid Bone (Fig. 18.42)
1. Geniohyoid is attached to anterior surface of body
of hyoid bone.
2. Genioglossus is attached on the medial side of
superior border of body of hyoid bone.
3. Mylohyoid is attached to lower aspect of anterior
surface of body of hyoid bone.
4. Sternothyroid is attached to the medial half of
inferior border of body. and omohyoid is attached
to lateral half of inferior border of body of hyoid
bone.
5. Middle constrictor muscle of pharynx and hyo-
glossus is attached along the length of upper
surface of greater cornu of hyoid bone.
6. The stylohyoid ligament is attached to the tip of
the lesser horn and is sometimes ossified.
S E C T I O N-2
Fig. 18.42: Hyoid bone showing muscle attachments (anterio-
superior view )
CERVICAL VERTEBRAE
There are seven cervical vertebrae. They are small in size
as compared to thoracic vertebrae as they have to carry
less weight. They are identified by the presence of
foramen transversariumthe cardinal feature of
cervical vertebrae.
Fig. 18.43: Typical cervical vertebra (postero-superior view)
General Features of Cervical Vertebrae (Fig. 18.43)
1. The body: It is small, broader from side to side than
from before backwards. Its superior surface is
concave transversely and presents with upward
projecting lips on each side known as uncinate
processes. The anterior margin of the inferior
surface of body projects downwards in front of the
intervertebral disc while the lateral margins are
bevelled laterally. They form synovial joints with
the projecting lips of the lower vertebra. These are
called as unco-vertebral joints or joints of Luschka.
2. The vertebral foramen is triangular in shape and
larger than the body.
3. The superior and inferior articular facets are flat.
Superior facets are directed backwards and
upwards. Inferior facets, are directed forwards and
downwards.
4. The transverse processes are small and pierced by
a foramina called the foramina transversaria. Each
process has anterior and posterior roots which end
in tubercles called anterior and posterior tubercles.
They are joined together by a costotransverse bar.
The costal element consists of the anterior root and
tubercle the costotransverse bar, and the posterior
tubercle.
5. The spine is short and bifid.
Classification
The cervical vertebra are classified into following two
groups:
1. Typical cervical vertebrae (Figs 18.43 and 18.44):
They present with all the general features of a
cervical vertebra as discussed above. The 3rd, 4th,
5th, and 6th cervical vertebrae belong to this group.
2. Atypical cervical vertebrae: They do not conform
to all the general features of the cervical vertebrae,
1st, 2nd and 7th cervical vertebrae belong to this
group.

Fig. 18.44: Typical cervical vertebra (inferior view)
FIRST CERVICAL VERTEBRA (Figs 18.45 to 18.47 )
The first cervical vertebra is called atlas because
it supports the globe of the head.
It is in the shape of a ring and has no body and
spine.
It consists of right and left lateral masses, right and
left transverse processes with the foramen
transversaria and two arches, anterior and posterior
arches.
Each lateral mass presents following features:
a. Its upper and lower surfaces bear superior and
inferior articular facets respectively.
The superior articular facet, is concave and
elongated. It is directed upwards and
medially to articulate with the corresponding
condyle of the occipital bone to form the
atlanto-occipital joint.
The inferior articular facet, is flat and circular.
It is directed downwards, medially and
backwards to articulate with the correspond-
ing facet on the axis vertebra to form the
atlanto-axial joint.
Fig. 18.45: Atlas vertebra, 1st cervical vertebra (superior view)
Osteology of Head and Neck 251
b. The medial surface of the lateral mass on each
side is marked by a small roughend tubercle to
provide attachment to the transverse ligament
of the atlas.
The anterior arch is marked by a median
anterior tubercle on its anterior aspect and
an oval facet on its posterior aspect for
C H A P T E R-18
articulation with the dens of the 2nd cervical
vertebra.
The posterior arch forms 2/5th of the ring
and its posterior aspect is marked by a
median posterior tubercle. The upper surface
of the posterior arch behind the lateral mass
is marked by groove which lodges vertebral
artery and first cervical nerve.
POINT TO REMEMBER
The most important feature of atlas vertebra is the
absence of its body. The body is absent because during
development the centrum of first cervical vertebra get
fused with the centrum of axis to form the dens.
 252 Human Anatomy For Dental Students

Fig. 18.46: Atlas vertebra, 1st cervical vertebra (antero-inferior view)

S E C T I O N-2

Fig. 18.47: Relations and attachments of atlas vertebra (superior view)

Fig. 18.48: Axis vertebra, 2nd cervical vertebra (Antero-superior view)

SECOND CERVICAL VERTEBRA (Figs 18.48 and 18.49)
The second cervical vertebra is called axis because the
atlas rotates like a wheel around the axis provided by
its odontoid process or dens.
It possess a strong tooth like process projecting
upwards from the body called the odontoid
process. The odontoid process of dens represents
the centrum (body) of the atlas which has fused with
the centrum of the axis vertebra.

Fig. 18.49: Axis vertebra, 2nd cervical vertebra (postero-superior view)
The dens articulates anteriorly with the anterior
arch of the atlas and posteriorly with the transverse
ligament of the atlas.
The dens provides the attachment to the apical
ligament at its apex and to the alar ligaments on
each side below the apex.
The prominent anterior margin of the inferior
surface of the body projects downwards for a consi-
derable extent.
The spine is massive, i.e., it is large thick and very
strong and deeply grooved inferiorly.
The transverse processes are very small and lacks
the anterior tubercles. The foramen transversarium
is directed upwards and laterally.
The laminae are thick and strong.
The superior articular facets on the upper surface
of the body extend on the pedicles. Each is large
flat and circular and is directed upwards and
laterally to articulate with the corresponding facet
on the atlas.
Fig. 18.50: Seventh cervical vertebra (superior view)
Osteology of Head and Neck 253
The inferior articular facet on each side lies posterior
to the transverse process and is directed
downwards and forwards to articulate with the
third cervical vertebra.
C H A P T E R-18
The massive pedicle overhangs the foramen
transversarium laterally.
POINT TO REMEMBER
The old name of the axis was the OS Chelonit because
of its resemblance to the head of a tortoise.
SEVENTH CERVICAL VERTEBRA (Figs 18.50 and
18.51)
The seventh cervical vertebra is called as vertebra
prominens because its spine is very long and prominent.
It is visible through the skin in the lower part of the
nuchal furrow.
Its spine is thick, long and nearly horizontal. It is
not bifid and ends in a tubercle.
The transverse processes are comparatively larger
in size and lacks the anterior tubercles.
 254 Human Anatomy For Dental Students
Fig. 18.51: Seventh cervical vertebra (inferior view)
The foramen transversarium is relatively small and
does not transmit the vertebral artery. It transmits
only accessory vertebral vein.
S E C T I O N-2
CLINICAL AND APPLIED ANATOMY
The anterior tubercle of the transverse process of
sixth cervical vertebra is large and called the carotid
tubercle because common carotid artery can be
compressed and felt against it.
The death in execution by hanging is due to fracture
of odontoid process of axis vertebra with
subsequent posterior dislocation of atlas vertebra
which compresses the medulla resulting in death.
This is called Hangmans fracture.
Luschkas joints are very common sites of osteo-
phyte formation. Since cervical nerve roots lie
posterolateral to these joints, the osteophytes may
produce cervical nerve involvement. The osteo-
phytes may also intrude on the foramen
transversaria transmitting vertebral artery. This
may cause distortion of the artery which produces
vertebro-basilar insufficiency.
The atlanto-occipital joint is a condylar type of
synovial joint while atlanto-axial joint is a pivot
type of synovial joint.
a. The movements between the atlas and the skull
(atlanto occipital joint)are flexion and extension,
i.e., nodding or yes movements.
b. The movements between the atlas and axis
(atlanto-axial joint) are rotation around a
vertical axis, i.e., turning the head from side to
side or No movements.
OSSIFICATION OF SKULL BONES AND MANDIBLE
Occipital Bone
It ossifies in membrane and cartilage by the following
parts:
1. Squamous part of bone above highest nuchal line
ossifies in fibrous membrane by 2 centres at 6 to 7
weeks of intrauterine life.
2. Squamous part of bone below highest nuchal line
ossifies in cartilage by 2 centres in 7th week of
intrauterine life.
3. The two squamous parts unite by 3rd month.
4. Each condylar parts of the bone ossifies in cartilage
by 2 centres at 8th week of intrauterine life.
5. The basilar part ossifies in cartilage by 1 centre at
6th week of intrauterine life.
Fusion: Occipital bone is seen as four pieces at birth.
1. The squamous and condylar parts fuse at 2 years
of age.
2. The condylar parts fuse with basilar part by 3 to 4
year.
Sphenoid Bone
It ossifies in membrane and cartilage, by two parts.
Anterior to tuberculum sellae is presphenoidal part and
posterior to it is post sphenoidal part.
1. Presphenoidal part ossifies in cartilage by six
centres.
Two centres appear for lesser wings at 9th week.
This is soon followed by 2 centres for presphe-
noidal body.
2 more centres appears for sphenoidal concha
at 5th month of intrauterine life.
2. Post sphenoidal part ossifies by eight centres.
Two centres appear for root of greater wings at
8th week in cartilage. The surrounding mesen-
chyme develops into rest of greater wing and
lateral pterygoid plates.
Two centres appears for medial pterygoid plate,
in membrane, at 9th week.
Two centres appear in cartilage for pterygoid
hamulus at 3rd month.
Two centres appear for post sphenoidal body
in cartilage at 4th month.

Fusion: Sphenoid bone appears in three parts at birth.
1. The presphenoid and postsphenoid body fuse by
8th month of intrauterine life.
2. The greater wings fuse with the body by 1st year of
life. Sphenoid bone fuses to occipital bone by age
of 25 years.
Temporal Bone
It ossifies in membrane by four parts:
1. Squamous part ossifies in membrane by one centre
which appears at 7 to 8 weeks of intrauterine life.
2. Tympanic part ossifies in membrane by one centre
appearing at 3rd month of intrauterine life.
3. Petromastoid part ossifies in cartilage, from
multiple centres which can be upto 14 in number.
These appear at 3rd month of intra-uterine life.
4. Styloid process develops in cartilage by 2 centres,
proximal centre appears at birth while distal centre
just after birth.
Fusion
1. Tympanic ring unites with squamous part just
before birth.
2. Petromastoid and proximal part of styloid process
unite with tympanic ring by 1 year of life.
3. The petrous and squamous part of bone are
separated by the petrosquamous fissure in infancy
and fuses by puberty (may remain as such in about
1/4th individuals).
Parietal Bone
It ossifies from two centres in the mesenchyme
(membranous ossification) which appear at 7th week of
intrauterine life and unite soon. Ossification proceeds
from centre outwards.
Frontal Bone
It ossifies from the mesenchyme by 2 centres which
appear at 8th week of intrauterine life at site of frontal
tuberosity. Ossification proceeds superiorly, posteriorly
and inferiorly.
Fusion
At birth frontal bone is seen to have two halves. Suture
present between the two halves is called metopic suture
which fuses by 8 years of life.
Ethmoid Bone
It ossifies in cartilage from three centres
1. One centre appears for each labyrinth around 4 to
5th month of intrauterine life.
2. One centre appears for perpendicular plate in the
first year of life.
Fusion
1. Labyrinths are partially ossified at birth and
develop in infancy.
2. Perpendicular plate ossifies after birth and fuses
with labyrinths by 2nd year of life.
3. Cribriform plate and crista galli ossify from
perpendicular plate and labyrinths.
Osteology of Head and Neck 255
4. All parts of bone unite to form single bone by 3 years
of age.
Inferior Nasal Concha
It ossifies in cartilage by one centre appearing at 5th
month of intra-uterine life in the lower border of
cartilaginous lateral wall of nasal capsule.
Nasal Bone
It ossifies in mesenchyme (membrane) by one centre
appearing in 3rd month of intrauterine life.
Vomer
It ossifies in mesenchyme from 2 centres that appear in
midline, one on either side of septal cartilage, in its
postero-inferior aspect, at 8th week of intrauterine life.
The two unite inferiorly at 12th week and ossification
proceeds superiorly with reabsorption of cartilage.
Lacrimal Bone
It ossifies in mesenchyme from one centre which appears
at 12th week of intra-uterine life.
Zygomatic Bone
It ossifies in the mesenchyme from one centre which
appears at 8th week of intra-uterine life.
C H A P T E R-18
Palatine Bone
It ossifies in the mesenchyme from one centre that
appears at 8th week of intra-uterine life.
Maxilla
It ossifies in mesenchyme from one centre.
1. The centre appears in the region above the canine
fossa. Ossification proceeds in all directions to
complete the bone.
2. Maxillary sinus appears as a small groove at 4th
month of intrauterine life and can be identified on
X-ray at birth. It gradually enlarges and is fully
formed by the time full permanent dentition occurs.
Mandible
It ossifies in the following manner:
1. One centre appears for each half of the body in the
fibrous mesenchyme near mental foramen, at the
6th week of intrauterine life. Ossification proceeds
medially and postero-superiorly then upwards to
form crypts for the teeth. The ventral part of
Meckels cartilage below incisors is invaded by
ossification from mesenchymatous centre.
2. Secondary cartilages appear in mid-fetal life at the
following places:
a. Condylar cartilage at head of mandible.
b. Along anterior border of coronoid process.
c. 1 to 2 small cartilage nodules at symphysis
menti.
Fusion: All ossify and fuse to form one bone by birth.
Cartilaginous part of ramus grows after birth and
completely ossifies by third decade of life.
 Chapter

19
Scalp and Face

SCALP 1. Skin: Skin of the scalp is thick and richly supplied

with hairs, sweat glands and sebaceous glands. It
The soft tissue covering the vault of skull is termed as has about 1,20,000 hairs.
scalp. 2. Subcutaneous tissue: Superficial fascia consists of
lobules of fat bounded in tough fibrous septae
Extent which form a very dense network. It is adherent to
the skin above and to the underlying aponeurosis.
Anterior : Supraciliary arches. Blood vessels of the scalp lie in this layer. Any injury
Posterior : External occipital protuberance and here results in failure of the lumen of blood vessels
to retract because their walls are adherant to the

C H A P T E R-19
superior nuchal lines.
Lateral : Zygomatic arch and upper border of underlying connective tissue. As a result,
lacerations of the scalp bleed profusely.
external acoustic meatus, on each side.
3. Aponeurotic layer: It is formed by the aponeurosis
of occipito-frontalis muscle over the dome of the
Layers of Scalp (Fig. 19.1) skull.
Occipitofrontalis muscle (Fig. 19.6): It originates
The soft tissues of the scalp are arranged in five layers:
from 2 parts:
S : Skin a. Occipital bellies: Muscular fibres arise from the
C : Connective tissue lateral 2/3rd of highest nuchal lines on either
A : Aponeurosis side and adjacent mastoid part of temporal
L : Loose areolar tissue bone.
P : Periosteum b. Frontal bellies: The fibres are attached to the skin
The skin and superfacial fascia of scalp continue in of the eye brows and root of nose. It does not
front over the forehead and behind over the back of neck. have any bony attachment.

Fig. 19.1: Layers of scalp

 258 Human Anatomy For Dental Students

The fibres from both the bellies are inserted into a

central fibrous layer known as the galea aponeuro-
tica or epicranial aponeurosis.
Extent of Galea Aponeurotica
Anterior: It begins at the coronal suture and extents
over the frontal bellies till the eyebrows. A part of
the fibrous tissue extends upto the root of nose as a
median prolongation.
Posterior: It blends with the occipital bellies and
extends further to attach over the external occipital
protuberance and highest nuchal lines on either
side.
Lateral: It extends over the temporal fascia and
thins out to attach to the zygomatic arch.
The superficial fascia connects the apponeurosis to
the skin above while it is separated from the
periosteum by the layer of loose areolar tissue. Fig. 19.2: Arterial supply of scalp
4. Layer of loose areolar tissue: It lies beneath the
aponeurotic layer and accounts for the mobility of
scalp on the underlying bone. It is limited
posteriorly upto the posterior attachment of
occipitofrontalis muscle but anteriorly it continues
below the muscle over the forehead till the
S E C T I O N-2

eyebrows. It is in this plane that the surgeons

mobilize scalp flaps for reconstructive surgery.
5. Periosteum: It is the pericranium covering the skull
bones and is adherent at the suture-lines of the skull.

Arterial Supply of Scalp (Figs 19.2 and 19.3)

The scalp is richly supplied by blood vessels which form
an anastomosis in the subcutaneous tissue. Each half of
the scalp is supplied by branches of the following five
arteries.
In front of the ear: Three in number:
1. Supra trochlear artery, branch of ophthalmic artery.
2. Supra orbital artery, branch of ophthalmic artery.
3. Superficial temporal artery, branch of external
carotid artery.
Behind the ear: Two in number: Fig. 19.3: Arterial supply of scalp vertical view showing
4. Posterior auricular artery, branch of external carotid anastomoses between various arteries
artery.
5. Occipital artery, branch of external carotid artery.

Venous Drainage of Scalp (Fig. 19.9)
The veins accompany arteries and form an inter-
connecting network over the scalp. They are:
1. Supratrochlear and supraorbital veins: They join
to form the angular vein at the medial angle of eye
and further continue as the facial vein.
2. Superficial temporal vein: It forms the retro-
mandibular vein after joining with maxillary vein.
3. Posterior auricular vein: It joins the posterior
division of rectromandibular vein and forms the
external jugular vein.
4. Occipital vein: Terminates into suboccipital plexus
of veins.
Emissary veins: These are veins that connect the
intracranial dural venous sinuses to the external veins
of the scalp and face. Emissary veins of scalp are:

Fig. 19.4: Lymphatic drainage of scalp and face
1. Parietal and mastoid emissary veins which connects
occipital vein to sagittal and sigmoid sinuses
respectively.
2. Emissary vein from facial vein to cavernous sinus.
Lymphatic Drainage of Scalp (Fig. 19.4)
Scalp is drained by the following lymph nodes:
1. Pre-auricular lymph nodes: These drain anterior
part of scalp, except an area below the centre of
forehead.
2. Post auricular lymph nodes: These drain posterior
part of scalp.
3. Occipital lymph nodes: A part of posterior aspect
of scalp is drained by these nodes also.
Nerve Supply of Scalp (Figs 19.10 and 19.11)
1. Sensory supply: Each half of the scalp is supplied
by 8 sensory nerves.
In front of the ear: These are four in number. All
are branches of the trigeminal nerve.
1. Supratrochlear nerve
2. Supraorbital nerve
3. Zygomaticotemporal nerve
4. Auriculotemporal nerve
Behind the ear: These are also four in number and
arise from the cervical plexus.
5. Great auricular nerve (C2, 3)
6. Lesser occipital nerve (C2)
7. Greater occipital nerve (C2)
8. Third occipital nerve (C3)
2. Motor supply: Each half of the scalp is supplied by
branches of facial nerve.
a. Temporal branch of facial nerve: Supplies the
frontal belly of occipitofrontalis muscle.
b. Posterior auricular branches of the facial nerve:
Supplies the occipital belly of occipito-frontalis
muscle.
Scalp and Face 259
CLINICAL AND APPLIED ANATOMY
The neurovascular bundle of scalp lies in its tough
layer of superficial fascia. In case of injury to the
scalp, the tough connective tissue layer prevents
retraction of blood vessels in the superficial fascia
leading to excessive bleeding. Therefore, scalp
wound bleed profusely.
Head injury resulting in soft tissue damage can
cause collection of blood in the loose
subaponeurotic layer of scalp which is continuous
with the upper eye lid. The blood easily tracks
down anteriorly over the eyelids leading to
discoloration of the eye known as black eye. The
spread of this collection is limited posteriorly and
laterally due to attachment of the aponeurosis to
the supranuchal lines and to the zygomatic arches
at these points.
Cephalhaematoma: It is the collection of blood
below the periosteal layer of scalp due to an injury.
The swelling due to the haematoma is localized
over the particular bone involved as the
C H A P T E R-19
periosteum is adherent to the underlying bone at
the sutures which limits its spread. In a new born,
this has to be differentiated from caput formation.
Caput is the collection of fluid in the loose areolar
tissue of scalp due to forces of labour. The swelling
due to caput is generally diffuse and more on the
dependant areas instead of a particular bone. The
collection of caput crosses the sutures and the
midline as it is not limited by sutures. Caput
disappears in 24 to 48 hours of birth while
cephalhaematoma may take upto 4 to 7 days to
disappear.
Dangerous layer of the scalp: The layer of loose
areolar tissue is often called as dangerous layer of
the scalp because it lodges the emissary veins.
These veins do not have any valves. Hence, if there
is any infection of scalp it can travel along the
emissary veins into the intracranial dural venous
sinuses leading to thrombosis of the sinuses.
FACE
Face is the anterior aspect of head and consists of soft
tissue over the facial skeleton or norma frontalis. It
presents with forehead, anterior aspect of eyeballs with
eyelids, proximal opening of nostrils and the oral cavity.
Extent (Fig. 19.5)
Superior : Hair line of scalp (frontal prominences
if person is bald).
Inferior : Chin and base of mandible.
 260 Human Anatomy For Dental Students
Fig. 19.5: Extent of face
Lateral : Tragus of ear on either side.
The soft tissue of face is made up of skin and
superficial fascia. A layer of superficial musculo-
aponeurotic system containing the facial muscle is now
described as a distinct layer from superficial fascia. There
is no deep fascia in the face. However, extensions from
deep cervical fascia form the fascia covering parotid
S E C T I O N-2
gland (parotid capsule), fascia over masseter and
buccinator muscles.
Skin
Facial skin is thick and elastic. It is mostly loose over
the skeleton except in the area of nose and auricle
where it is adherent to the underlying cartilage.
It is richly supplied by blood vessels hence bleeding
Fig. 19.6: Muscles of facial expression
is profuse in facial injuries.
There are numerous sweat glands and sebaceous
glands in the skin.
The facial skin gives attachment to facial muscles.
Subcutaneous Tissue (Superficial Fascia)
It is mostly made up of fibro adipose tissue and consists
of the following:
1. Fat: This is most abundant over the cheeks. It forms
the buccal pad of fat especially seen in children. It
is absent over the eyelids.
2. Muscles of the face
3. Vessels
4. Nerves
Muscles present in relation to orifices present in
face (Muscles of Facial Expression) (Fig. 19.6)
These muscles extend from the bony attachments on
norma frontalis and directly insert into skin of face.
Features of Facial Muscles
The facial muscles develop from the 2nd branchial
arch of the embryo.
All are supplied by facial nerve (nerve of 2nd
branchial arch) except, levator palpebrae superioris
which is supplied by oculomotor nerve.
The muscles are arranged in groups around the
orifices of the mouth, nose, eyes and ears. They act
as dilators and constrictors of these orifices.

These muscles are attached to the skin and their
contractions are responsible for facial expressions
which help in non verbal communication.
They represent the remnants of subcutaneous
muscle fibres seen in some lower animals (panni-
culus carnosus).
Muscles present in relation to orifices of mouth, nose,
eyes and ears (Muscles of Facial Expression)
1. OccipitofrontalisFrontal part
Origin: Subcutaneous tissue and skin of the
eyebrow and root of nose.
Insertion: Galea aponeurotica.
Action: Raises eyebrows upwards.
2. Orbicularis oculi: It surrounds the palpebral
fissure. Has three parts:
a. Palpebral
b. Orbital
c. Lacrimal
Origin: Medial palpebral ligament, adjoining
frontal bone and frontal process of maxilla, lacrimal
fascia and crest of lacrimal bone.
Insertion: Subcutaneous tissue of eyebrow, lateral
palpebral raphae.
Actions:
1. It causes closure of eyelids both voluntary or
while blinking.
2. Aids in transport of lacrimal fluid by dilating
lacrimal sac.
3. Corrugator supercilli
Origin: Medial end of supraciliary arch of frontal
bone.
Insertion: Subcutaneous tissue of eyebrow in the
middle.
Action: Pulls eyebrows medially and downwards.
4. Levator palpebrae superioris: It is a triangular
sheet of muscle.
Origin: Inferior surface of lesser wing of sphenoid.
Insertion: The fibres insert as follows:
Medial margin attaches to the medial palpebral
ligament.
Lateral margin attaches to the Whitnalls
tubercle on zygomatic bone.
Central part inserts to skin of upper eyelid,
anterior surface of superior tarsus, superior
conjunctival fornix.
Action: Elevates the eyelids.
Scalp and Face 261
5. Procerus
Origin: Fascia covering nasal bone.
Insertion: Skin between eyebrows.
Action: Acts during frowning.
6. Nasalis
Origin: Anterior surface of maxilla near the nasal
notch.
Insertion: It inserts into the alar cartilage and
continues over the bridge of nose with opposite
muscle.
Actions:
1. Compresses the nasal aperture below bridge of
nose.
2. Alar part dilates anterior nasal aperture
7. Depressor septi
Origin: Incisive fossa on the anterior surace of
maxilla.
Insertion: Nasal septum.
C H A P T E R-19
Action: Dilatation of anterior nasal aperture.
8. Levator labii superioris alaeque nasi
Origin: Lateral surface of frontal process of maxilla.
Insertion: It forms two thin slips which attach on
ala of the nose and skin of upper lip.
Actions:
1. Elevates and everts the upper lip
2. Dilates nostril.
9. Levator labii superoris
Origin: Anterior surface of maxilla close to infra
orbital margin and above the infra-orbital foramen.
Insertion: Lateral side of skin and subcutaneous
tissue of upper lip.
Action: Elevates and everts the upper lip.
10. Levator anguli oris
Origin: Below the infra-orbital foramen, in the
cannine fossa of maxilla.
Insertion: Angle of mouth.
Action: Raises angle of mouth.
11. Zygomaticus minor
Origin: Zygomatic bone.
Insertion: Skin of upper lip in lateral part.
Actions:
1. Elevates and everts upper lip.
2. Increases the nasolabial furrow.
12. Zygomaticus major
Origin: Zygomatic bone.
 262 Human Anatomy For Dental Students

Insertion: Angle of mouth. Origin: Outer surface of alveolar process of maxilla

Action: Pulls angle of mouth upwards and laterally. and mandible opposite the three molar teeth,
pterygomandibular raphe.
13. Depressor labii inferioris
Insertion: Upper fibres insert into upper lip, lower
Origin: Oblique line of mandible.
fibres insert into lower lip while intermediate fibres
Insertion: Skin of lower lip.
deccussate to upper and lower lips.
Action: Pulls lower lip downwards and laterally.
Actions:
14. Depressor anguli oris 1. Flattens cheek against the gums and teeth which
Origin: Posterior part of oblique line of mandible. helps during mastication.
Insertion: Angle of mouth. 2. Helps in blowing out air through mouth.
Action: Pulls angle of mouth downwards and
laterally. 18. Orbicularis oris
Origin:
15. Risorius a. Extrinsic part : Facial mucles surrounding oral
Origin: Parotid fascia. orifice, depressors and elevators of lip.
Insertion: Angle of mouth. b. Deep part: Incisive fossa of maxilla and
Action: Pulls angle of mouth downwards and mandible.
laterally.
Insertion: Fibres intermingle and surround the
16. Mentalis orifice of mouth and attach to angle of mouth and
Origin: Incisive fossa. skin of lips.
S E C T I O N-2

Insertion: Skin of chin.

Action: Puckers the chin. Actions:
1. Closure of lips
.17. Buccinator: It is the main muscle of cheek. It is 2. Compresses lip against gums and teeth which
covered by buccopharyngeal membrane. It is helps in mastication
actually not a muscle of facial expression. 3. Protrusion of lips

Facial expressions and concerned muscles (Fig. 19.7)

Expression Changes in skin of face Muscle involved

Surprise Transverse wrinkles of forehead. Frontalis

Transverse wrinkles at bridge of nose. Procerus
Frowning Vertical wrinkles of forehead Corrugator supercilli
Anger Dilatation of anterior nasal aperture Dilator naris
Depression of lower part of Depressor septi
nasal septum (columella)
Laughing, Smiling Angle of mouth is drawn upwards and laterally Zygomaticus major
Sadness Angle of mouth drawn downwards and laterally Depressor anguli oris
Sorrow and grief Accentuation of nasolabial furrow with elevation Levator labii superioris
and eversion of upper lip Levator anguli oris
Zygomaticus minor
Grinning Retraction of angle of mouth Risorius
Disdain/Doubt Puckering of skin over chin with Mentalis
protrusion of lower lip
Whistling Pressing the cheek against gum Buccinator
with pursing of mouth with small opening
 Scalp and Face 263

C H A P T E R-19

Fig. 19.7: Facial expressions and concerned muscles

 264 Human Anatomy For Dental Students
Arterial Supply of Face (Fig. 19.8)
The face has a rich blood supply. It is supplied by
branches of the following arteries:
1. Facial artery: This is the chief artery of face and
arises from external carotid artery. The following
branches supply the face:
a. Superior labial
b. Inferior labial
c. Lateral nasal
d. Angular artery
2. Superficial temporal artery via transverse facial
artery, auricular artery and anterior terminal
branch.
3. Maxillary artery via mental, buccal and infraorbital
arteries.
4. Ophthalmic artery via terminal part of supratro-
chlear and supraorbital arteries and lacrimal artery.
Venous Drainage of Face (Fig. 19.9)
The following veins drain the face:
1. Facial vein: This is the main vein of the face. The
S E C T I O N-2
supratrochlear and supraorbital veins unite at the
medial angle of eye and form the angular vein
which continues below as facial vein. The vein runs
below zygomaticus major and platysma taking a
straight course behind the facial artery. It runs along
the anterior border of masseter and pierces the deep
fascia of neck just below the mandible. It joins the
anterior division of the retromandibular vein and
forms the common facial vein which further drains
into the internal jugular vein.
2. Retromandibular vein: It is formed by the union
of maxillary and superficial temporal veins in the
Fig. 19.8: Arterial supply of face
posteior part of parotid gland. It lies superficial to
external carotid artery and facial nerve. It divides
at the lower apex of the gland into an anterior and
a posterior division. The anterior division joins with
the facial vein to form common facial vein. The
posterior division joins with the posterior auricular
vein to form external jugular vein.
3. Supratrochlear vein.
4. Supraorbital vein: This joins with the supratrochlear
vein at the medial canthus of eye to form facial vein.
5. Tributaries of superficial temporal vein.
6. Tributaries of pterygoid plexus of veins, e.g.,
infraorbital, buccal and mental veins.
CLINICAL AND APPLIED ANATOMY
Dangerous area of face: The area of face drained by
the facial vein is the dangerous area of face. It comprises
of lower part of nose, upper lip and the adjoining cheek.
The facial vein communicates with the cavernous sinus
via two routes namely:
1. Through the angular or ophthalmic veins.
2. Through the deep facial vein that joins with
pterygoid plexus of veins. This plexus further
communicates with cavernous sinus by emissary
veins.
Also, the facial vein does not contain valves and it rests
directly on the muscles of facial expressions. Contraction
of these muscles aid the retrograde spread of infective
emboli from an infected part in the area mentioned above.
These emboli can thus reach the cavernous sinus and
cause thrombosis which can be fatal.
Fig. 19.9: Venous drainage of face and scalp
 Scalp and Face 265

Lymphatic Drainage of Face (Fig. 19.4)

Face is drained by the following lymph nodes:
1. Preauricular lymph nodes: These drain forehead,
lateral half of eyelids, conjunctiva, lateral part of
cheek and parotid area.
2. Submandibular lymph nodes: These drain median
strip of forehead, medial half of eyelids, nose,
medial part of cheek, upper lip, lateral part of lower
lip and lower jaw.
3. Submental lymph nodes: These drain central part
of lower lip and adjoining chin. Fig. 19.10: Sensory distribution on the face

Nerve Supply of Face c. From mandibular division

Sensory Supply of Face (Figs 19.10 to 19.11) i. Mental branch
ii. Buccal branch
The face receives its sensory innervation from following iii. Auriculotemporal nerve
two sources:
1. Trigeminal nerve: The three divisions of trigeminal 2. Great auricular nerve (C2): This branch of cervical
nerve supply almost the entire skin of face except plexus supplies the area of skin over the angle of
an area over the angle of mandible. mandible.

C H A P T E R-19
The various branches are:
a. From ophthalmic division Motor Supply of Face (Fig. 19.12)
i. Lacrimal nerve Nerve supply to the muscles of the face is derived from
ii. Supraorbital nerve the facial nerve.
iii. Supratrochlear nerve The following five branches of facial nerve emerge
iv. Infratrochlear nerve from parotid gland and supply the muscles of the face:
v. External nasal nerve 1. Temporal
b. From maxillary division 2. Zygomatic
i. Infraorbital nerve 3. Buccal
ii. Zygomatico-facial nerve 4. Marginal mandibular
iii. Zygomatico-temporal nerve 5. Cervical

Fig. 19.11: Sensory supply to face and scalp

 266 Human Anatomy For Dental Students
Fig. 19.12: Motor nerve supply of face: Branches of facial
nerve
a. Temporal branch: It runs across the zygomatic
arch and supplies the muscles of the ear, frontal
belly of occipital frontalis and corrugator
supercilii.
S E C T I O N-2
b. Zygomatic branch: It runs below and parallel
to the zygoma and supplies the orbicularis oculi.
c. Buccal branches: These are usually two in
number. The upper one supplies zygomaticus
major, zygomaticus minor and levators of the
upper lip. The lower one supplies the buccinator
and the orbicularis oris.
d. Marginal mandibular branch: This first runs
downwards and forwards below the angle of
the mandible and then curves upwards across
the base of the mandible to supply the muscles
of the lower lip and chin.
e. Cervical branch: It passes downwards and
forwards to the front of the neck and supplies
the platysma.
FACIAL NERVE (Fig. 19.13)
Facial nerve is the seventh cranial nerve. It is a mixed
nerve containing both sensory and motor fibres.
Functional Components
1. Special visceral efferent is motor to muscles
derived from 2nd branchial arch viz. muscles of
facial expression.
2. General visceral efferent: Provides secretomotor
fibres to:
a. Submandibular and sublingual salivary glands.
b. Lacrimal gland.
c. Mucous glands of the nose, palate and pharynx.
3. Special visceral afferent: Carries taste sensations
from anterior 2/3rd of the tongue (except from
vallate papillae) and palate.
4. General somatic afferent: For proprioceptive
impulses from the muscles of facial expressions
(muscles derived from 2nd branchial arch) and
sensation from external auditory meatus.
Nuclear Origin
The facial nerve fibres are connected to the following
four cranial nuclei:
1. Motor nucleus of facial nerve: This lies in the lower
part of pons below and in front of the abducent
nerve nucleus. The fibres supplying muscles of 2nd
branchial arch originate here.
2. Superior salivatory nucleus: It also lies in the pons,
lateral to the motor nucleus. It provides the
preganglionic parasympathetic secretomotor fibres.
3. Nucleus of tractus solitarius: It receives those fibres
of facial nerve which are responsible for taste
sensation.
4. Spinal nucleus of trigeminal nerve: It lies in the
medulla and receives fibres for pain and tempera-
ture sensations from the external auditory meatus.
Intracranial Course
The facial nerve arises from the brain stem by two roots:
Motor root: It is larger and arises from the lower
border of pons between the olive and inferior
cerebellar peduncle.
Sensory root: It arises from the lateral part of the
groove between pons and medulla. The sensory
root is attached between the motor root medially
and the vestibulo-cochlear nerve laterally. Hence,
it is also known as, nervous intermedius.
After arising from the brain stem the two roots of
the facial nerve pass forwards and laterally along
with the vestibulo-cochlear nerve and enter the
internal acoustic meatus located on the posterior
surface of the petrous temporal bone.
They run through the meatus laterally and combine
at its lower end to form a single trunk.
The nerve then enters the facial canal in the petrous
temporal bone and runs for a short distance laterally
above the vestibule of internal ear.
As it reaches the medial wall in the epitympanic
part of the middle ear, it turns sharply backwards
making an acute bend called the genu or knee of
facial nerve. The nerve presents with a ganglion on
this bend called the geniculate ganglion. Geniculate
ganglion contains sensory neurons for taste and
general sensations.
The nerve now runs horizontally backwards in a
bony canal above the promontory producing a
bulge in the medial wall of the middle ear.
Fig. 19.13: Facial nerve and its distribution
Scalp and Face
267

C H A P T E R-19
 268 Human Anatomy For Dental Students
On reaching the junction between the medial and
posterior walls of the middle ear the nerve turns
downwards and continues vertically in the facial
canal located along the junction of the medial and
posterior walls of the middle ear. It finally emerges
out of the skull through the stylomastoid foramen.
Extracranial Course
On emerging from the stylomastoid foramen, the facial
nerve curves forwards around the lateral aspect of the
styloid process and enters the posteromedial aspect of
the parotid gland. In the parotid gland it divides into its
terminal branches.
Branches of the Facial Nerve
1. Greater petrosal nerve: It arises from the geniculate
ganglion and leaves the middle ear through tegmen
tympani. It joins with the deep petrosal nerve to
form nerve to pterygoid canal. This nerve conveys
preganglionic secretomotor fibres to the lacrimal
S E C T I O N-2
gland and nasal mucosa. They relay in the
pterygopalatine ganglion.
2. A twig from geniculate ganglion joins the lesser
petrosal nerve
3. Nerve to stapedius: This arises in the facial canal
behind the middle ear and runs forwards through
a short canal to reach and supply the stapedius
muscle.
4. Chorda tympani nerve: It arises in the facial canal
about 6 mm above the stylomastoid foramen and
enters the middle ear. It passes forward across the
inner surface of the tympanic membrane internal
to the handle of malleus and then leaves the middle
ear by passing through the petrotympanic fissure
to appear at the base of skull. Here it runs
downwards and forwards in the infratemporal
fossa and joins the lingual nerve at an acute angle.
The chorda tympani nerve carries
a. Taste fibres from anterior 2/3rd of the tongue,
except from vallate papillae.
b. Secretomotor fibres to the submandibular and
sublingual salivary glands.
5. Posterior auricular nerve: It arises just below the
stylomastoid foramen. It further divides into two
branches:
a. Auricular branch, which supplies the muscles
of auricle.
b. Occipital branch, which supplies the occipital
belly of the occipito-frontalis.
6. Nerve to posterior belly of digastric: It arises near
the origin of posterior auricular nerve and supplies
the posterior belly of digastric. It also gives a branch
to the stylohyoid muscle.
7. Terminal branches: They are 5 in number and arise
within the parotid gland. From above downwards
they are:
a. Temporal branch: It runs across the zygomatic
arch and supplies the muscles of the ear, frontal
belly of occipital frontalis and corrugator
supercilli.
b. Zygomatic branch: It runs below and parallel
to the zygoma and supplies the orbicularis oculi.
c. Buccal branches: These are usually two in
number. The upper one supplies zygomaticus
major, zygomaticus minor and levators of the
upper lip. The lower one supplies the buccinator
and the orbicularis oris.
d. Marginal mandibular branch: This first runs
downwards and forwards below the angle of
the mandible and then curves upwards across
the base of the mandible to supply the muscles
of the lower lip and chin.
e. Cervical branch: It passes downwards and
forwards to the front of the neck and supplies
the platysma.
8. Communicating branches: It communicates with
the following neighbouring nerves at various sites:
a. Vestibulo-cochlear nerve, at the internal acoustic
meatus.
b. Sympathetic plexus around middle meningeal
artery, at geniculate ganglion.
c. Auricular branch of vagus nerve, in the facial
canal.
d. 9th and 10th cranial nerves, below the
stylomastoid foramen.
e. Lesser occipital nerve, behind the ear.
f. Branches of trigeminal nerve, in the face.
CLINICAL AND APPLIED ANATOMY
Facial nerve palsy: It is the paralysis of the facial nerve.
It is of two types:
1. Upper motor neuron type
2. Lower motor neuron type
1. Upper motor neuron facial palsy (Figs 19.14 and
19.15): It is due to involvement of the cortico-
nuclear fibres, i.e., the upper motor neurons. These
fibres arise in the cerebral cortex, pass through
internal capsule and end in the motor nucleus of
the facial nerve. These are most commonly

Fig. 19.14: Central connections of facial nerves
involved in patients with cerebral haemorrhage
which is always associated with hemiplegia. Since
the lesion is above the nucleus, it is also called as
supranuclear type of facial palsy.
It leads to paralysis of the contralateral lower part of
face below the palpebral fissure. The upper part of
the face is spared because the part of facial nucleus
which supplies it, is innervated by corticonuclear
fibres from both the cerebral hemispheres.
2. Lower motor neuron facial palsy: It is further of
two types:
a. Nuclear paralysis: It is due to involvement of
the nucleus of facial nerve. This can occur due
to poliomyelitis or lesions of the pons. The
motor nucleus of facial nerve is close to the
abducent nerve which is also usually affected.
Effect: Paralysis of muscles of the entire face
on ipsilateral side.
b. Infranuclear paralysis: This occurs due to
involvement of the facial nerve. Clinical effects
vary according to the site of injury of the nerve.
Facial nerve can get injured at various sites
(Fig. 19.15)
Site 1: Injury proximal to the geniculate ganglion
produces the following sign and symptoms:
a. Diminished lacrimation, due to involvement of
secretomotor fibres to lacrimal gland.
b. Hyperacusis, due to paralysis of stapedius.
c. Loss of facial expression, due to paralysis of
muscles of facial expression.
d. Loss of salivation and taste sensations in the
anterior 2/3rd of tongue, due to involvement
of chorda tympani.
Scalp and Face 269
Site 2: Injury in the middle ear segment of the
nerve.All effects as at site 1 occur except that there
will be no loss of lacrimation.
Site 3: Lesion in the vertical course of the facial
nerve within the mastoid bone.All effects as seen
in lesion of site 1 occur except that there will be no
hyperacusis and no loss of lacrimation.
Site 4: Injury at or distal to the stylomastoid
foramen. It is the common site of involvement
especially in young children. In a child the mastoid
process is absent and the stylomastoid foramen
with facial nerve are superficial. Thus the nerve is
easily injured by any incisions given around the
ear. It leads to:
Paralysis of muscles of facial expression
No loss of lacrimation
No hyperacusis
No loss of taste sensations
No loss of salivation.
Bells palsy is a lower motor neuron type of facial
nerve involvement. It has a varied etiology, e.g.,
C H A P T E R-19
exposure to sudden cold, middle ear infections.
Mostly it is idiopathic, believed to be a viral
infection. It leads to paralysis of muscles of facial
expression. There may be associated symptoms
according to the site of lesion. It requires only
supportive therapy and physiotherapy. In majority
it recovers completely with in 2 to 8 weeks. Facial
muscles of the same side are paralysed and this
leads to the following features:
a. Facial asymmetry: due to unopposed action of
muscles of the normal side. There is deviation
of angle of mouth to the opposite side.
b. Loss of wrinkles on forehead: due to paralysis
of fronto-occipitalis muscle.
c. Widening of palpebral fissure and inability
to close the eye: due to paralysis of orbicularis
oculi.
d. Inability of angle of mouth to move upwards
and laterally during laughing: due to paralysis
of zygomaticus major.
e. Loss of naso-labial furrow: due to paralysis of
levator labii superioris alaeque nasi.
f. Accumulation of food into the vestibule of
mouth: due to paralysis of buccinator muscle.
g. Dribbling of saliva from the angle of mouth:
due to paralysis of orbicularis oris.
h. When one presses the cheek with inflated
vestibule, the air leaks out between the lips:
due to paralysis of orbicularis oris.
i. Loss of resistance while blowing out air in
mouth: due to paralysis of buccinator.
 S E C T I O N-2 270
Human Anatomy For Dental Students

Fig. 19.15: Sites of lesions of facial nerve

 Chapter
20
Eye and Orbit
EYELIDS
Each eye presents with a pair of eyelids, one upper and
one lower. Eyelids are folds of skin and mucus membrane
present in front of the eyeball in the form of movable
curtains. They help protect the eye from injury, foreign
bodies and bright light by approximating together and
blinking of eyelids helps to spread the tear film and keep
the cornea moist and clean.
The upper eyelid is larger and is seen to overlap upper
part of cornea while lower eyelid lies at the lower margin
of cornea when the eye is open. When eye closes the upper
eyelid moves towards the lower eyelid covering the entire
cornea.
The space between the two eyelids is known as
palpebral fissure. Margins of the upper and lower eyelids
meet at an angle at their lateral and medial ends
respectively. These are named as medial and lateral
canthus.
The eyelids are covered with skin externally and
conjunctiva internally which meet at the lid margin. The
lateral 5/6th of the margin presents with an outer and an
inner lip. A grey line is present between the outer and
inner lips which is the mucocutaneous junction. The outer
lip has 2 or more layers of eyelashes or cilia and the
associated openings of sweat glands and sebaceous
glands. Medial end of the margin does not have cilia. At
the junction of medial 1/6th and lateral 5/6th it presents
with a small elevation known as the papilla which has
the lacrimal punctum (opening) at its summit. This
punctum leads to the lacrimal canaliculus medially
which drains the lacrimal fluid (tears) into the
lacrimal sac.
Structure of the Eyelid (Fig. 20.1)
Each eyelid made up of five layers. From without
inwards these are:
1. Skin: It is thin and continues with the conjunctiva
at the margin of the eyelid. It consists of:
a. Large sebaceous glands (Zies glands) which
open at the lid margin closely associated with
cilia.
b. Modified sweat glands (Mollglands) which lie
along the lid margin closely associated with Zies
glands.
c. Skin of upper eyelid receives the insertion of
levator palpebral superioris.
C H A P T E R-20
2. Superficial fascia: The subcutaneous tissue is thin
and devoid of fat and contains the palpebral part of
orbicularis oculi muscle.
3. Tarsal plate: It is a sheet of dense fibrous tissue
present adjacent to and parallel to the palpebral
margins. It provides support to the lid. The upper
tarsal plate is bigger (10 mm in height) than the lower
tarsal plates (4 mm in height). The plates are convex
anteriorly, their lower margins are just adjacent to
the lid margins while their upper margins are
attached to the orbital septum. Upper tarsal plate
also receives insertion of levator palpebrae
superioris.
Tarsal glands (meibomian glands) are embedded
in the posterior surface of the tarsal plate. They open
by channels in a row behind the cilia along the inner
lip of margin of eyelid.
The upper and lower tarsal plates fuse medially and
laterally to form the medial and lateral palpebral
ligaments respectively.
4. Palpebral fascia (orbital septum): It is a sheet of
fascia which connects the anterior surface of each
tarsal plate with the corresponding periosteum of
the bony orbital margin.
5. Conjunctiva (palpebral part): It is the inner most
layer which lines the posterior surface of the tarsal
plate and continues over the sclera at the fornices.
Upper palpebral conjunctiva receives the insertion
of levator palpebrae superioris.
S E C T I O N-2 272 Human Anatomy For Dental Students
Fig. 20.1: Structure of eyelids with conjunctiva seen in section
Blood Supply of Eyelids
Eyelids are supplied by the following arteries:
1. Palpebral branch of ophthalmic artery.
2. Palpebral branch of lacrimal artery.
The veins from eyelids are present along the arteries
and drain into ophthalmic vein and facial vein.
Lymphatic Drainage of Eyelids
1. Submandibular lymph nodes: These drain from
medial half of eyelids.
2. Preauricular lymph nodes: These drain lateral half
of eyelids.
Nerve Supply of Eyelids
Upper eyelid receives branches of infratrochlear,
supratrochlear, supraorbital and lacrimal nerves while
lower eyelid receives supply from infraorbital and
infratrochlear nerves.
CONJUNCTIVA (Fig. 20.1)
It is a transparent mucus membrane lining the external
anterior surface of eyeball (except cornea) and inner
aspect of eyelids. It is accordingly named as:
1. Palpebral conjunctiva: It is the conjunctiva which
lines the inner aspect of eyelids and continues with
the skin of eyelids, lacrimal canaliculi and lacrimal
sac at the lid margins. It is highly vascular.
2. Bulbar conjunctiva: It covers the anterior aspect of
the outer most coat or sclera of the eyeball. It is thin
and has minimal vascularity. It continues with the
epithelium of cornea in front. The junction of cornea
and conjunctiva is known as limbus. The bulbar
conjunctiva reflects onto the inner aspect of eyelids
along the superior and inferior fornices. Ducts of
lacrimal gland open into the lateral part of superior
fornix. Glands of Krusae and Wolfring are also
present in relation to superior fornix.
 Eye and Orbit 273

CLINICAL AND APPLIED ANATOMY

Stye is an acute suppurative inflammation of a Zies
gland. The pus of stye points near the base of the
cilia. It requires hot compresses and antibiotics.
Epilation of the eyelash may help to drain the pus.
Chalazion (internal stye) is the inflammation of a
tarsal (meibomian) gland. The swelling points on
the inner aspect of the eyelid. It is usually a chronic
condition and requires surgery to remove it.

LACRIMAL APPARATUS
The structures concerned with the production and
drainage of lacrimal (tear) fluid constitute the lacrimal
apparatus.
Components of Lacrimal Apparatus (Fig. 20.2)
1. Lacrimal gland and its ducts.
Fig. 20.2: Lacrimal apparatus of right side
2. Accessory lacrimal glands. Glands of Krusae and
Wolfring
3. Conjunctival sac. About a dozen ducts from the gland open into the
4. Lacrimal puncta and canaliculi, common canali-
superior fornix of the conjunctiva and pour lacrimal

C H A P T E R-20
culus.
fluid into the conjunctival sac.
5. Lacrimal sac
6. Nasolacrimal duct Nerve supply to lacrimal gland (Fig. 20.3): Lacrimal gland
7. Tears is supplied by secretomotor parasympathetic and
sympathetic fibers.
Lacrimal Gland 1. Parasympathetic secretomotor supply: The pre
It is a serous gland about the size of an almond. ganglionic fibers arise from superior salivatory
It is situated in the lacrimal fossa of the antero-lateral nucleus in the pons and carried by greater petrosal
part of the orbital roof (orbital part) and upper eyelid nerve a branch of facial nerve. These fibers are carried
(palpebral part). by facial nerve. Pathway is shown below:

Pre ganglionic parasympathetic fibers relay in the
pterygopalatine ganglion and post ganglionic fibers
are carried by zygomatic branch of the maxillary
nerve.
2. Sympathetic supply: Post ganglionic fibers from
superior cervical ganglion are carried along internal
carotid artery. These fibers give rise to the deep
petrosal nerve which joins greater petrosal nerve to
form nerve to pterygoid canal. Sympathetic fibers
pass through the pterygopalatine ganglion without
relay and supply the gland.
S E C T I O N-2 274 Human Anatomy For Dental Students
Fig. 20.3: Nerve supply to lacrimal gland
Conjunctival Sac (Fig. 20.2)
It is a potential space present between the palpebral
conjunctiva and bulbar conjunctiva.
The periodic blinking of eyelids helps in spreading
the lacrimal fluid over the eye that keeps the cornea
moist and prevents it from drying.
Most of the fluid evaporates and the remaining fluid
is drained by the lacrimal canaliculi.
Lacrimal Puncta and Canaliculi (Fig. 20.2)
Each lacrimal canaliculus begins from a lacrimal
punctum present at the summit of the lacrimal
papilla located at the medial end of the free margin
of eyelid.
The superior canaliculus of upper eyelid, first runs
upwards and then downwards and medially while
the lower canaliculus, in lower eyelid first runs
downwards and then horizontally and medially to
open into the common canaliculus.
Each is 10 mm long.
The common canaliculus drains into the lacrimal sac.
These canaliculi drain the lacrimal fluid from the
conjunctival sac to the lacrimal sac.
Lacrimal Sac (Fig. 20.2)
It is a membranous sac, 12 mm long and 8 mm wide,
located in the lacrimal groove on the medial wall of
the orbit, behind the medial palpebral ligament.
The lacrimal sac continues inferiorly with the
nasolacrimal duct.
Nasolacrimal Duct (Fig. 20.2)
It is a membranous duct, 18 mm long which runs
downwards, backwards and laterally from the
lacrimal sac and opens in the inferior meatus of the
nose.
It is lodged in the nasolacrimal canal formed by the
articulation of maxilla, lacrimal bone and inferior
nasal concha.
It drains the lacrimal fluid from lacrimal sac to the
nose. Its opening in the nose is guarded by a fold of
mucous membrane called lacrimal fold or valve of
Hasner. This prevents retrograde entry of air and
nasal secretions into the eye when one blows his
nose.

Tears or Tear Film
Tear film consists of following three layers:
1. Superficial lipid layer, secreted by Meibomian glands
of tarsal plate.
2. Middle aqueous layer, secreted by accessory lacrimal
glands and main lacrimal gland.
3. Basal mucus layer, secreted by goblet cells of
conjunctiva.
CLINICAL AND APPLIED ANATOMY
Inflammation of lacrimal sac is called dacryocystitis.
It hampers the drainage of lacrimal fluid into the
nose. This causes overflow of the lacrimal fluid from
the conjunctival sac on to the face, a condition called
epiphora.
Dry eye: Decrease secretion of tear film leads to dry
eye syndrome. It is often seen in allergic conditions,
computer operators and in dry weather conditions.
BONY ORBIT (Fig. 20. 4)
The orbits are a pair of bony cavities, situated one on
either side of the root of the nose in the skull. Each orbit is
a four sided pyramid with its apex directed behind at the
optic canal and base in front, represented by the orbital
margin. The medial walls of the two orbital cavities are
parallel to each other but the lateral walls are set at right
angle to each other.
Fig. 20.4: Bony orbits showing lateral and medial walls
Boundaries of the Orbit (Figs 20.5 and 20.6)
Medial wall: It is the thinnest and is formed by four bones.
They are, from before backwards:
1. Frontal process of maxilla.
2. Lacrimal bone.
3. Orbital plate of ethmoid.
4. Body of sphenoid.
Eye and Orbit 275
Lateral wall: It is strongest and is formed by two bones:
1. Zygomatic bone, in front.
2. Orbital surface of greater wing of sphenoid, behind.
Floor: It is formed by three bones:
1. Orbital surface of the body of maxilla.
2. Zygomatic bone, anterolaterally.
3. Orbital process of palatine bone, posteromedially.
Roof: It is formed by two bones:
1. Orbital plate of frontal bone, in front.
2. Lesser wing of sphenoid, behind.
Apex of the orbit: It is formed by the centre of the bony
bridge between optic canal and superior orbital fissure.
Base: It is open and quadrangular in shape. Its boundaries
form the orbital margins.
Presenting Features
Medial wall presents two features:
1. Lacrimal fossa, bounded in front by the anterior
lacrimal crest of frontal process and behind by the
posterior lacrimal crest of the lacrimal bone. The
lacrimal fossa lodges the lacrimal sac and
communicates with the nasal cavity through naso-
C H A P T E R-20
lacrimal duct.
2. Anterior and posterior ethmoidal foramina. They lie
at the junction of medial wall and roof of the orbit.
Lateral wall presents two features
1. Two small foramina, for zygomaticofacial and
zygomatico-temporal nerves.
2. Whitnalls tubercle, a small bony tubercle lying just
behind the lateral orbital margin and slightly below
the fronto-zygomatic suture.
Floor presents two features
1. Infraorbital groove and canal which transmits the
nerve and vessels of same name.
2. A small rough impression at the antero-medial angle
for origin of inferior oblique muscle.
Roof presents three features
1. Fossa for lacrimal gland, in the antero-lateral part
2. Trochlear notch or spine at the antero-medial angle
3. Optic canal, at the extreme posterior part of the roof
between the lesser wing and body of sphenoid. This
canal transmits the optic nerve to middle cranial
fossa. Ophthalmic artery enters orbit through the
optic canal.
Contents of the Orbit (Fig. 20.7)
1. Eyeball
2. Fascia bulbi
3. Muscles of orbit
4. Nerves:
a. Optic nerve
b. 3rd, 4th and 6th cranial nerves
c. Ophthalmic nerve
 276 Human Anatomy For Dental Students

Fig. 20.5: Right bony orbit

S E C T I O N-2

Fig. 20.6: Right bony orbit-diagrammatic representation

Fig. 20.7: Sagittal section of orbit showing contents of orbit

 Eye and Orbit 277

d. Infraorbital nerve 3. Frontal nerve

e. Zygomatic nerve 4. Superior ophthalmic vein
5. Ciliary ganglion 5. Recurrent meningeal branch of lacrimal artery
6. Ophthalmic and infraorbital arteries
In intermediate/central compartment
7. Superior and inferior ophthalmic veins
8. Lacrimal gland 1. Upper and lower divisions of oculomotor nerve
9. Lymphatics 2. Nasociliary nerve
10. Orbital fat 3. Abducent nerve
Major Openings in Relation to Orbit In inferomedial compartment
1. Superior orbital fissure Inferior ophthalmic vein
2. Inferior orbital fissure
3. Optic canal
Inferior Orbital Fissure (Fig. 20.5 and 20.6)
Superior Orbital Fissure (Figs 20.5, 20.6 and 20.8) It is a gap present between the posterior part of lateral
It is a retort shaped gap between the posterior part of surface and floor of bony orbit. It connects orbit to the
lateral wall and roof of the bony orbit. It connects the infratemporal and pterygo-palatine fossae.
orbit to middle cranial fossa.
Boundaries
Boundaries Anteromedial : Posterior border of orbital surface of
Superior : Lower surface of lesser wing of maxilla.
sphenoid. Posterolateral : Lower margin of orbital surface of
Inferior : Medial margin of orbital surface of greater wing of sphenoid.

C H A P T E R-20
greater wing of sphenoid. Lateral : Orbital surface of zygomatic bone
Medial : Body of sphenoid. where it meets the maxilla.
The fissure is divided into three parts by a tendinous ring Medial : It meets with the bulb like medial end
attached in a circular manner. This ring extends from a of the superior orbital fissure in the
small tubercle on the inferior margin of the fissure upto form of a V-shape.
the undersurface of lesser wing of sphenoid around the
Structures passing through inferior orbital fissure
upper and medial margins of optic canal. The ring
1. Infraorbital vessels.
provides a common origin for the four extraocular muscles
2. Infraorbital nerve.
of the eyeball.
3. Zygomatic nerve.
Structures passing through superior orbital fissure. 4. Orbital branch of pterygopalatine ganglion.
In superolateral compartment 5. Communicating vessels between inferior ophthal-
1. Lacrimal nerve mic veins and pterygoid venous plexus.
2. Trochlear nerve

Fig. 20.8: Superior orbital fissure, optic canal and origin of extraocular muscles
 278 Human Anatomy For Dental Students
Optic Canal
Optic canal is a passage bounded by anterior and
posterior roots of lesser wing of sphenoid, laterally and
body of sphenoid, medially. It connects the orbit to middle
cranial fossa.
Structures passing through optic canal
1. Optic nerve
2. Ophthalmic artery: It lies inferolateral to optic nerve
in the canal.
MUSCLES OF THE ORBIT
There are seven voluntary and three involuntary muscles
in the orbit. Voluntary muslces consist of 4 recti, 2 oblique
and 1 levator palpebrae superioris muscles.
Extraocular Muscles of the Eyeball (Fig. 20.8 and
20.9)
Six muscles move the eyeball and one muscle moves the
upper eyelid. These consist of:
1. Four recti muscles
a. Superior rectus
S E C T I O N-2
b. Inferior rectus
c. Medial rectus
d. Lateral rectus
2. Two oblique muscles
a. Superior oblique
b. Inferior oblique
Recti Muscles
Origin (Fig. 20.8): A common tendinous ring encloses the
optic canal and middle part of the superior orbital fissure.
It is attached medially to apex of orbit and laterally to a
small tubercle (tubercle of Zinn) on the lower border of
superior orbital fissure. All the recti arise from the
corresponding margins of the common tendinous ring.
The lateral rectus arises by two heads.
Insertion (Fig. 20.9): All are inserted into the sclera a little
posterior to the limbus, in front of equator of the eyeball.
Average distance of each muscle from the limbus is medial
rectus, 5.5 mm, inferior rectus, 6.5 mm, lateral rectus, 6.9
mm, superior rectus, 7.7 mm.
Fig. 20.9: Insertion of recti muscles
Oblique Muscles
1. Superior oblique
Origin (Fig. 20.8): From body of sphenoid
superomedial to the optic canal.
Insertion (Fig. 20.20): Into sclera behind the equator
in the posterior superior quadrant of the eye ball,
between the superior rectus and lateral rectus. The
tendon of superior oblique passes through a
fibrocarti-laginous pulley attached to the trochlear
notch in the antero medial part of the roof of the orbit
before insertion.
2. Inferior oblique
Origin: From the rough impression in the antero-
medial angle of the floor of orbit, lateral to the lacrimal
groove.
Insertion (Fig. 20.23): Into the sclera behind the
equator in the postero-superior quadrant of the
eyeball a little below and posterior to the insertion of
superior oblique.
Nerve supply of extra-ocular muscles
1. Medial rectus: Oculomotor nerve (Inferior division)
2. Lateral rectus: Abducent nerve
3. Superior rectus: Oculomotor nerve (Superior
division)
4. Inferior rectus: Oculomotor nerve (Inferior division)
5. Superior oblique: Trochlear nerve
6. Inferior oblique: Oculomotor (Inferior division)
Movements of the eyeball: Movements of eyeball are
considered in relation to three axes. These are vertical,
transverse and anteroposterior (Fig. 20.10) Primary
position of eye ball is shown in Fig. 20.11.
Fig. 20.10: Axes of movements of eye ball
Fig. 20.11: Primary position of eye ball

Action of Extraocular Muscles
1. Medial rectus (Fig. 20.12): Adduction in primary
position.
Fig. 20.12: Action of right medial rectus (Adduction)
2. Lateral rectus (Fig. 20.13): Abduction in primary
position.
Fig. 20.13: Action of right lateral rectus (Abduction)
3. Superior rectus (Figs 20.14 to 20.16)
a. Elevation, adduction and intorsion in primary
position.
Fig. 20.14: Action of right superior rectus in primary position
(Elevation, adduction and intorsion)
b. Intorsion in adducted eye
Fig. 20.15: Action of right superior rectus in adducted eye
(Intorsion only)
Eye and Orbit 279
c. Elevation in abducted eye, this the position of
test.
Fig. 20.16: Action of right superior rectus in abducted eye
(Elevation only): Position of test
4. Inferior rectus (Figs 20.17 to 20.19)
a. Depression, adduction and extorsion in primary
position.
C H A P T E R-20
Fig. 20.17: Action of right inferior rectus in primary position
(Depression, adduction and extorsion)
b. Extorsion in adducted eye
Fig. 20.18: Action of right inferior rectus in adducted eye
(Extorsion only)
c. Depression in abducted eye, this is the position
of test.
Fig. 20.19: Action of right inferior rectus in abducted eye
(Depression only): Position of test
 280 Human Anatomy For Dental Students

5. Superior oblique (Fig. 20.20 to 20.22) b. Elevation and extorsion in adducted eye, this is
a. Intorsion, abduction and depression in primary the position of test.
position.

Fig. 20.20: Action of right superior oblique in primary position Fig. 20.24: Action of right inferior oblique in adducted eye
(Intorsion, abduction and depression) (Elevation and extorsion): Position of test
c. Extorsion in abducted eye.
b. Depression and intorsion in adducted eye, this
is the position of test.
S E C T I O N-2

Fig. 20.25: Action of right inferior oblique in abducted eye

(Extorsion)
Fig. 20.21: Action of right superior oblique in adducted eye
(Depression and intorsion): Position of test

c. Intorsion in abducted eye

Fig. 20.22: Action of right superior oblique in abducted eye

(Intorsion)

6. Inferior oblique (Figs 20.23 to 20.25)

a. Extorsion, abduction and elevation in primary
position.

Fig. 20.23: Action of right inferior oblique in primary position Fig. 20.26: Method of testing of action of various muscles on
(Extorsion, abduction and elevation) movement of eyeball in right eye
 Eye and Orbit 281

Movements of the eyeball (Figs 20.10 to 20.25)

Movement Muscle responsible Axis

1. Elevation 1. Superior rectus Transverse axis through equator.
2. Inferior oblique
2. Depression 1. Inferior rectus Transverse axis through equator.
2. Superior oblique
3. Adduction 1. Medial rectus Vertical axis through equator.
2. Inferior rectus
3. Superior rectus
4. Abduction 1. Lateral rectus Vertical axis through equator.
2. Inferior oblique
3. Superior oblique
5. Rotatory movements Anteroposterior axis from anterior to posterior pole of eyeball.
a. Intorsion 1. Superior rectus Medial rotation of the 12o clock
2. Superior oblique position of cornea.
b. Extorsion 1. Inferior rectus Lateral rotation of the 12o clock
2. Inferior oblique position of cornea.

Associated movements of the two eyeballs (Fig. 20.27) 3. Lower lamella is inserted on to the superior fornix of
1. Conjugate movements: When both the eyes move the conjunctiva.

C H A P T E R-20
in same direction with their visual axes being parallel Nerve supply: Superior ramus of oculomotor nerve.
to each other. Action: Elevation of upper eyelid.

Involuntary Extra Ocular Muscles

Fig. 20.27: Conjugate eye movement
2. Disconjugate movements (Fig. 20.28): When the
axes of both eyes converge or diverge in one
movement.
1. Superior tarsal muscle: It extends from the
intermediate lamella of levator palpebrae superioris
to the superior tarsus.
2. Inferior tarsal muscle: It extends from the fascia of
inferior rectus and oblique muscles to the inferior
tarsus.
3. Orbitalis muscles: Consists of few muscle fibers
bridging the inferior orbital fissure
Nerve supply: These three muscles are supplied by post-
ganglionic sympathetic fibers from superior cervical
ganglion.

CLINICAL AND APPLIED ANATOMY

Fig. 20.28: Disconjugate eye movement
Levator Palpebrae Superioris Muscle (Fig. 20.7)
Origin: From undersurface of the lesser wing of sphenoid
above the common tendinous ring, by a narrow tendon.
Insertion: It forms three lamellae which are inserted as
follows:
1. Upper lamella penetrates the orbital septum and
passes through the fibers of orbicularis oculi to be
inserted into the skin of upper eyelid.
2. Intermediate lamella forms the unstriped superior
tarsal muscle which is inserted on to the upper
margin of the superior tarsus.
Unilateral paralysis of an individual muscle, due to
involvement of the corresponding nerve, produces
strabismus or squint and may result in diplopia
(double vision). Diplopia occurs because light from
an object is not focussed on identical areas of both
retinae. The real image falls on the macula of the
unaffected eye while the false image falls on some
peripheral part of the retina in the paralysed eye
leading to diplopia.
Paralysis of levator palpebrae superioris leads to
ptosis, i.e., drooping of upper eyelid. This can be
due to either, involvement of oculomotor nerve or of
the cervical sympathetic chain (as in Horners
syndrome).
 282 Human Anatomy For Dental Students
NERVES OF ORBIT
Optic Nerve (Fig. 20.29)
This is the nerve of sight and is made up of axons of
ganglion cells of the retina. It is made up of about 1 million
myelinated Fibers.
Functional Components
1. Special somatic afferent: For sense of vision.
2. Afferent for visual reflex
3. Few efferents (exact function not known)
Origin
The fibers of this special sensory nerve arise from
the axons of ganglion cells of retina.
They converge in the region of the optic disc which
lies 3 mm towards the nasal side of the posterior
pole of eyeball.
The Fibers group together and form the optic nerve.
Course
The nerve runs backwards and medially in the orbit
S E C T I O N-2
and enters the cranial cavity through the optic canal.
In the canal it is enclosed in three meninges i.e. dura,
arachnoid and pia. It continues as the optic pathway.
Parts of optic nerve:
1. Intraorbital: 2.5 cm long.
2. Intra-canalicular: 0.6 cm long.
3. Intra-cranial: 1.0 cm long.
Relations of Optic Nerve
The central artery and vein of retina pierce the dural sheath
over optic nerve inferomedially about 1.25 cm behind the
eyeball and then run forwards towards the eyeball. The
optic nerve is crossed superiorly, from lateral to medial
side in the orbit by:
1. Superior ophthalmic vein
2. Nasociliary nerve
3. Ophthalmic artery.
Fig. 20.29: Optic nerve
Peculiarities of Optic Nerve
1. Developmentally and structurally, optic nerve is the
prolongation of the white matter of brain itself.
Retina is a part of the central nervous system and
grows out from the diencephalon during embryonic
development carrying with it the optic nerve fibers
to the eyeball.
2. The nerve is enclosed in the three meninges i.e.,
duramater, arachnoid and piamater. Thus it is highly
susceptible to changes in the intracranial
cerebrospinal fluid pressures.
3. It does not have neurolemmal sheath and thus
cannot regenerate if damaged.
Oculomotor Nerve (Fig. 20.30)
Oculomotor is the third cranial nerve.
Functional Components
1. General visceral efferent: Conveys preganglionic
parasympathetic fibers for constriction of pupil and
accommodation.
2. General somatic efferent: Motor to extraocular
muscles of the eyeball
3. General somatic afferent: Receives proprioceptive
impulses from the muscles of the eyeball.
Nuclear Origin
Fibers arise from the oculomotor nuclear complex
situated in the periaqueductal grey matter of upper
part of the midbrain at the level of superior colliculus.
This nuclear complex consists of two components:
1. Somatic efferent (motor nucleus): The fibers
arising from the somatic efferent component
supply all the extraocular muscles except
superior oblique and lateral rectus.
2. Visceral efferent (nucleus of Edinger-
Westphal): The fibers arising from Edinger-
Westphal nucleus relay in the ciliary ganglion.
From there the postganglionic fibers supply the
sphincter pupillae and the ciliary muscle.
After arising from the nuclear complex, the fibers
run forwards through the substance of the midbrain
to emerge on the anteromedial side of the cerebral
peduncle.
Course
The nerve emerges as a single trunk from the
oculomotor sulcus of midbrain and runs in front of
the crus cerebri between the posterior cerebral and
superior cerebellar arteries. Here it lies in the
interpeduncular cistern.
It then pierces the arachnoid and runs forwards and
laterally to reach the triangular interval between the
free and attached margins of the tentorium cerebelli.

Fig. 20.30: Oculomotor nerve and its distribution
It passes lateral to the posterior clinoid process and
pierces the dura mater to enter the roof of the
cavernous sinus.
Now, it runs forwards in the lateral wall of the
cavernous sinus.
In the anterior part of the cavernous sinus the nerve
divides into superior and inferior rami which enter
the orbit by passing through the superior orbital
fissure within the common tendinous ring.
Distribution
1. The smaller superior ramus passes upwards on the
lateral side of the optic nerve to supply the superior
Eye and Orbit 283
C H A P T E R-20
rectus (which it pierces) and the levator palpebrae
superioris.
2. The large inferior ramus divides into 3 branches:
a. One branch passes below the optic nerve and
supplies the medial rectus.
b. The second branch supplies inferior rectus.
c. The third branch passes between inferior rectus
and lateral rectus to supply inferior oblique.
3. The nerve to inferior oblique gives a motor root to the
ciliary ganglion. From the ganglion short ciliary
nerves arise and supply the ciliary muscle and
sphincter pupillae.
 284 Human Anatomy For Dental Students
Ciliary Ganglion
It is a peripheral parasympathetic ganglion, topho-
graphically connnected with the nasociliary nerve,
branch of ophthalmic division of trigeminal nerve.
However, functionally it is connected to the oculomotor
nerve.
Situation: It lies near the apex of the orbit, between the
optic nerve and lateral rectus muscle. The ophthalmic
artery is medial to it.
Roots
1. Motor (parasympathetic) root: It is derived from the
nerve to inferior oblique and consists of pre-
ganglionic parasympathetic fibers from Edinger-
Westphal nucleus. These fibers relay in the ganglion.
The postganglionic parasympathetic fibers arise
from the cells of the ganglion and pass through short
ciliary nerves to supply the ciliary muscle and
sphincter pupillae.
2. Sensory root: It is derived from the nasociliary nerve.
It consists of sensory fibers for pain, touch and
temperature from the eyeball which pass through
S E C T I O N-2
the ciliary ganglion without relaying in it.
3. Sympathetic root: It is derived from the sympathetic
plexus around internal carotid artery. It consists of
postganglionic sympathetic fibers from the superior
cervical sympathetic ganglion. These fibers pass
through the ganglion without relay, into the long
ciliary nerves to supply the dilator pupillae and
blood vessels of the eyeball.
Branches of Ciliary Ganglion
Short ciliary nerves (8 to 10 in number). They contain
fibers from all the three roots. The nerves run above and
below the optic nerve towards the eyeball. On reaching
the eyeball they pierce the sclera around the attachment
of optic nerve and pass forward in the space between the
sclera and choroid to reach the target organs.
CLINICAL AND APPLIED ANATOMY
Complete involvement of the oculomotor nerve by a
lesion will result in the following signs and symptoms:
1. Ptosis (drooping of upper eyelid), due to paralysis
of levator palpebrae superioris.
2. Lateral squint, due to unopposed action of lateral
rectus.
3. Dilatation of pupil, due to unopposed action of
dilator pupillae.
4. Loss of accommodation, convergence and light
reflex, due to, paralysis of ciliary muscle, medial
rectus and constrictor pupillae.
5. Diplopia (double vision), where the false image is
higher than the true image.
Trochlear Nerve (Fig. 20.31)
Trochlear is the fourth cranial nerve. It is the most slender
of all the cranial nerves and the only one which arises
from the dorsal aspect of the brain.
Functional Components
1. Somatic efferent: Motor to superior oblique muscle.
2. General somatic afferent: Receives proprioceptive
impulses from the superior oblique muscle.
Nuclear Origin
Fibers arise from the trochlear nerve nucleus
situated in the lower part of the midbrain at the level
of inferior colliculus. It lies in the ventro-medial part
of the central grey mater around the cerebral
aqueduct.
The Fibers wind backwards around the central gray
matter and decussate with the nerve fibers of the
opposite side in the superior medullary velum.
They finally emerge on the dorsal surface of the brain
as a single trunk, one on either side of the frenulum.
Course
The two trochlear nerves arise from the dorsal surface
of brain stem, one on each site of the frenulum veli
(Fig. 49.2).
Each passes laterally crossing the superior cerebellar
peduncle.
Then it winds forward between the temporal lobe
and cerebral peduncle.
Now it passes between the posterior cerebral and
superior cerebellar arteries and appears in the
triangular area of dura mater in front of the crossing
of the attached and free margins of the tentorium
cerebelli.
It pierces the dura mater lateral to the posterior
clinoid process and passses forward in the lateral
wall of the cavernous sinus below the oculomotor
nerve.
In the anterior part of the sinus the nerve passes
lateral to the oculomotor nerve and enters the orbit
through the lateral part of superior orbital fissure.
In the orbit, the nerve passes forwards and medially
above the levator palpebrae superioris and supplies
the superior oblique muscle from its orbital surface.
Distribution
It supplies the superior oblique muscle.
Peculiarity of Trochlear Nerve
1. It is the only cranial nerve which emerges from the
dorsal aspect of the brain stem. This dorsal
emergence represents the position of the nerve in
 Eye and Orbit 285

C H A P T E R-20
Fig. 20.31: Trochlear nerve and its distribution

early phylogeny, where it supplied the extraocular
muscle of the 3rd (pineal) eye.
2. It is the only peripheral nerve that undergoes
complete decussation with the nerve of opposite side
before emerging.
CLINICAL AND APPLIED ANATOMY
Complete damage to trochlear nerve results in inability
to turn the eye downwards and laterally due to paralysis
of superior oblique muscle.
Abducent Nerve (Fig. 20.32)
It is the 6th cranial nerve.
Functional Components
1. Somatic efferent: Responsible for lateral movement
of the eyeball. (Motor to lateral rectus).
2. General somatic afferent: Receives proprioceptive
impulses from the lateral rectus muscle.
Nuclear Origin
Fibers arise from the abducent nerve nucleus located
in the lower part of pons beneath the floor of 4th
 286 Human Anatomy For Dental Students
Fig. 20.32: Abducent nerve and its distribution
S E C T I O N-2
ventricle. The nucleus is surrounded by the internal
genu of facial nerve fibers which produce an
elevation in the floor of the 4th ventricle called facial
colliculus.
The fibers of abducent nerve pass forwards and
downwards through the medial lemniscus and
basilar part of the pons to appear on the surface of
brain stem between the lower border of the pons and
the upper end of the pyramid of the medulla
oblongata.
Course
The abducent nerve arises from the ventral aspect of
the brain stem at the junction of pons and the
pyramid of the medulla.
It takes a long intracranial course. First it runs
forwards, upwards and laterally in the cisterna
pontis usually dorsal to the anterior inferior
cerebellar artery.
It pierces dura mater lateral to the dorsum sellae of
the sphenoid and bends sharply forwards across
the sharp upper border of the petrous temporal bone
below the petrosphenoid ligament to enter the
cavernous sinus.
The nerve traverses the cavernous sinus lying at first
lateral and then inferolateral to the internal carotid
artery.
Finally, it enters the orbit by passing through the
superior orbital fissure within the common
tendinous ring inferolateral to the oculomotor and
nasociliary nerve.
The nerve supplies lateral rectus muscle from its
ocular surface.
Distribution
It supplies the lateral rectus muscle.
CLINICAL AND APPLIED ANATOMY
The abducent nerve is commonly involved in cases of
increased intracranial pressure due to the following
reasons:
1. The nerve is very slender and takes a long intracranial
course from the pontomedullary junction to the orbit.
2. At the upper border of the petrous temporal bone, the
nerve makes a sharp bend.
3. Downward shift of the brainstem through foramen
magnum results in stretching of the nerve.
Abducent nerve palsy results in medial or convergent
squint and diplopia due to paralysis of lateral rectus.
Ophthalmic Nerve (Fig. 23.2)
It is the smallest of the three divisions of trigeminal nerve.
It is purely sensory and is given off in the beginning. It
arises from the medial part of the convex anterior border
of the trigeminal ganglion.
Then it pierces the duramater of the trigeminal cave
and enters into the lateral wall of cavernous sinus
where it lies below the trochlear nerve.
Finally, it enters the orbit through the superior orbital
fissure and divides into three branches namely
lacrimal, frontal and nasociliary.

Branches
1. Lacrimal nerve
It is the smallest branch and enters the orbit via
superior orbital fissure lateral to the tendinous
ring.
It runs along the lateral wall of the orbit and ends
in the lacrimal gland (hence its name).
It is joined by a communicating twig from the
zygomatico-temporal branch of the maxillary
nerve carrying postganglionic secretomotor
fibers to the lacrimal gland.
The lacrimal nerve supplies lacrimal gland and
conjunctiva and finally pierces the orbital septum
to also supply the lateral part of upper eyelid.
2. Frontal nerve
It is the largest branch and it enters the orbit via
the superior orbital fissure, lateral to the common
tendinous ring. It runs forwards between the
levator palpebrae superioris and the periosteum
lining the roof of orbit.
In the middle of orbit it divides into two branches:
a. Supraorbital nerve: This continues along the
line of the frontal nerve and passes through
the supraorbital notch along with the vessels.
It then turns upwards into the forehead
supplies the conjunctiva and upper eyelid and
then divides into medial and lateral branches.
These supply the scalp as far back as the
lambdoid suture.
b. Supratrochlear nerve: It runs forwards medial
to the supraorbital nerve. It passes above the
trochlea for the tendon of superior oblique
muscle and then turns upwards along the
superior orbital margin. It supplies the
conjuctiva, upper lid and finally the skin of
the lower part of forehead.
3. Nasociliary nerve
It enters orbit within the tendinous ring of
superior orbital fissure and runs forwards and
medially, crossing above the optic nerve from
lateral to medial side along with the ophthalmic
artery.
On reaching the medial wall of the orbit it ends
by dividing into anterior ethmoidal and infra-
trochlear nerves.
Branches of nasociliary nerve:
a. Sensory communicating branch to the ciliary
ganglion is given just before crossing the optic
nerve.
b. Long ciliary nerves: 2 or 3 in number. These arise
from the nasociliary nerve as it crosses the optic
Eye and Orbit 287
nerve. They pass forward to enter the eyeball and
supply sensory Fibers to the ciliary body, iris and
cornea.The long ciliary nerves also carry
postganglionic sympathetic fibers to the dilator
pupillae.
c. Posterior ethmoidal nerve: This enters the
posterior ethmoidal foramen and supplies the
ethmoidal and sphenoidal air sinuses.
d. Anterior ethmoidal nerve: It enters the anterior
ethmoidal foramen and then passes through
anterior ethmoidal canal to reach the anterior
cranial fossa. Now it runs forwards over the
cribriform plate of ethmoid and enters the nasal
cavity by passing through a slit at the side of
crista galli. In the nasal cavity the nerve lies in a
groove on the posterior surface of the nasal bone
and gives of internal nasal branches to the nasal
septum and lateral wall of the nose. At the lower
border of the nasal bone, the nerve leaves the
nasal cavity and appears on the dorsum of nose
as the external nasal nerve.
e. Infratrochlear nerve: This runs forwards on the
C H A P T E R-20
medial wall of the orbit and ends by supplying
the skin of both eyelids and adjoining part of the
nose.
Infraorbital Nerve
It is the terminal, sensory branch of maxillary nerve
which enters the orbit from the pterygopalatine fossa
via the inferior orbital fissure.
It lies in the infraorbital groove and canal in the floor
of the orbit and appears on the face via the
infraorbital foramen.
It gives rise to palpebral branches to lower eyelid,
nasal branches to the side of the nose and labial
branches to anterior part of cheek and the upper lip.
Zygomatic Nerve
It is a branch of maxillary nerve given in the pterygo-
palatine fossa and enters the lateral wall of orbit via
inferior orbital fissure.
It immediately divides into zygomaticotemporal and
zygomaticofacial nerves.
These nerves exit the orbit passing through
zygomatic bone and supply skin over temple and
cheek.
OPHTHALMIC ARTERY (Fig. 20.33)
It is a branch of internal carotid artery and arises from it,
medial to the anterior clinoid process close to the optic
canal.
Course
 288 Human Anatomy For Dental Students
Fig. 20.33: Right ophthalmic artery and its branches
It enters the orbit from its origin through the optic
S E C T I O N-2
canal, inferolateral to the optic nerve in a common
dural sheath.
It pierces the duramater and ascends over the lateral
side of the optic nerve. It crosses the nerve superiorly
from lateral to medial side along with the nasociliary
nerve.
It then runs forwards along the medial wall of the
orbit and terminates near the medial angle of the eye
by dividing into supratrochlear and dorsal nasal
branches.
Branches of Ophthalmic Artery
1. Central artery of retina: It arises from ophthalmic
artery (while still in dural sheath) below the optic
nerve.
It runs forwards in the dural sheath and pierces the
optic nerve inferomedially about 1.25 cm behind the
eyeball. The central artery reaches the optic disc
through the central part of the nerve. It supplies the
optic nerve and inner 6/7 layers of retina.
2. Lacrimal artery: It arises from ophthalmic artery just
before it crosses the optic nerve. It passes forwards
along the upper border of lateral rectus and supplies
the lacrimal gland, eyelids and conjunctiva.
Branches of lacrimal artery
a. Glandular branches to lacrimal gland.
b. 2 lateral palpebral arteries, one to each eyelid.
c. 2 zygomatic brancheszygomatico-facial and
zygomatico-temporal.
d. Recurrent meningeal branch: It runs backwards
to enter the middle cranial fossa through the
superior orbital fissure.
3. Muscular arteries: These branches arise from
common trunk to form superior and inferior group.
Inferior group gives rise to anterior ciliary arteries.
4. Posterior ciliary arteries: These consist of two sets
namely, long and short ciliary arteries. Both of these
pierce the sclera around the optic nerve and chiefly
supply the choroid and sclera. Long ciliary arteries
are usually two and short ciliary arteries are usually
in 7 in number. (Remember anterior ciliary arteries
arise from muscular arteries).
5. Supraorbital artery: This accompanies the supra-
orbital nerve.
6. Posterior ethmoidal artery: It enters the posterior
ethmoidal foramen in the medial wall.
7. Anterior ethmoidal artery: It enters the anterior
ethmoidal foramen in the medial wall.
8. Dorsal nasal artery: This supplies the upper part of
the nose.
9. Supratrochlear artery: It accompanies the
supratrochlear nerve to supply the forehead.
10. Medial palpebral branches: One for each eyelid.
INFRAORBITAL ARTERY (Fig. 23.3)
It is a branch of maxillary artery and enters orbit through
the posterior part of inferior orbital fissure. It gives of
branches in infraorbital groove and supply inferior rectus,
inferior oblique, nasolacrimal sac and lacrimal gland.

CLINICAL AND APPLIED ANATOMY
The central artery of retina is an end artery and
obstruction of this artery by an embolism or pressure
results in sudden total blindness.
OPHTHALMIC VEINS
1. Superior ophthalmic vein: It runs above the optic
nerve accompanying the ophthalmic artery and
passes through the superior orbital fissure to drain
into the cavernous sinus. It communicates anteri-
orly with the supraorbital and angular veins.
2. Inferior ophthalmic vein: It runs below the optic
nerve and ends either by joining the superior
ophthalmic vein or drains directly into the cavernous
sinus. It communicates with the pterygoid venous
plexus by small veins passing through the inferior
orbital fissure.
LYMPHATIC DRAINAGE OF ORBIT
Lymphatics from orbit drain into preauricular lymph
nodes.
FASCIAL SHEATH OF EYEBALL OR FASCIA BULBI
(Fig. 20.7)
The fascia bulbi (Tenons capsule) is a membranous
envelope of the eyeball.
It extends from the optic nerve behind to the sclero-
corneal junction in front.
It is separated from the sclera by the episcleral space
and forms a socket for the eyeball to facilitate free
ocular movements.
At the posterior pole of the eyeball the fascia bulbi
becomes continuous with the dural sheath of the
optic nerve.
Fig. 20.34: Structure of eye ball in sagittal section.
Eye and Orbit 289
The fascia bulbi is pierced by:
a. Tendons of 4 recti and 2 oblique muscles of the
eyeball.
b. Ciliary nerves and vessels around the entrance of
optic nerve.
Suspensory ligament of the eye (suspensory ligament
of Lockwood)
The fascia bulbi provides a tubular sheath around
each muscle which pierces it.
From the sheath of lateral rectus a triangular
expansion known as the lateral check ligament
extends laterally for attachment to the lateral wall of
the orbit on Whitnalls tubercle.
Similarly, a triangular expansion from the sheath
over medial rectus extends medially for attachment
to the medial wall of the orbit on the posterior
lacrimal crest of lacrimal bone. This is the medial
check ligament.
Both the check ligaments are connected to the eyeball
below, by a fascial thickening of the lower part of the
Tenons capsule.
It encloses the inferior rectus and inferior oblique
muscles.
C H A P T E R-20
This forms the suspensory ligament of the eye or
suspensory ligament of Lockwood.
It is expanded in the centre and is narrow at its
extremities.
It forms a sling like a hammock below the eyeball by
the union of the margins of the sheaths of the inferior
rectus and the inferior oblique muscles with the
medial and lateral check ligaments.
EYE BALL (BULBUS OCULI) (Fig. 20.34)
Eyeball is the organ of sight. It functions like a camera
and has a lens system for focussing images.
 290 Human Anatomy For Dental Students

Location: The eyeball occupies anterior half of the orbital
cavity. Optic nerve emerges from it, a little medial to its
posterior pole.
Shape and size: It is almost spherical in shape and has a
diameter of about 24 mm.
Tunics of eyeball: The eyeball consists of three concentric
coats:
1. An outer fibrous coat consisting of sclera and cornea.
2. A middle vascular coat consisting of choroid, ciliary
body and iris.
3. An inner nervous coat consisting of the retina.
Sclera
Sclera forms the posterior five-sixths of the outer coat.
It is opaque and consists of dens fibrous tissue.
A small portion of it is visible as the white of the
eye in the palpebral fissure.
It is continuous anteriorly with the cornea.
Functions of sclera:
a. Helps to maintain the shape of the eyeball.
S E C T I O N-2
Structure of Cornea (Fig. 20.35)
Cornea consists of five layers. From outside inwards these
are as follows:
1. Corneal epithelium: It consists of five layers of cells.
It is made up of stratified squamous epithelium.
Middle cells are polyhedral with peripheral
processes. These cells are known as wing cells.
2. Anterior limiting membrane (Bowmans membrane):
It is made up of a structureless homogenous mass
without any elastic fibers.
3. Substantia propria: It is made up of lamellae of dense
connective tissue which cross each other at right
angles to form corneal spaces.
4. Posterior elastic lamina (Descemets membrane):
It consists of a structureless homogenous mass
containing elastic fibers.
5. Mesothelium of anterior chamber (Corneal endo-
thelium): It is formed by squamous epithelium.

b. Protects internal structures.

c. Provides attachment to muscles that move the
eyeball.
Structures piercing the sclera
a. Optic nerve pierces the sclera a little inferomedial
to the posterior pole of the eyeball.
b. Long and short ciliary nerves.
c. Long and short ciliary arteries pierce the sclera
around the emergence of the optic nerve.
d. 4 choroidal veins (also called venae vorticosae)
pierce the sclera just behind the equator.
e. Anterior ciliary arteries enter the eyeball around
limbus.

Cornea
The cornea forms the anterior one-sixths of the outer
coat.
It is transparent and more convex than the sclera.
It is avascular and is nourished primarily by
permeation from the periphery.
It not only permits the light to enter the eye but also
refracts the entering light.
It is highly sensitive and is supplied by the
ophthalmic division of trigeminal nerve.
These nerves form the afferent limb of the corneal
reflex. Closure of eyelids on stimulation of the cornea
is known as corneal reflex.

Fig. 20.35: Layers of cornea (seen under 10x)

 Eye and Orbit 291

CLINICAL AND APPLIED ANATOMY 3. Capillary lamina: It consists of fine network of

Due to ageing there is fatty degeneration along the
periphery of the cornea. This becomes visible as a
white ring in old people and is known as arcus
senilus.
Transparency of cornea is essential for adequate
vision. It can be affected by following conditions.
1. Injuries: This is the most common cause of
corneal opacities as any injury heals by fibrosis.
2. Inappropriate contact lens use: Semisoft lenses
should not be worn for long periods as they are
impermeable to gases. The central part of cornea
receives oxygen from air by diffusion and this
gets cut off by these lenses. Soft lenses are
relatively more permeable to gases and can be
used for longer hours.
3. Vitamin A deficiency in childhood leads to
destruction of cornea which is known as
keratomalacia. This heals by fibrosis and
opacification.
Loss of normal curvature of cornea is known as
capillaries.
4. Basal lamina or membrane of Bruch: It is a thin,
transparent membrane which provides attachment
to the pigment layer of retina.
Functions: The inner surface of choroid is firmly attached
to the retina and nourishes the rods and cones of the
retina by diffusion.
Ciliary Body (Fig. 20.36)
Ciliary body is present in the form of a circular
thickening in the vascular tunic.
It extends from the choroid posteriorly at the level of
ora-serrata of retina to the iris anteriorly, at the level
of corneo-scleral junction.
The iris is attached along its lateral margin.
The ciliary body suspends the lens via suspensory
ligaments or zonules.
Features of Ciliary Body
1. The ciliary body is triangular in cross section, thick
in front and thin behind.

C H A P T E R-20
astigmatism. In this case the cornea is more curved 2. Its outer surface lines the inner aspect of the sclera
in one meridian than the other. It leads to eye strain 3. The inner surface consists of following features:
due to irregular refraction of light. a. Ciliary ring or pars plana: It is an outer fibrous
ring which is continuous with the choroid.
Middle Coat of Eyeball (Fig. 20.34) b. Ciliary processes or pars plicata: These are a
group of 60 to 90 folds present on the inner aspect
The middle coat is often called as the vascular coat because
of the ciliary body. They are arranged radially
it contains most of the blood vessels of the eyeball. This
between the ciliary ring and the iris. The grooves
coat also contains a large number of melanin-containing
between the processes provide attachment to the
cells.
fibers of the suspensory ligament of the lens. The
It is divided into three parts: From behind forwards these
ciliary processes are a complex of capillaries
are, choroid, cillary body and iris. These three parts
which secrete aqueous humor. They may be
together form the uvea or uveal tract.
compared with the choroidal plexuses of the
ventricles in brain which are involved in the
Choroid secretion of cerebro spinal fluid.
Choroid is the larger posterior part of the vascular
coat of eyeball.
It is a brown, thin and highly vascular membrane
lining the inner surface of the sclera.
Anteriorly, it is connected to iris by the ciliary body
and posteriorly, it is pierced by the optic nerve.
Structure of choroid: It presents with following layers
from outside inwards:
1. Supra-choroid lamina: It is a loose network of elastic
and collagen fibers which separate it from the sclera.
2. Vascular lamina: It is formed by blood vessels within
the connective tissue.
Arteries: They are derived from short ciliary arteries
which pierce the sclera around the optic nerve.
Veins: They are arranged in the form of whorls which
converge to form 4 or 5 venae vorticosae which pierce Fig. 20.36: Irido-corneal angle (sagittal section)
the sclera to open into the ophthalmic vein.
 292 Human Anatomy For Dental Students
Structure of ciliary body: It is made up of the following:
1. Stroma: It consists of loose collagen fibers
supporting the ciliary vessels, nerves and muscles.
2. Ciliary muscle: It is a small unstriped muscle mass
consisting of mainly two types of fibers:
a. Outer radial fibers
b. Inner circular fibers and longitudnal fibers.
It is supplied by the parasympathetic nerves via short
ciliary nerves.
Action: The ciliary muscle as a whole acts as a
sphincter. Therefore, when its fibers, both radial and
circular contract, the choroid is pulled towards the
lens reducing the tension on the suspensory
ligaments. This allows the lens to assume a more
spherical form because of its own elastic nature and
results in an increase in the refraction.This process
is called accommodation that allows a person to
adjust for near vision.
3. Bilaminar ciliary epithelium linning the inner
surface of the ciliary body.
S E C T I O N-2
Iris (Figs 20.34 and 20.36)
Iris is a pigmented contractile diaphragm present
between the cornea and the lens.
Fig. 20.37: Layers of retina
It is attached along periphery to the choroid by the
ciliary body. In the centre it presents with an opening
called the pupil.
Structure of iris: The iris consists of 4 layers. From
anteroposterior these are:
1. Anterior mesothelial lining.
2. Connective tissue stroma containing pigment cells
and blood vessels.
3. Layer of smooth muscle which consists of two parts,
namely:
a. Constrictor pupillae: An annular band of muscle
fibers encircling the pupil. It constricts the pupil in
response to parasympathetic stimulation.
b. Dilator pupillae: It constists of radially arranged
fibers from circumferance of the pupil. It dilates
the pupil in response to sympathetic stimulation.
4. Posterior layer of pigmented cells which is conti-
nuous with the ciliary part of retina.
RetinaThe Inner Nervous Coat of Eyeball (Figs 20.34
and 20.37)
Retina is the innermost coat of the eyeball. It lies between
the choroid externally and the hyaloid membrane of the
vitreous internally. The thickness of retina decreases
gradually from behind forwards.

Structure of retina: It is primarily made up of two layers
namely, outer retinal pigment epithelium and inner neuro
sensory layer. The inner sensory layer of retina is sensitive
to light and is made up photoreceptor cells called rods
and cones as well as numerous relay neurons viz. bipolar
neurons and ganglion cells. This layer ends at a crenated
margin anteriorly, called the ora serrata. Retina is divided
into ten layers for the purpose of description. These layers
are (Fig. 20.37):
1. Retinal pigment epithelium: It is insensitive to light
and is made up of pigmented cuboidal epithelium.
This is the outer most layer lying next to choroid. It
prevents scattering of light and provide nutrition to
rods and cones.
2. Layer of rods and cones: They are photoreceptors.
3. Outer limiting membrane: It is made up of processes
of Mullers cells which are connective tissue cells of
retina.
4. Outer nuclear layer: It is formed by the nuclei of
rods and cones.
5. Outer plexiform layer: It is formed by the connec-
tions of rods and cones with bipolar cells and
horizontal cells.
6. Inner nuclear layer: It is formed by nuclei of bipolar
cells.
7. Inner plexiform layer: It is formed by connections
of bipolar cells with the ganglion cell and amacrine
cells.
8. Ganglion cell layer: It is formed by ganglion cells.
9. Nerve fibre layer: It is formed by axons of ganglion
cells which form optic nerve.
10. Internal limiting membrane: It is formed by process
of Mullers cells.
Blood Supply of the Retina
1. The deeper part of the retina, i.e., up to the bipolar
neurons is supplied by the central artery of the retina,
a branch of ophthalmic artery.
2. The superficial part of the retina upto the rods and
cones is nourished by diffusion from the capillaries
of the choroid.
Venous Drainage of Retina
It is by the central vein of retina which drains into the
cavernous sinus.
CLINICAL AND APPLIED ANATOMY
In retinal detachment there is separation of the two
layers of retina. Retinal pigment epithelium
separates from the neurosensory layer of retina.
Eye and Orbit 293
Fig. 20.38: Appearance of retina seen through ophthalmo-
scope
The following features are observed on the retina as
seen through the ophtahalmoscope (Fig. 20.38).
a. Macula lutea, a pale yellowish area seen near
C H A P T E R-20
the posterior pole.
It is approximately 5 mm in diameter. A small
pit in its center is called the fovea centralis.
This is the point where light is normally
focussed.
The fovea is that portion of retina which has
the maximum concentration of cones. Hence,
it is the site of greatest visual acuity, i.e., the
ability to see fine images.
b. Optic disc, a white spot seen about 3 mm medial
to the macula. It has a depressed area in the center
called the physiological cup. Nerve fibers from
retina meet and pass through this region of the
eyeball and form the optic nerve. The blood
vessels of retina also pass through this spot.
There are no photoreceptor cells in the optic disc.
Hence, it does not respond to light. Therefore,
the optic disc is also called as the blind spot.
c. Central artery of the retina: It enters the eye
through center of the optic disc. It divides into
superior and inferior branches, each of which
then divides into temporal and nasal branches.
The retinal veins follow the arteries. The branches
of the central artery of retina are seen radiating
over the edges of the optic disc. They are smaller
and paler than veins. At points where they cross
the veins, the wall of the veins can be seen
through them. In patients with high blood
pressure the arteries may appear narrowed.
Haemorrhages may be seen around the arteries.
. Normal optic disc seen on ophthalmoscopy
appearce as a cup shaped area, paler than the
 294 Human Anatomy For Dental Students

surrounding area i.e., the fundus. The edges of the
cup are sharp and well defined. In patients with
raised intracranial pressure the optic disc is
congested and the cup gets obscured and the disc
margin is blurred. This is known as papilloedema.
The intracranial pressure gets transmitted to the disc
via the meningeal coverings which continue over
the optic nerve. The raised pressure also compresses
the central retinal artery which lies in the
subarachnoid space around the optic nerve.
COMPARTMENTS OF EYE BALL
The interior of the eyeball is divided into two
compartments by the lens.
1. Anterior compartment
It is further divided into two chambers by the iris
namely anterior and posterior chambers.
The anterior chamber lies between the iris and
cornea (Fig. 20.34).
The posterior chamber lies between iris and lens
(Fig. 20.34).
The two chambers are filled with aqueous humor
S E C T I O N-2
CLINICAL AND APPLIED ANATOMY
Glaucoma: An abnormal increase in intraocular
pressure leads to the condition called glaucoma. This
occurs due to a block in the circulation and drainage of
the aqueous humor. In acute conditions there is severe
pain due to pressure on the highly sensitive cornea.
Glaucoma results in pressure necrosis of the retina and
eventually can cause blindness.
LENS (Fig. 20.39)
The lens is an unusual biological structure. It is also
known as crystalline lens.
It is transparent and biconvex in shape.
It is placed between the anterior and posterior
compartments of the eyeball and is suspended from
the ciliary body by zonular fibers.
External features: It presents with:
a. Anterior and posterior surfaces.
b. Anterior and posterior poles: These are the centre
points of the respective surfaces. The line
connecting anterior and posterior poles forms the
axis of the lens.

which helps in maintaining the intraocular c. The equator, which constitutes the circumference
pressure. The aqueous humor is rich in ascorbic of the lens.
acid, glucose and aminoacids. It nourishes the
cornea and the lens which are otherwise Structure of lens: Lens consists of the following layers:
avascular. 1. Lens capsule: It is a transparent, elastic membrane
that envelops the lens all around.
Circulation of aqueous humor
2. Anterior epithelium: Under the anterior surface of
The aqueous humor is secreted in the posterior
capsule the lens is lined by a single layer of cuboidal
chamber by the vessels in the ciliary processes.
cells in the centre. These cells elongate as they
From here it passes into the anterior chamber
approach the equator of lens and give rise to lens
through the pupil.
fibers.
Then it passes through the spaces in the irido-
corneal angle, located between the fibers of
ligamentum pectinatum, to enter the canal of
Schlemm, a venous ring.
Finally, it drains into the anterior ciliary veins.
2. Posterior compartment
It lies behind the lens and is much larger than
the anterior compartment.
It constitutes posterior 4/5th of the inner part of
eyeball.
It is surrounded almost completely by the retina
and is filled with a colourless, transparent gelly
like substance called vitreous humour/vitreous
body. The vitreous humour is enclosed in a
delicate hyaloid membrane.
The vitreous humour also helps in maintaining
the intraocular pressure and the shape of the
eyeball. Further it holds the lens and the retina
in place.

Fig. 20.39: Structure of lens


3. Lens fibers: They are arranged concentrically and
form the substance of the lens.
The centre of the lens is hard as it contains the
oldest fibers. It is called the nucleus. Here the
fibers loose their nucleus and organelles and
accumulate a special protein known as
crystalline.
The periphery of lens or cortex is soft and is made
up of more recently formed fibers.
Suspensory ligaments of the lens (zonules of Zinn)
The lens is suspended between the anterior and posterior
compartments of the eye by the suspensory liga-
ments.These ligaments extend from the ciliary body to
the lens capsule and are present mostly in front of the
equator.
CLINICAL AND APPLIED ANATOMY
The change in focal length of the lens of the eye when
it focuses on a nearby object is called
accommodation.
This occurs by the contraction of ciliary muscles and
enables us to see both the far and near objects with
the same lens.
Opacification of the lens is known as cataract. The
most common cause is senile cataract. The lens
absorbs much of the ultraviolet rays and
increasingly becomes yellow with ageing. It also
becomes hard and ultimately opaque so that light
cannot pass through. This results in blindness
which is easily cured by surgery.
Fig. 20.40: Optics of eye and refractive errors
Eye and Orbit 295
Presbyopia is the gradual loss of power of
accommodation of the lens due to changes
secondary to ageing as mentioned above. The lens
plays an important role in accommodation and as it
hardens with age it looses its flexibility. Spectacles
are prescribed for near vision.
FUNCTIONS OF THE EYE
As mentioned before the eye functions much like a camera.
The iris allows light to enter the eye through its aperture
called pupil. The light rays are focussed by the lens (also
by cornea and humour) on the photosensitive retina. The
light striking the retina is converted into action potentials
that are relayed through optic pathways to the visual
cortex of the brain and an image is perceived.
Refractive Media of the Eye
These include:
1. Cornea: It is highly refractile but not adjustable
2. Aqueous humour
3. Lens: Refractive and adjustable
C H A P T E R-20
4. Vitreous humour/vitreous body.
OPTICS OF EYE
Emmetropia: It is the normal focussing eye in which
parallel rays of light from infinity are focussed on
the neurosensory layer of retina, when accommoda-
tion is at rest (Fig. 20.40).
 296 Human Anatomy For Dental Students
Refractive error (Ametropia) (Fig. 20.40): This is a
clinical condition characterised by defect in the
image forming mechanism of the eye in which the
rays coming from an object are not focussed on the
retina. It can be classified into the following types:
a. Myopia or near sightedness: This occurs when
the axial length of eye ball is increased or the
refractive power of lens is increased. The light
rays from a distant object are focused in front of
the retina and hence the image appears blurred.
It can be treated by using appropriate concave
lenses.
b. Hypermetropia or far sightedness: This occurs
when the axial length of eye ball is decreased or
the refractive power of lens is decreased. The light
rays from an object are focused behind the retina
and hence appears blurred. It can be treated by
using appropriate convex lenses.
c. Astigmatism: In this there is defective focussing
of an image on the retina due to alteration in the
horizontal and vertical curvatures of the cornea.
It is treated by using cylindrical lenses.
S E C T I O N-2
Fig. 20.41: Visual pathway
Presbyopia: It is the inability to clearly see the near
objects. This occurs in old age due to gradual loss of
power of accommodation of eye and increase in
opacification of the lens. The primary complaint is
difficulty in reading. It is treated by using appro-
priate convex lenses.
Accommodation: Change in focal length of the lens
of the eye when it focuses on a nearby object is called
accommodation. This occurs by the contraction of
ciliary muscles and enables us to see both the far
and near objects with the same lens.
VISUAL PATHWAY (Fig. 20.41)
The retina is the photoreceptive layer of the eye and
impulses generated in rods and cones of retina are finally
transmitted along the axons of ganglion cells of retina
which converge to the optic disc and exit the eyeball as
optic nerve.
The impulses course through optic nerve, optic
chiasma and optic tract to relay in lateral geniculate
body of corresponding side.

Fig. 20.42: Lesions of visual pathway
The fibers originating from nasal halves of the retina
cross to opposite side at the chiasma. Hence, each
optic tract consists of fibers from temporal region of
retina of ipsilateral side and nasal region of retina of
contralateral side.
The fibers from nuclei of lateral geniculate body
extend to the visual cortex in the medial aspect of
occipital lobe via the optic radiation.
Image is perceived in visual area of occipital cortex.
CLINICAL AND APPLIED ANATOMY
Lesions of visual pathway (Fig. 20.42):
1. Optic nerve lesion causes total blindness of
corresponding eye.
2. Lesions of optic chiasma causes bitemporal
hemianopia.
3. Lesion of optic tract causes contralateral homony-
mous hemianopia.
4. Lesion of pretectal region causes Argyll-Robertson
pupil.
5. Partial lesion of visual cortex causes upper or lower
quadrantic homonymous hemianopia.
Eye and Orbit 297
C H A P T E R-20
PUPILLARY LIGHT REFLEX PATHWAY (Fig. 20.43)
Pupillary light reflex is defined as constriction of the
pupil of the eye when it is exposed to bright illumination.
The path of nerve impulses causing this reflex is as
follows:
On stimulation with bright light the nerve impulses
pass through ganglion cells of retina, optic nerve,
optic chiasma and optic tract to pretectal nucleus of
mid brain.
Fibers of secondary neurons from pretectal nuclei
then convey impulses to the Edinger-Westphal nuclei
bilaterally.
Preganglionic fibers from Edinger-Wesphal nuclei
carry impulses to ciliary ganglia via oculomotor
nerve.
Post ganglionic fibers from ciliary ganglion on each
side travel along short ciliary nerves to supply
sphincter pupillae muscle which contracts in
response. Hence, the pupil constricts.
S E C T I O N-2 298 Human Anatomy For Dental Students
Fig. 20.43: Light reflex pathway
Thus, when one eye is exposed to a beam of light, the
pupil of both eyes contract together and equally.
Constriction of pupil which is exposed to beam of
light is called direct light reflex while simultaneous
constriction of pupil of opposite eye is called
consensual or indirect light reflex.
NEAR VISION REFLEX PATHWAY (Fig. 20.44)
In order to view near objects the eyes respond by:
1. Convergence of eyes.
2. Contraction of ciliary muscles leading to change in
shape of anterior surface of lens known as acco-
mmodation reflex.
3. Constriction of pupils to increase depth of focus.
Afferent path is along optic nerves, optic chiasma, optic
tracts, lateral geniculate bodies, optic radiation to the
visual areas in cerebral cortex. Then impulses are
transmitted to pretectal region and Edinger-Westphal and
motor nuclei of oculomotor nerve via superior
longitudinal fasciculus, frontal eye field and internal
capsule.
Efferent path consists of parasympathetic fibers which
arise from the Edinger-Westphal nucleus and travel along
oculomotor nerve to relay in ciliary ganglion. Post
ganglionic fibers from the ganglion supply ciliary muscle
and sphincter pupillae via short ciliary nerves. They lead

Fig. 20.44: Near vision reflex pathway
to accommodation and constriction of pupil.
Efferent fibers from oculomotor nerve also supply the
medial rectus muscle of eyeball which causes con-
vergence.
CORNEAL AND CONJUNCTIVAL REFLEX PATHWAY
On touching the cornea or conjunctiva there is blinking
of eyes. This is known as corneal and conjunctival reflex.
This reflex helps to protect the eyes against any foreign
body.
Afferent impluses are transmitted by ophthalmic
division of trigeminal nerve to ventral posterior
Eye and Orbit 299
C H A P T E R-20
medial nucleus of thalamus and relay in post central
gyrus of cortex.
Efferent impluses travel down from motor cortex to
facial nerve nucleus, along facial nerve and via its
branches to the orbicularis occuli muscles causing
its contraction and blinking of eyelids.
VISUAL FIELDS
It is the extent to which the eye can seen the outside world.
The field of vision of each eye is limited by more medially
and eyebrow superiorly. Visual fields are tested by the
perimeter (Fig. 20.45).
 300 Human Anatomy For Dental Students
Fig. 20.45: Diagrammatic representation of visual fields and binocular vision
BINOCULAR VISION
The visual impulses from one object are carried by
optic pathway of both the eyes and the images from
them are fused into one at the level of visual cortex.
S E C T I O N-2
When two corresponding points of the retina are
stimulated, single image is seen. This is binocular
single vision.
Binocular single vision provides us with ability to
appreciate depth and proportion of an object.
COLOUR VISION
There are three primary colours namely, red, green
and blue. The red light has a wavelength of 723 to
647 nm green light wavelength is 575 to 492 nm and
blue light wavelength is 492 to 450 nm.
Mixing of wavelengths of these colours in variable
proportion produces the full spectrum of colours.
Colour vision is the function of cones of retina. There
are three types of cones namely, red sensitive, green
sensitive and blue sensitive and the sensations are
integrated by the ganglion cells of retina, lateral
geniculate bodies and the visual cortex (area no. 19).
 Chapter

21 Dura Mater,
Intra Cranial Venous Sinuses
Cavity present in cranium of skull is known as cranial 1. Subdural space: It is a potential space present
cavity. It lodges brain, meninges, CSF and blood supply between the duramater and the arachnoid mater. It
of brain. usually has a thin capillary layer of fluid in it.
2. Subarachnoid space: It lies between the arachnoid
MENINGES mater and the pia mater. Subarachnoid space
contains cerebrospinal fluid (CSF).
The brain is enclosed in three protective membranes called
The three meninges continue over the caudal exten-
meninges (Figs 21.1 and 21.2). From without inwards
tion of brain, which is the, spinal cord.
these are:
The duramater is also called pachymeninx. The

C H A P T E R-21
1. Duramater (outermost); also known as pachymeninx
2. Arachnoid mater (middle) arachnoid and piamater are together known as
3. Pia mater (innermost) leptomeninges. The are described with brain in section
The three membranes are separated from each other of neuroanatomy. Cranial duramater and its features are
by two spaces described in this chapter.

Fig. 21.1: Folds of duramater and dural venous sinuses (sagittal section of head and neck)
 302 Human Anatomy For Dental Students

DURA MATER (Fig. 21.1) 1. Falx cerebri

2. Tentorium cerebelli
Cranial dura is the thickest and the toughest
3. Falx cerebelli
membrane in our body.
4. Diaphragma sellae.
It develops from the mesoderm surrounding the
neural tube.
Falx Cerebri
It consists of two layers:
It is a large sickle-shaped fold of duramater
a. Outer endosteal layer: It serves as the inner
occupying the median longitudinal fissure between
periosteum (endocranium). It lines the inner
the two cerebral hemispheres.
aspect of cranial cavity and is adhered to the bone
Its narrow anterior end is attached to the crista galli
by fibrous bands best seen at the sutures. This
and the broad posterior end to the upper surface of
layer becomes continuous with the periosteum
tentorium cerebelli along the median plane.
over the skull (pericranium) at the sutures and
Its upper margin is convex and is attached to the
foramina. It provides sheaths that enclose the
lips of the sagittal sulcus. The lower concave margin
cranial nerves.
is free.Various venous sinuses enclosed in the falx
b. Inner meningeal layer: This encloses the brain.
cerebri are:
It continues as the spinal dura at the foramen
a. Superior sagittal sinus: Within the convex upper
magnum. It is fused with the endosteal layer
border.
except at places where venous sinuses are
b. Inferior sagittal sinus: Is enclosed within the
enclosed between the two layers. It fuses with
lower concave margin.
the adventitia of blood vessels (branches of
c. Straight sinus: Lies along the line of attachment
internal carotid and vertebral vessels) at the site
of the falx cerebri with the tentorium cerebelli.
of their entry into the cranial cavity.
S E C T I O N-2

Tentorium Cerebelli (Fig. 21.2)

Folds of Duramater (Fig. 21.1)
At places, the meningeal layer is folded on itself to form
folds which serve as partitions that divide the cranial
cavity into compartments. The various folds are:
It is a tent-shaped fold of duramater which forms
the roof of posterior cranial fossa.
It separates the cerebellum from the occipital lobes
of cerebrum.

Fig. 21.2: Base of cranial cavity showing attachment of tentorium cerebelli and venous sinuses

It has 2 margins and 2 surfaces.
The anterior free margin is U shaped and encloses
the tentorial notch for the passage of midbrain.
Each end of the U are attached to the anterior clinoid
processes on either side.
The outer attached margin is convex and is attached
on each side, from before backwards, to the posterior
clinoid process, posterior inferior angle of parietal
bone and lips of transverse sulcus on occipital bone.
The free and attached margins cross each other near
the apex of the petrous temporal bone to enclose a
triangular area anteriorly which is pierced by the
oculomotor nerve.
The convex upper surface slopes to either side from
the median plane. In the median plane it provides
attachment to falx cerebri
The concave inferior surface provides attachment to
falx cerebelli in its posterior part.
Venous sinuses enclosed in the tentorium cerebelli
on each side are:
a. Transverse sinus: Lies within the posterior part
of the attached margin.
b. Superior petrosal sinus: Present within the
anterolateral part of the attached margin.
Falx Cerebelli
It is a small sickle shaped fold of dura mater in the
sagittal plane projecting forwards into the posterior
cerebellar notch.
It has a free concave anterior margin. The convex
posterior border is attached to the posterior part of
inferior surface of tentorium cerebelli above and the
internal occipital crest below.
Occipital sinus is enclosed by the falx cerebelli along
its posterior attached part.
Diaphragma Sellae
It is a small, circular, horizontally placed fold of dura
mater that forms the roof of the hypophyseal fossa.
It is attached anteriorly to tuberculum sellae and
posteriorly to the upper margin of dorsum sellae. It
becomes continuous on each side with the duramater
of the middle cranial fossa.
It has a central aperture which provides passage to
the stalk of the hypophysis cerebri.
Arterial Supply of Duramater
The outer endosteal layer is richly vascular but the inner
layer, being more fibrous and has little vascular supply.
The cranial dura is supplied by the following arteries:
Dura Mater, Intra Cranial Venous Sinuses 303
1. Middle meningeal artery, branch of maxillary artery.
2. Anterior meningeal branches of anterior ethmoidal
artery and posterior ethmoidal artery.
3. Meningeal branches of internal carotid artery.
4. Lacrimal artery, branch of ophthalmic artery.
5. Accessory meningeal artery, branch of maxillary
artery.
7. Meningeal branch of ascending pharyngeal artery.
8. Posterior meningeal branch of vertebral artery.
9. Meningeal branch of occipital artery.
Middle Meningeal Artery (Fig. 23.3)
It is the largest of the meningeal arteries.
Middle meningeal artery is a branch of first part of
maxillary artery, given off in the infratemporal fossa.
It ascends upwards deep to the lateral pterygoid
muscle and behind the mandibular nerve.
Then, it passes between the two roots of auriculo-
temporal nerve and enters the cranial cavity through
C H A P T E R-21
the foramen spinosum along with the meningeal
branch of mandibular nerve.
In the cranial cavity, it passes forwards and laterally
in a groove on the squamous part of the temporal
bone. It divides into two branches:
1. Frontal (anterior) branch: It crosses the greater
wing of sphenoid and lodges in the groove or
bony canal at the sphenoidal angle of the parietal
bone beneath the pterion. There after it divides
into branches which spread upward as far as
the vertex.
2. Parietal (posterior) branch: It arches backwards
on the squamous part of the temporal bone and
crosses the lower border of parietal bone in front
of its mastoid angle. Here, it divides into branches
which spread out as far as the lambda.
The middle meningeal artery and its branches
lie outside the dura (extradural) and mainly
supply the periosteum and bone marrow of
the skull bones.
It gives branches to duramater, trigeminal
ganglion, facial nerve and tympanic cavity etc.
The tributaries of middle meningeal vein
accompany the branches of middle meningeal
artery. The veins are however closer to the
bone.
 304 Human Anatomy For Dental Students
Nerve Supply of Duramater
The dura lining the floor of cranial cavity has a rich nerve
supply. It receives both sensory and sympathetic nerve
supply and is quite sensitive to pain. It is supplied by the
meningeal branches of the following nerves:
1. In the anterior cranial fossa: Anterior and posterior
ethmoidal nerves, maxillary nerve.
2. In the middle cranial fossa: Maxillary nerve,
mandibular nerve and trigeminal ganglion.
3. In the posterior cranial fossa: Recurrent branches
from C1, 2, 3 spinal nerves and meningeal branches
from 10th and 12th cranial nerves.
CLINICAL AND APPLIED ANATOMY
Extra-dural haematoma: It is the collection of blood
between the endosteal layer of duramater and the
bone of the skull. It generally occurs following head
injury. The commonest vessel involved is the middle
meningeal vein followed by middle meningeal
artery. The blood gradually collects and strips off
S E C T I O N-2
the endosteal layer from the skull. The patient may
present initially with loss of conciousness for a short
duration followed by a lucid interval of normal
conciousness. As the intracranial pressure
gradually increases the patient again presents with
confusion, drowsiness, paralysis and
unconciousness. Hematoma following injury to
anterior branch of middle meningeal artery causes
pressure on the motor area of the brain giving rise to
hemiplegia of the opposite side. Surgical drainage
of hematoma is done by burring a hole through the
pterion.
Subdural hematoma: It is the collection of blood
between the meningeal layer of duramater and the
arachnoid mater. It occurs following head injury
with damage to superficial cerebral veins.
INTRACRANIAL DURAL VENOUS SINUSES (Fig. 21.1)
There are various venous channels enclosed within the
cranial dura. They are present at either of the two sites:
a. Between the endosteal and meningeal layers of
cranial dura.
b. Between the reduplicated meningeal layer of dura.
Characteristic features of intracranial dural venous
sinuses:
1. The sinuses lie between the two layers of duramater.
2. They are lined by endothelium only, muscular coat
is absent.
3. The sinuses are valveless.
4. They receive venous blood and CSF.
5. They also receive valveless emissary veins which
regulate the intracranial blood flow and maintain
equilibrium of venous pressure within and outside
the skull.
Classification of Dural Venous Sinuses
They are classified as paired and unpaired sinuses
(7 paired and 7 unpaired).
Unpaired Dural Venous Sinuses
1. Superior sagittal sinus
2. Inferior sagittal sinus
3. Straight sinus
4. Occipital sinus
5. Anterior intercavernous sinus
6. Posterior intercavernous sinus
7. Basilar venous plexus (sinus)
Paired Dural Venous Sinuses
1. Cavernous sinus
2. Superior petrosal sinus
3. Inferior petrosal sinus
4. Transverse sinus
5. Sigmoid sinus
6. Spheno-parietal sinus
7. Petro-squamous sinus
Superior Sagittal Sinus
It begins at the crista galli behind the foramen
caecum and lies between the convex attached margin
of the falx cerebri. It lodges in the sagittal groove on
the vault of skull.
On reaching the internal occipital protuberance, it
deviates usually to the right to become continuous
with the right transverse sinus which in turn becomes
continuous with the right sigmoid sinus.
The right sigmoid sinus leaves the skull through
jugular foramen to continue as the right internal
jugular vein. The right internal jugular vein is
therefore larger than the left vein.
Features of Superior Sagittal Sinus
1. It is triangular in cross section.
2. It presents with 3 venous lacunae on each side
namely, frontal, parietal and occipital lacunae. The
diploic veins and meningeal veins drain into these
lacunae.

3. Arachnoid granulations project into its lumen.
4. The posterior end of the sinus is dilated and is called
confluence of sinuses. This is present slightly to the
right of internal occipital protruberance. It is the site
of communication of 4 sinuses namely superior
sagittal sinus, corresponding transverse sinus,
occipital sinus and opposite side transverse sinus.
Tributaries
1. Superior cerebral veins
2. Parietal emissary veins
3. Small veins from nasal cavity (if foramen caecum is
patent)
4. Veins of frontal air sinus.
5. Diploic veins
6. Meningeal veins
CLINICAL AND APPLIED ANATOMY
Thrombosis of superior sagittal sinus can occur
secondary to the spread of infection from nose, scalp
and diploe. The presenting features of superior sagittal
sinus thrombosis are :
1. Marked increase in intracranial tension, due to
defective absorption of CSF.
2. Delirium, due to congestion of superior cerebral
veins.
Inferior Sagittal Sinus
It is a small venous channel present in the lower free
margin of the falx cerebri.
It ends by joining the great cerebral vein to form the
straight sinus.
Straight Sinus
It is the continuation of inferior sagittal sinus. It lies
in a straight line along the attachment of posterior
end of falx cerebri over tentorium cerebelli.
It terminates into the left transverse sinus.
Occipital Sinus
It is the smallest sinus and is present between the
attached margins of falx cerebelli.
It consists of small channels which communicate
with sigmoid sinus, internal vertebral plexus and
confluence of sinuses.
Transverse Sinus
Each transverse sinus is present along the posterior
attached margin of tentorium cerebelli on the
Dura Mater, Intra Cranial Venous Sinuses 305
transverse sulcus in the inner aspect of occipital bone
on either side of internal occipital protruberance.
The right sinus is larger and is the continuation of
superior sagittal sinus.
The left sinus is smaller and is a continuation of the
straight sinus.
On either side, the transverse sinus ends at the
mastoid angle of parietal bone by continuing as the
sigmoid sinus.
Tributaries
1. Superior petrosal sinus: Opens at the junction of
transverse and sigmoid sinuses.
2. Inferior cerebral veins.
3. Inferior cerebellar veins.
4. Diploic veins.
5. Anastamotic veins.
Sigmoid Sinus
Each sigmoid sinus is a direct continuation of the
transverse sinus.
C H A P T E R-21
It is sigmoid or S-shaped; hence the name. It lodges
in the S-shaped groove present in the inner surfaces
of the mastoid part of temporal bone and jugular
process of occipital bone.
Finally, it curves down to open in the superior bulb
of internal jugular vein at jugular foramen.
Tributaries
1. Mastoid and condylar emissary veins
2. Cerebellar veins
3. Internal auditory vein
CLINICAL AND APPLIED ANATOMY
The sigmoid sinus is separated from the mastoid antrum
and mastoid air cells by a thin plate of bone only.
Thrombosis of the sigmoid sinus therefore can occur
secondary to an infection of the middle ear or mastoid
process. It is for the same reason that utmost care should
be taken not to expose the sigmoid sinus during
operations on the mastoid process.
Superior Petrosal Sinus
It continues from the cavernous sinus and ends into
the transverse sinus on each side.
It is lodged in the groove on the upper border of
petrous temporal bone.
It receives cerebellar, inferior cerebral and tympanic
veins.
It communicates with inferior petrosal sinus and
basilar sinus.
 306 Human Anatomy For Dental Students

Inferior Petrosal Sinus Inferior

It continues from lower end of cavernous sinus and a. Foramen lacerum
ends into the superior bulb of internal jugular vein. b. Junction of body and greater wing of sphenoid
Medial
It is lodged on either side along the posterior border
a. Pituitary gland (hypophysis cerebri)
of petrous temporal bone which articulates with the
b. Sphenoid air sinus
basiocciput.
Lateral
It receives labyrinthine veins and veins from pons,
a. Temporal lobe (uncus) of cerebral hemisphere
medulla and cerebellum.
b. Cavum trigeminale containing trigeminal ganglion
Anterior
CAVERNOUS SINUS (Fig. 21.3) a. Superior orbital fissure
The cavernous sinus is an important venous channel b. Apex of the orbit.
and is situated in the middle cranial fossa, between Posterior
the two layers of cranial dura, one on either side of a. Crus cerebri of midbrain
the body of sphenoid. b. Apex of petrous temporal bone.
It is 2 cm long and 1 cm wide.
Structures present within the lateral wall of the sinus
Its interior is divided into a number of small spaces (Fig 21.2): From above downwards:
or caverns by various trabeculae. 1. Oculomotor nerve
It consists of roof, floor, medial and lateral walls. 2. Trochlear nerve
Roof and lateral wall are formed by the meningeal 3. Ophthalmic nerve
layer of duramater. The medial wall and floor are 4. Maxillary nerve
formed by the endosteal layer of duramater. The oculomotor and trochlear nerves enter the lateral
S E C T I O N-2

wall of the sinus by piercing its roof while, ophthalmic

Extent
and maxillary nerves pierce the lateral wall of the sinus.
Anterior : Medial end of superior orbital fissure.
Posterior : Apex of petrous temporal bone. Here, it Structures passing through the sinus
1. Internal carotid artery surrounded by sympathetic
drains into the transverse sinus via
plexus of nerves: It is present in the floor of the sinus.
superior petrosal sinus.
It enters from the apex of petrous temporal bone and
runs forwards in the carotid canal. It emerges out
Relations of Cavernous Sinus from the anterior end of sinus by piercing the roof of
Superior sinus.
a. Optic tract 2. Abducent nerve: It enters the sinus by passing below
b. Internal carotid artery the petrosphenoid ligament and accompanies the
artery on its inferolateral aspect.
c. Anterior perforated substance

Fig. 21.3: Cavernous sinus (Coronal section)


Fig. 21.4: Communications and tributaries of cavernous sinus
Tributaries of Cavernous Sinus (Fig. 21.4)
1. From orbit
a. Superior ophthalmic vein
b. Inferior ophthalmic vein
c. Central vein of retina (sometimes)
2. From meninges
a. Sphenoparietal sinus
b. Anterior (frontal) trunk of middle meningeal vein
3. From brain
a. Superficial middle cerebral vein
b. Inferior cerebral veins (only few)
Communications of the Cavernous Sinus (Fig. 21.4)
The cavernous sinus communicates with the following:
1. Transverse sinus, via superior petrosal sinus.
2. Internal jugular vein, via inferior petrosal sinus.
3. Pterygoid venous plexus, via an emissary vein which
passes through foramen ovale.
4. Facial vein via two routes:
a. Superior ophthalmic vein and angular vein.
b. Emissary veinpterygoid venous plexusdeep
facial vein.
5. Opposite cavernous sinus, via anterior and posterior
inter cavernous sinuses.
6. Superior sagittal sinus, via superficial middle
cerebral vein and superior anastomotic vein.
7. Internal vertebral venous plexus, via basilar venous
plexus.
CLINICAL AND APPLIED ANATOMY
Thrombosis of cavernous sinus has a varied etiology
due to its numerous communications. The
commonest cause of thrombosis is due to passage of
Dura Mater, Intra Cranial Venous Sinuses 307
septic emboli from an infection in the dangerous
area of the face through facial plexus of veins to the
C H A P T E R-21
deep facial vein then to the pterygoid venous plexus
and finally via emmissary vein into the sinus.
Features of cavernous sinus thrombosis
a. Severe pain in the eye and forehead, due to
involvement of ophthalmic nerve.
b. Ophthalmoplegia (paralysis of ocular muscles)
due to involvement of 3rd, 4th and 6th cranial
nerves.
c. Marked oedema of eyelids with exophthalmos,
due to congestion of orbital veins following
obstruction of ophthalmic veins.
An arterio-venous communication may be
established between the internal carotid artery and
cavernous sinus in cases of fracture of base of skull
following severe head injuries. In such cases the
patient may present with the following features:
a. Pulsating exophthalmos.
b. A loud bruit (loud systolic murmur) that is easily
heard over the eye.
c. Ophthalmoplegia due to an increase in the
venous pressure of the cavernous sinus which
compresses upon the 3rd and 4th cranial
nerves.
d. Marked orbital and conjunctival oedema because
the venous pressure of the cavernous sinus is
raised to the arterial pressure.
Basilar Sinus of Plexus of Veins (Fig. 21.2)
It consists of interconnecting channels of veins that
lie on the clivus of base of skull.
 308 Human Anatomy For Dental Students
It forms a connection between the two inferior
petrosal sinuses.
It communicates with vertebral venous plexus,
cavernous sinus and superior petrosal sinus.
Middle Meningeal Vein
It arises from veins accompaning the corresponding
branches of middle meningeal artery.
Two tributeries are primarily identified, these are
frontal and parietal.
It drains into the cavernous sinus via venous lacunae
and into pterygoid venous plexus via foramen ovale
and foramen spinosum.
Emissary Veins (Fig. 21.5)
Emissary veins are channels between intracranial venous
sinuses and the extracranial veins. They pass along the
various foramina of the skull. Their clinical significance
lies in the fact that they can aid the spread of extra cranial
infections into the cranial cavity.
Important emissary veins are:
1. Mastoid emissary vein: It connects sigmoid sinus
S E C T I O N-2
with posterior auricular or occipital vein via the
mastoid foramen.
Fig. 21.5: Different emissary veins
2. Parietal emissary vein: It connects superior sagittal
sinus with veins of scalp (occipital vein) via parietal
foramen.
3. Venous plexus in hypoglossal canal: It connects
sigmoid sinus with internal jugular vein.
4. Condylar emissary vein: It connects sigmoid sinus
to the veins in the suboccipital triangle via condylar
canal.
5. Venous plexus of foramen ovale: It connects
cavernous sinus to pterygoid plexus of veins.
6. Venous plexus in carotid canal: It connects
cavernous sinus to internal jugular vein.
7. Petrosquamous sinus: It connects tranverse sinus
to external jugular vein.
8. Occipital emissary vein: It connects confluence of
sinuses with occipital vein.
Note: Ophthalmic veins functionally act as emissary
veins. The facial vein (extracranial vein) is connected to
the ophthalmic vein via supraorbital vein or a
communicating vein and the ophthalmic vein in turn
drains into the cavernous sinus. Thus, it acts as a channel
between extracranial vein and intracranial dural venous
sinus.
 Chapter

22
Pituitary Gland
Pituitary gland is also known as hypophysis cerebri Relations of Pituitary Gland (Figs 22.2 and 22.3)
(Fig. 22.1). It is a small endocrine gland situated in the Superior : It is covered by diaphragma sellae.
hypophyseal fossa on the superior surface of the body of Optic chiasma lies anteriorly over
sphenoid. It is suspended from the floor of the 3rd the diaphragma sellae.
ventricle of brain by a narrow stalk called infundibulum. Inferior : Superior surface of body of sphe-
noid with sphenoidal air sinuses.
Shape and Measurments Lateral : Cavernous sinus on each side
The gland is oval in shape and measures 8 mm with its contents.
anteroposteriorly, 12 mm transversely. It weighs about Anterior to stalk : Anterior intercavernous sinus.

C H A P T E R-22
500 mg. Posterior to stalk : Posterior intercavernous sinus.

Fig. 22.1: Pituitary gland (sagittal section)

Fig. 22.2: Relations of pituitary gland

 310 Human Anatomy For Dental Students
Subdivisions
The gland has two main subdivisions which differ from
each other embryologically, morphologically and
functionally. They are:
1. Adenohypophysis: The adenohypophysis develops
as an upward growth (Rathkes pouch) from the
ectodermal roof of the stomodeum. It forms the
anterior lobe and consists of:
a. Pars anterior (pars distalis)
b. Pars intermedius (is rudimentary and a
remanant of the lumen of Rathkes pouch)
c. Pars tuberalis
2. Neurohypophysis: The neurohypophysis develops
as a downgrowth from the floor of the diencephalon.
It forms the posterior lobe of pituitary and consists
of:
a. Pars posterior (neural lobe).
b. Infundibulum, is attached to tuber cinerium of
hypothalamus above.
c. Median eminence.
Various cell types and hormones secreted by pituitary
gland
S E C T I O N-2
1. The anterior lobe has 2 types of cells namely,
chromophobes and chromophils. The exact function
of chromophobes (non staining cells) is not known.
Chromophils are the cells which produce hormones.
Chromophils are granular secretory cells and are
further divided into:
a. Basophils: These consists of:
Fig. 22.3: Connection of hypothalamus to posterior pituitary
Gonadotropes: They secrete FSH (Follicular
stimulating hormone) and LH (Leuteinising
hormone).
Thyrotropes: They secrete thyroid stimulating
hormone (TSH). TSH stimulates growth and
vascular supply of thyroid gland. It increases
rate of thyroid hormone production. Secretion
of TSH is controlled by thyrotropin releasing
hormone (TRH) from hypothalamus and
plasma levels of T3 and T4.
Corticotropes: They secrete adreno cortico-
tropic hormone (ACTH). ACTH controls the
growth and secretion of zona fasciculata and
zona reticularis of adrenal gland. It regulates
the basal and stress induced secretion of
glucocorticoids from adrenal cortex. It also
regulates secretion of mineralocorticoids to
some extent. Secretion of ACTH is inhibited
by level of glucocorticoids in plasma and is
stimulated by corticotrophin releasing
hormone (CRH) from hypothalamus.
b. Acidophils: These consists of:
Mammotropes: They secrete prolactin.
Somatotropes: Secrete growth hormone (GH).
2. The posterior lobe primarily has endings of axons
from supra-optic and paraventricular nuclei of
hypothalamus and secretes hormones conducted
from hypothalamus (Fig. 22.3). These are:

a. Vasopressin (ADH)
b. Oxytocin
3. The intermediate lobe is primarily rudimentary and
produces melanocyte stimulating hormone (MSH).
Arterial Supply of Pituitary Gland (Fig. 22.4)
1. Superior hypophyseal arteries, branches of internal
carotid artery. They are usually more than one and
the arteries of each side anastomose with each other
and supply the median eminence and the infundi-
bulum (neurohypophysis).
2. Inferior hypophyseal artery, branch of internal
carotid artery. Each inferior hypophyseal artery
divides into medial and lateral branches and
surrounds the infundibulum anastomosing with
branches of the other side to supply the pars
posterior.
3. Portal vessels: The anterior lobe or adenohypophysis
of pituitary is supplied by long and short portal
Fig. 22.4: Blood supply of pituitary gland (hypothalamo-hypophyseal portal system)
Pituitary Gland 311
vessels. The portal vessels are continuations of the
external and internal capillary plexuses formed by
the two superior hypophyseal arteries at the median
eminence and upper infundibulum.
Hypothalamo-hypophyseal Portal System (Fig. 22.4)
It consists of two sets of capillary plexuses:
1. Long and short portal vessels arising from
infundibular and median eminence plexuses.
2. Vascular sinusoids interspersed between endocrine
cells of pars anterior. These receive the portal vessels.
The neurons of hypothalamus produce various
releasing and inhibiting hormones. The tubulo-
infundibulur tract releases these hormones in the upper
part of portal tract, i.e., median eminence and
infundibulum. From here, they are carried to the pars
anterior via the portal system where they control the
release of appropriate hormones.
C H A P T E R-22
 312 Human Anatomy For Dental Students
Venous Drainage
The venous drainage of pituitary is as follows:
1. Portal system: It is derived from venous end of
capillaries from the plexus supplying neuro-
hypophysis. It supplies the adenohypophysis and
joins to form hypophyseal veins.
2. Hypophyseal veins: They drain into the
surrounding dural venous sinuses.
The hormones produced in the gland pass out of it
through the venous blood to the target sites.
CLINICAL AND APPLIED ANATOMY
Tumors of pituitary glands produce two types of clinical
signs and symptoms:
1. Endocrine symptoms: Due to excessive secretion of
a particular hormone, produced by the tumor cells
S E C T I O N-2
e.g., acromegaly, due to excess of growth hormone;
Cushings syndrome, due to excess of ACTH.
2. Pressure symptoms: These occur due to pressure
on the surrounding structures due to enlarging
tumor.
a. Bitemporal hemianopia, due to pressure on the
optic chiasma.
b. Deepening of pituitary fossa, due to an intrasellar
growth. In X-ray photographs of the skull a
characteristic ballooning of the hypophyseal
fossa (sella turcica) may be seen. The clinoid
processes may also be eroded.
The pituitary tumours may be approached for surgery
via the transfrontal approach or by the trans-sphenoidal
route.
 Chapter

23 Temporal and
Infratemporal Regions
TEMPORAL FOSSA (Figs 23.1, 18.6) Antero-inferior part of parietal bone, below temporal
The lateral aspect of skull above the zygomatic arch upto lines.
the superior temporal line constitutes the temporal region. Squamous part of temporal bone.
The temporal fossa forms the floor of this region. Lateral surface of greater wing of sphenoid.
The four bones meet at an H-shaped suture line
Boundaries termed pterion.
Anterior : Temporal surface of zygomatic bone and
Contents of Temporal Fossa
adjoining frontal process of zygomatic
bone. Adjoining part of greater wing of 1. Temporalis muscle.

C H A P T E R-23
sphenoid. 2. Temporal fascia.
Posterior : Posterior part of superior temporal line 3. Deep temporal vessels. Deep temporal artery is a
leading to supramastoid crest. branch of 2nd part of maxillary artery.
Superior : Superior temporal line. 4. Deep temporal nerves, branches of anterior division
Inferior : It communicates with infratemporal of mandibular nerve.
fossa, in front under the zygomatic arch. 5. Auriculotemporal nerve, branch of posterior
Floor of temporal fossa is formed by division of mandibular nerve.
Temporal part of frontal bone, postero-inferior to 6. Superficial temporal vessels, the artery is a branch
temporal lines. of external carotid artery.

Fig. 23.1: Temporal, infratemporal and pterygopalatine fossae

 314 Human Anatomy For Dental Students
Temporal Fascia
It is a thick sheet of fascia covering the temporalis
muscle.
Attachments:
Superior : Superior temporal line
Inferior : It splits into two layers which are
attached to the outer and inner lips
of upper margin of zygomatic arch.
The superficial surface of fascia is covered by galea
aponeurotica in its upper part and is related to
superficial temporal vessels and auriculotemporal
nerve. The deep surface gives origin to temporalis
muscle.
INFRATEMPORAL FOSSA (Fig. 23.1)
When the mandible is disarticulated from the skull
infratemporal region is revealed on either side of skull,
deep to ramus of mandible, behind the body of maxilla.
This corresponds to inferior surface of middle cranial
fossa.
S E C T I O N-2
Boundaries
Anterior wall : Posterior surface of body of maxilla.
Posterior wall : It is open and limited posteriorly by
the styloid process of temporal bone
and carotid sheath.
Medial wall : Lateral pterygoid plate of sphenoid
bone.
Lateral wall : Inner aspect of the ramus and coro-
noid process of mandible.
Roof : Infratemporal or lateral surface of
greater wing of sphenoid.
Floor : It opens along the sides of the pharynx
and esophagus.
Communications: The infratemporal fossa communicates
with the following:
1. Temporal fossa superiorly, through the gap between
zygomatic arch and side of skull.
2. Pterygopalatine fossa medially, in anterior part,
through pterygomaxillary fissure.
3. Orbit anteriorly, through inferior orbital fissure.
Contents of Infratemporal Fossa
Muscles
1. Tendon of temporalis muscle.
2. Lateral and medial pterygoid muscles.
Nerves
3. Mandibular nerve and its branches.
4. Chorda tympani, branch of facial nerve.
5. Otic ganglion.
Vessels
6. Maxillary artery
7. Pterygoid venous plexus
PTERYGOPALATINE FOSSA (Fig. 23.1)
The pterygopalatine fossa is a pyramidal shaped space
situated deep to the infratemporal fossa, below the apex
of orbit.
Boundaries
Anterior : Upper part of posterior or infratemporal
surface of body of maxilla.
Posterior : Anterior surface of root of pterygoid
process and adjoining part of sphenoid
bone.
Superior : Inferior surface of body of sphenoid
bone, Inferior orbital fissure.
Inferior : This is the apex of the fossa and is
formed by meeting of the anterior and
posterior boundaries, inferiorly.
Medial : Posterosuperior part of lateral surface of
perpendicular plate of palatine bone.
Lateral : Fissure between anterior border of lateral
pterygoid plate and posterior surface of
maxilla. This is the pterygomaxillary
fissure.
Posteriorly it presents with three openings related to
body of sphenoid bone.
1. Foramen rotundum
2. Anterior opening of pterygoid canal
3. Palato-vaginal canal
Communications: The pterygopalatine fossa communi-
cates with the following:
1. Infratemporal fossa, via the pterygomaxillary fissure.
2. Orbit, through the inferior orbital fissure.
3. Middle cranial fossa, through foramen rotundum.
4. Foramen lacerum via pterygoid canal.
5. Pharynx through palato-vaginal canal.
6. Nasal cavity via sphenopalatine foramen present in
upper part of palatine bone.
Contents of Pterygopalatine Fossa
1. Maxillary nerve: It reaches the fossa through the
foramen rotundum over the anterior surface of root
of pterygoid process.
2. Pterygopalatine ganglion and its connections.
3. Maxillary artery, 3rd part: It enters the fossa via the
pterygomaxillary fissure and divides into its
terminal branches.

TRIGEMINAL NERVE (Fig. 23.2)
Trigeminal nerve is the fifth cranial nerve. It is called
trigeminal because it consists of three divisions, namely:
1. Ophthalmic nerve, nerve of orbit
2. Maxillary nerve, nerve of pterygopalatine fossa
3. Mandibular nerve, nerve of infratemporal fossa
The three nerves arise from a large, semilunar
trigeminal ganglion which lies in the trigeminal fossa on
the anterior surface of the petrous temporal bone near its
apex.
Functional Components
1. General somatic afferent: Receives exteroceptive
sensations from the skin of face and mucosal surfaces
and proprioceptive impulses from muscles of
mastication.
2. Special visceral efferent: Motor to muscles of 1st
branchial arch.
Nuclear Origin
1. The sensory nuclei: Sensory fibres arise from the
trigeminal ganglion and enter the lateral aspect of
the pons as the sensory root. The nuclei are arranged
in three groups and their connections are as follows:
a. Chief (principal) sensory nucleus of trigeminal:
The fibres concerned with sensation of touch from
the face arise from the bipolar neurons in
trigeminal ganglion and ascend up to relay in
the nucleus which lies in the lateral part of pons,
deep to the rhomboid fossa.
b. Spinal nucleus of trigeminal nerve (Nucleus of
spinal tract of trigeminal nerve): The fibres
concerned with sensation of pain and
temperature from all trigeminal areas also arise
from bipolar neurons in the trigeminal ganglion.
The central connection is the spinal nucleus of
trigeminal nerve which lies caudal to the chief
sensory nucleus. It extends from the lower part
of pons into medulla down upto the 1st and
sometimes the 2nd cervical segment of spinal
cord.
The fibres carrying sensations from upper 1/3rd
of the face relay in the lower third of the nucleus
while from middle 1/3rd of the face relay in the
middle third of the nucleus and from a lower 1/
3rd of the face relay in the upper third of the
nucleus
c. Mesencephalic nucleus: Fibres carrying prop-
rioceptive sensations do not have their cell bodies
in the trigeminal ganglion. Instead they enter the
Temporal and Infratemporal Regions 315
pons directly and pass upwards to the cell bodies
in a third sensory nucleus of trigeminal nerve
which is the mesencephalic nucleus of the
trigeminal. This nucleus is made up of pseudo-
unipolar cells, the only 1st order sensory neurons
which lie within the central nervous system (is
present in mid brain).
2. The motor nucleus: This lies in the pons, close to
the medial side of the chief sensory nucleus. Fibres
emerge from lateral aspect of pons as the motor root
lying just medial to the sensory root.
Course
The trigeminal nerve is attached to the ventral aspect
of the pons by two roots, a large sensory and a small
motor root.
The motor root lies venteromedial to the sensory root.
They pass forward in the posterior cranial fossa
towards the apex of the petrous temporal bone.
The two roots invaginate the dura of the posterior
cranial fossa below the superior petrosal sinus
C H A P T E R-23
forming the trigeminal cave.
In this cave the sensory root joins the trigeminal
ganglion.
The motor root lies deep to the ganglion and does
not join it. Instead, it passes out to join the
mandibular nerve just at its emergence from the
cranial cavity in the foramen ovale.
Trigeminal Ganglion
It is semilunar in shape. It lies in the trigeminal fossa
in relation to apex of petrous temporal bone, in
middle cranial fossa.
It is covered by double fold of duramater which forms
a trigeminal cave (Meckels cave).
The ganglion is made up of pseudounipolar neurons.
The ganglion is connected to the pons by a thick
sensory root. The three divisions of trigeminal nerve
arise from the anterior convex margin of the ganglion.
The smaller motor root of trigeminal nerve emerges
from pons just medial to the sensory root (remember
m for motor and m for medial) and passes deep to
the ganglion. It enters the foramen ovale to join the
mandibular nerve just below the base of skull.
Relations of Trigeminal Ganglion
Lateral : Middle meningeal artery.
Medial : Internal carotid artery, cavernous sinus.
Inferior : Foramen lacerum, greater petrosal nerve,
motor root of trigeminal nerve.
Superior : Parahippocampal gyrus.
 S E C T I O N-2 316
Human Anatomy For Dental Students

Fig. 23.2: Trigeminal nerve and its distribution (diagrammatic representation)


Distribution of Trigeminal Nerve
Three large nerves emerge from the convex antero-medial
border of the trigeminal ganglion. These divisions of the
trigeminal nerve are:
1. Ophthalmic nerve
2. Maxillary nerve
3. Mandibular nerve
OPHTHALMIC NERVE (Fig. 23.2)
It is the smallest of the three divisions of trigeminal nerve.
It is purely sensory and is given off in the beginning.
Functional Component
3. Nasociliary nerve
General somatic afferent.
Origin and Course
It arises from the medial part of the convex anterior
border of the trigeminal ganglion.
Then it pierces the duramater of the trigeminal cave
and enters into the lateral wall of cavernous sinus
where it lies below the trochlear nerve.
Finally, it enters the orbit through the superior orbital
fissure and divides into three branches namely
lacrimal, frontal and nasociliary.
Branches of Ophthalmic Nerve
1. Lacrimal nerve
It is the smallest branch and enters the orbit via
superior orbital fissure lateral to the tendinous
ring.
It runs along the lateral wall of the orbit and ends
in the lacrimal gland (hence its name).
It is joined by a communicating twig from the
zygomatico-temporal branch of the maxillary
nerve carrying postganglionic secretomotor
fibres to the lacrimal gland.
The lacrimal nerve supplies lacrimal gland and
conjunctiva and finally pierces the orbital septum
to also supply the lateral part of upper eyelid.
2. Frontal nerve
It is the largest branch and it enters the orbit
lateral to the common tendinous ring via the
superior orbital fissure. It runs forwards between
the levator palpebrae superioris and the
periosteum lining the roof of orbit.
In the middle of orbit it divides into two branches
namely:
a. Supraorbital nerve: This continues along the
line of the frontal nerve. It passes through the
Temporal and Infratemporal Regions 317
supraorbital notch along with the supraorbital
vessels and then turns upwards into the
forehead. It supplies the conjunctiva and
upper eyelid and then divides into medial and
lateral branches. These supply the middle of
forehead and scalp as far back as the lambdoid
suture.
b. Supratrochlear nerve: It runs forwards medial
to the supraorbital nerve, in the roof of orbit. It
passes above the trochlea for the tendon of
superior oblique muscle. It then turns
upwards at the frontal notch, on medial end
of superior orbital margin. It supplies the
conjuctiva, upper lid and finally the skin of
the lower part of forehead.
It enters orbit within the tendinous ring of
superior orbital fissure and runs forwards and
medially, crossing above the optic nerve from
lateral to medial side along with the ophthalmic
artery.
On reaching the medial wall of the orbit it ends
C H A P T E R-23
by dividing into anterior ethmoidal and
infratrochlear nerves.
Branches
a. Sensory communicating branch to the ciliary
ganglion is given just before crossing the optic
nerve.
b. Long ciliary nerves: These are 2 or 3 in number
and arise from the nasociliary nerve as it crosses
the optic nerve. They pass forwards and pierce
the sclera adjacent to the optic nerve to enter the
eyeball. They supply sensory fibres to the ciliary
body, iris and cornea. The long ciliary nerves
also carry postganglionic sympathetic fibres to
the dilator pupillae.
c. Posterior ethmoidal nerve: This enters the
posterior ethmoidal foramen and supplies the
ethmoidal and sphenoidal air sinuses.
d. Anterior ethmoidal nerve: It enters the anterior
ethmoidal foramen and then passes through
anterior ethmoidal canal to reach the anterior
cranial fossa. Now it runs forwards over the
cribriform plate of ethmoid and enters the nasal
cavity by passing through a slit at the side of
crista galli. In the nasal cavity the nerve lies in a
groove on the posterior surface of the nasal bone
and gives of internal nasal branches to the nasal
septum and lateral wall of the nose. At the lower
border of the nasal bone, the nerve leaves the
nasal cavity and appears on the dorsum of nose
as the external nasal nerve.
e. Infratrochlear nerve: This runs forwards on the
medial wall of the orbit and ends by supplying
 318 Human Anatomy For Dental Students

the skin of both eyelids and adjoining part of the 4. Posterior superior alveolar nerve: Enters the
nose. foramen on the posterior surface of the body of
maxilla and supplies the mucous membrane of the
MAXILLARY NERVE (Fig. 23.2) maxillary air sinus. Then it breaks up to form the
superior dental plexus which supplies the upper
Maxillary nerve is the second division of trigeminal nerve. molar teeth and adjoining part of the gum.
It is also purely sensory.
In the orbit: These are branches from infra-orbital nerve
which is a continuation of the maxillary nerve in the infra-
Functional Component
orbital canal.
General somatic afferent. 5. Middle superior alveolar nerve: Passes downwards
and forwards along the lateral wall of the maxillary
sinus to join the superior dental plexus and supplies
Origin and Course
the upper premolar teeth.
It arises from the convex anterior border of the 6. Anterior superior alveolar nerve: Runs in the
trigeminal ganglion and pierces the trigeminal cave anterior wall of the maxillary sinus through a bony
of duramater to reach the lower part of the lateral canal called canalis sinosus and divides into two
wall of the cavernous sinus. branches:
The nerve leaves the middle cranial fossa through a. The dental branches which join the dental plexus
foramen rotundum and reaches the pterygopalatine and supply the canine and incisor teeth of upper
fossa. jaw.
It traverses in a straight line in the upper part of the b. The nasal branches which appear in the lateral
fossa and enters orbit through the inferior orbital wall of the inferior meatus and supply the
S E C T I O N-2

fissure where it is called as the infraorbital nerve. mucous membrane of the lateral wall and the
The infraorbital nerve (in fact a continuation of floor of the nasal cavity.
maxillary nerve) runs forwards along the floor of
On the face: These are also branches of infra-orbital nerve
the orbit in the infraorbital groove and canal and
after it emerges out from infra-orbital foramen.
appears on the face through the infraorbital foramen.
7. Palpebral branches: These turns upwards and
Therefore, in its course the maxillary nerve traverses
supply the skin of the lower eyelid.
in succession, the middle cranial fossa, the
8. Nasal branches: Supply the skin of the side of nose
pterygopalatine fossa and the orbit.
and the mobile part of the nasal septum.
9. Superior labial branches: Supply the skin and
Branches of Maxillary Nerve mucous membrane of the upper lip.

The maxillary nerve gives off the following branches:

PTERYGOPALATINE GANGLION
In the middle cranial fossa (SPHENOPALATINE GANGLION) (Fig. 23.2)
1. Meningeal branch: Supplies the duramater of the Pterygopalatine ganglion is the largest peripheral
middle cranial fossa. ganglion of the parasympathetic system. It serves as a
In the pterygopalatine fossa relay station for the secretomotor fibres of the lacrimal
2. Ganglionic (communicating) branches: Are 2 in glands and mucous glands of the nose, palate, pharynx
number. They suspend the pterygopalatine ganglion and paranasal sinuses. Topographically, it is related to
from the lower border of maxillary nerve in the the maxillary nerve, but functionally, it is connected to
pterygo-palatine fossa. the facial nerve through greater petrosal nerve.
3. Zygomatic nerve: Enters the orbit through inferior Location: It lies in the deep part of the pterygopalatine
orbital fissure and divides on the lateral wall of the fossa, suspended from the maxillary nerve by 2 roots.
orbit into two.
Size: Head of a small tack
a. Zygomatico-temporal nerve: This passes
through a foramen in the zygomatic bone to Relations
supply the skin of the temple. Posterior : Pterygoid canal
b. Zygomatico-facial nerve: It passes through a Medial : Pharyngeal artery
foramen in the zygomatic bone to supply the skin Lateral : Artery of pterygoid canal
of the face on the prominence of cheek. Superior : Maxillary nerve
 Temporal and Infratemporal Regions 319

Roots or Connections nasal branches to supply the postero-inferior

quadrant of the lateral nasal wall.
1. Motor or parasympathetic root: It is derived from
b. Lesser (middle and posterior) palatine nerves:
the nerve of pterygoid canal which carries
These run downwards through the greater
preganglionic parasympathetic fibres from superior
palatine canal and then through the lesser
salivatory nucleus located in the lower part of the
palatine canals to emerge through lesser palatine
pons. These fibres pass via the geniculate ganglion
foramina. They supply the soft palate and the
and greater petrosal nerve to relay in this ganglion.
palatine tonsil.
The post ganglionic fibres arise from the cells in the
3. Nasal branches: These enter the nasal cavity
ganglion and provide secretomotor fibres to the
through the sphenopalatine foramen and divide into
lacrimal gland and mucous glands of the nose,
two posterosuperior branches namely:
palate, nasopharynx and paranasal sinuses. They
a. Posterosuperior lateral nasal branches: They are
pass via the maxillary nerve and its branches to the
about 6 in number and supply the postero-
lacrimal nerve.
superior quadrant of the lateral nasal wall.
2. Sympathetic root: It is derived from the sympathetic
b. Posterosuperior medial nasal branches: They
plexus around the internal carotid artery which
are 2 or 3 in number. These cross the roof of the
contains postganglionic fibres from the superior
nasal cavity and supply the nasal septum. One
cervical sympathetic ganglion. These fibres form the
of these nerves which is the longest is called
deep petrosal nerve. Deep petrosal nerve further joins
nasopalatine or sphenopalatine nerve. It passes
with greater petrosal nerve to form nerve to pterygoid
downwards and forwards along the nasal
canal. The fibres pass through the ganglion without
septum and reaches the under surface of the
relay and provide vasomotor supply to the mucus
anterior part of hard palate through the lateral

C H A P T E R-23
membrane of nose, paranasal sinuses, palate and
incisive foramen.
pharynx.
4. Pharyngeal branch: It passes backwards and
3. Sensory root: It is derived from the maxillary nerve
supplies the mucus membrane of nasopharynx
and passes through the ganglion without interrup-
behind the auditory tube.
tion to be distributed through the branches of the
ganglion.
MANDIBULAR NERVE (Fig. 23.2)
Branches and Distribution This is largest of the three divisions of the trigeminal nerve
and is the nerve of the first branchial arch. It consists of
The various branches are virtually derived from the
both sensory and motor fibres.
ganglionic branches of the maxillary nerve which pass
through the ganglion without relay. The ganglion
provides four sets of branches namely: Functional Components
1. Orbital
1. General somatic afferent
2. Palatine
2. Special visceral efferent
3. Nasal
4. Pharyngeal
Each branch carries parasympathetic, sympathetic Origin
and sensory fibres.
It is formed by two roots.
1. Orbital branches: They enter the orbit through
1. Larger sensory root: Arises from the convex aspect
inferior orbital fissure and supply the periosteum of
of the trigeminal ganglion.
orbit, orbitalis muscle and sphenoidal air sinuses.
2. Small motor root: Arises from the ventral aspect of
2. Palatine branches
pons and passes below the trigeminal ganglion.
a. Greater (anterior) palatine nerve: It descends
through the greater palatine canal to emerge
underneath the hard palate through the greater Course
palatine foramen. From here it passes forwards
Both roots pass through the foramen ovale and join to
along the lateral side of hard palate upto the
form the main trunk which lies in the infratemporal fossa.
incisive fossa. It supplies the mucus membrane
After a short course the main trunk divides into a small
of the hard palate and the adjoining gum. While
anterior and a large posterior division.
in the bony canal it gives off posterior inferior
 320 Human Anatomy For Dental Students
Relations of the trunk of mandibular nerve
Medial : Tensor veli palatini muscle
Lateral : Lateral pterygoid muscle
Anterior : Otic ganglion
Posterior : Middle meningeal artery
Branches of Mandibular Nerve
From Main Trunk
1. Nervous spinosus (meningeal branch): Supplies the
duramater of middle cranial fossa. It enters the
middle cranial fossa along with middle meningeal
artery through foramen spinosum.
2. Nerve to medial pterygoid: It supplies three muscles
namely:
a. Medial pterygoid
b. Tensor veli palatini
c. Tensor tympani
It also forms the motor root of the otic ganglion. It
passes through the otic ganglion without relay and
supplies the tensor veli palatini and tensor tympani.
From Anterior Division
S E C T I O N-2
It gives rise to 3 motor branches and one sensory branch.
1. Deep temporal nerves: They are two in number and
supply the temporalis muscle from its deep surface.
2. Nerve to lateral pterygoid, supplies lateral pterygoid
muscle.
3. Masseteric nerve, supplies masseter muscle.
4. Buccal nerve: It is the sensory branch which supplies
the skin and mucus membrane of cheek.
From Posterior Division
It gives rise to three nerves namely:
1. Auriculotemporal nerve: It is a sensory nerve.
It characteristically arises by two roots which
unite to form a single trunk after encircling the
middle meningeal artery.
Then it runs backwards passing behind the
insertion of lateral pterygoid muscle and around
the neck of mandible to reach behind temporo-
mandibular joint. Here it is on superior border of
the parotid gland. It then turns upwards along
posterior root of zygoma and divides into the
terminal superficial temporal branches.
Branches:
a. Auricular branches: Supplies the pinna, exter-
nal acoustic meatus and adjoining tympanic
membrane.
b. Articular branches: To temporomandibular
joint.
c. Superficial temporal branches: These supply the
area of skin over the temple.
d. Communicating branches: It receives postgang-
lionic secretomotor fibres from otic ganglion to
supply the parotid gland.
2. Inferior alveolar nerve: It is the larger terminal
branch of mandibular nerve and it is a mixed nerve.
It emerges below the lateral pterygoid and runs
over the ramus of mandible to enter the
mandibular foramen along with inferior alveo-
lar vessels.
It traverses the mandibular canal and divides
into terminal branches below the level of first and
second premolars.
a. Nerve to mylohyoid: It is given before the
inferior alveolar nerve enters the mandibular
foramen. It supplies mylohyoid and anterior
belly of digastric.
b. Inferior dental plexus: Few nerve fibres in
mandibular canal break away to form this
plexus which supplies the molar and
premolar teeth and the adjoining gum of lower
jaw.
c. Incisive nerve: Supplies the canine and
incisor teeth and adjoining gum of lower jaw.
d. Mental nerve: Supplies skin of chin and lower
lip.
e. Communicating branch to the lingual nerve.
3. Lingual nerve: It is primarily sensory nerve:
It is the smaller terminal branch of mandibular
nerve given off in front of the inferior alveolar
nerve. It is primarily sensory and also carries
secretomotor fibers to submandibular and
sublingual salivary glands.
About 2 cm below the base of skull, in the
infratemporal fossa, the chorda tympani nerve
joins it posteriorly at an acute angle.
It runs behind the lateral pterygoid muscle and
emerges below its lower border. It then runs
downwards and forwards between the ramus of
mandible and medial pterygoid.
It passes towards the medial surface of ramus of
mandible and runs between attachment of
superior constrictor of pharynx and
pterygomandibular raphe.
It comes in direct contact with the mandible
medial to the last molar tooth. Here it is covered
by mucus membrane of gum only.
It runs medial to mylohyoid and reaches the
tongue to lie on the lateral surface of styloglossus
and hyoglossus muscles successively. The
submandibular ganglion is present on the
hyoglossus suspended from the lingual nerve by
two roots (submandibular ganglion is described
in chapter 35, page 515).
Finally, it curves under the submandibular duct
at the level of genioglossus and turns up medially

to the anterior part of tongue and floor of oral
cavity.
Branches
a. Sensory branches to mucus membrane of
anterior 2/3rd of tongue, floor of mouth and
adjoining area of gum.
b. Communicating branches:
With chorda tympani: The lingual nerve
receives secretomotor fibres for submandi-
bular and sublingual glands. It also conveys
fibres for taste sensation from anterior 2/3rd
of tongue except vallate papillae to the chorda
tympani.
With hypoglossal nerve: Lingual nerve
transmits proprioceptive sensations from the
lingular muscles via its communicating
branches to the hypoglossal nerve.
CLINICAL AND APPLIED ANATOMY
When the mouth is opened wide, a mucosal fold is seen
at the posterior end of inner aspect of cheek which
overlies the pterygomandibular raphe. This raphe can
be felt as a firm band running upwards from behind the
third lower molar tooth. The upper end is an important
landmark for inferior alveolar nerve block.
OTIC GANGLION (Fig. 23.2)
It is a parasympathetic ganglion connected to the
mandibular division of trigeminal nerve which provides
a relay station to the secretomotor parasympathetic fibres
of the parotid gland. Topographically, it is connected to
mandibular nerve but functionally, it is asociated with
glossopharyngeal nerve.
Size : Pin-head
Shape : Oval
Location : Infratemporal fossa, just below foramen ovale
Relations
Anterior : Medial pterygoid muscle
Posterior : Middle meningeal artery
Lateral : Trunk of mandibular nerve
Medial : Tensor veli palatini muscle
Roots or Connections
1. Parasympathetic root: It is obtained from the lesser
petrosal nerve. The preganglionic fibres arise in the
inferior salivatory nucleus and pass via the tympanic
branch of glossopharyngeal nerve followed by
tympanic plexus to the lesser petrosal nerve. They
relay in the otic ganglion
2. Sympathetic root: It is derived from the sympathetic
plexus around middle meningeal artery and conveys
postganglionic fibres from the superior cervical
Temporal and Infratemporal Regions 321
ganglion. These fibres do not relay in the ganglion.
3. Somatic motor root: It receives 1 to 2 filaments from
nerve to medial pterygoid. They pass through the
ganglion without relay.
Branches and Distribution
1. Communicating branches to auriculotemporal
nerve. These convey postganglionic parasympa-
thetic secretomotor and sympathetic vasomotor
fibres to the parotid gland.
2. Communicating branches to chorda tympani which
form a part of the alternate taste pathway.
POINT TO REMEMBER
Nerve to medial pterygoid passes through the ganglion
without relay and supplies tensor tympani and tensor
palati muscles.
MAXILLARY ARTERY (INTERNAL MAXILLARY
ARTERY) (Fig. 23.3)
C H A P T E R-23
It is the larger terminal branch of the external carotid
artery.
Course
It begins behind the neck of mandible and runs
horizontally forwards upto the lower border of lower
head of lateral pterygoid.
From here, it turns upwards and forwards and
crosses the lower head of lateral pterygoid
superficially (sometimes deep).
After emerging between the two heads of lateral
pterygoid it enters the pterygopalatine fossa by
passing through the pterygomaxillary fissure. Here,
it ends by giving off its terminal branches.
Parts of Maxillary Artery
The maxillary artery is divided into 3 parts by the lower
head of lateral pterygoid muscle. These parts are:
1. First part (Mandibular part): From its origin to the
lower border of lateral pterygoid. It lies between the
neck of mandible laterally and the spheno-
mandibular ligament medially. The auriculo
temporal nerve lies above this part.
2. Second part (Pterygoid part): From the lower border
to the upper border of the lower head of lateral
pterygoid muscle.
3. Third part (Pterygopalatine part): From upper border
of lower head of lateral pterygoid muscle to
pterygopalatine fossa. In the pterygopalatine fossa
it lies in front of the pterygopalatine ganglion.
S E C T I O N-2 322 Human Anatomy For Dental Students

Fig. 23.3: Maxillary artery and its branches

Branches of Maxillary Artery

First Part - 5 branches Second Part - 4 branches Third Part - 6 Branches

1. Deep auricular artery 1. Deep temporal artery 1. Posterior superior alveolar

2. Anterior tympanic artery
3. Middle meningeal artery
4. Accessory meningeal artery
5. Inferior alveolar artery
2. Pterygoid branches (dental) artery
3. Masseteric artery 2. Infra-orbital artery
4. Buccal artery 3. Greater palatine artery
4. Pharyngeal artery
5. Artery of pterygoid canal
6. Spheno-palatine artery

Characteristics of Branches of Maxillary Artery MAXILLARY VEIN

Branches from the 1st and 2nd parts accompany the
branches of the mandibular nerve.
Branches from the 3rd part accompany the branches
of maxillary nerve and pterygopalatine ganglion and
supply nasal and oral cavities.
Branches from 2nd part supply the muscles of the
region and anastomose with branches of facial and
superficial temporal arteries.
Branches from the 1st and 3rd part and not from the
2nd part pass through various bony foramina and
fissures.
It is formed by the convergence of pterygoid plexus of
veins. It is a short trunk, present along the first part of
maxillary artery. It passes backwards between the
sphenomandibular ligament and neck of mandible to
reach the parotid gland. It unites with superficial temporal
vein in the substance of parotid gland to form
retromandibular vein.
PTERYGOID PLEXUS OF VEINS (Fig. 23.4)
It is the plexus of veins present over the lateral pterygoid
muscle. Part of plexus lies between the lateral and medial
pterygoid muscles. It is formed by the following veins:
 Temporal and Infratemporal Regions 323

C H A P T E R-23
Fig. 23.4: Pterygoid venous plexus
1. Sphenopalatine vein Four pairs of muscles move the mandible during
2. Deep temporal vein mastication. They are:
3. Pterygoid vein 1. Temporalis
4. Masseteric vein 2. Medial pterygoid
5. Buccal vein 3. Lateral pterygoid
6. Alveolar veins 4. Masseter
7. Greater palatine vein They present with the following features:
8. Middle meningeal veins 1. The muscles except masseter are located in the
9. Branches from ophthalmic vein infratemporal region.
It drains into the maxillary vein and communicates with 2. They are inserted in the ramus of mandible.
the following veins: 3. All four muscles are innervated by branches of the
anterior division and trunk of mandibular nerve
1. Facial vein via deep facial vein.
which is the branch of trigeminal nerve.
2. Cavernous sinus via emissary veins passing through
4. Their vascular supply is derived from branches of
foramen ovale and foramen lacerum.
maxillary vessels.
MUSCLES OF MASTICATION 5. All act on the temporomandibular joint.
They are classified as main and accessory muscles.
Muscles attached to rami of mandible are main muscles Temporalis (Fig. 23.5)
and buccinator is accessory muscle of mastication. Other
It is fan shaped, anterior fibers are vertical while posterior
muscles which assist in mastication are suprahyoid
fibers are almost horizontal with intermediate fibers of
muscles. Tongue and lips are important structures assist
in mastication. variable degrees of obliquity.
 324 Human Anatomy For Dental Students
Fig. 23.5: Attachment of temporalis and masseter
muscles
Origin
1. Floor of temporal fossa upto inferior temporal line.
2. Under surface of temporal fascia.
S E C T I O N-2
Insertion: The fibres converge to form a tendon which
passes down from temporal fossa, medial to anterior part
of zygomatic arch and inserts on:
1. Tip, anterior and posterior borders and medial
surface of coronoid process of mandible.
2. Anterior border of ramus of mandible.
Relations
1. Superficial: Skin, temporal fascia, superficial
temporal vessels, auriculotemporal nerve, temporal
branches of facial nerve, zygomatic arch and
masseter muscle.
2. Posterior: Contents of infratemporal fossa in lower
part.
3. Anterior: The tendon is seperated from zygomatic
bone by pad of fat.
Actions
1. Anterior and middle fibres elevate mandible to
occlude the teeth.
2. Posterior fibres retract the mandible after protrusion.
Medial Pterygoid (Fig. 23.6)
It is a thick quadrilateral muscle.
Origin: It originates from two heads:
1. Superficial head: Maxillary tuberosity on infra-
temporal surface of maxilla and adjoining surface
of pyramidal process of palatine bone.
2. Deep head: It is larger and arises from medial surface
of lateral pterygoid plate of sphenoid bone.
Fig. 23.6: Attachment of lateral pterygoid, medial pterygoid
and buccinator muscles
Insertion: The fibres form a tendinous lamina and
inserton:
1. Medial surface of ramus of mandible posteroinferior
to the mylohyoid groove.
2. Inner aspect of angle of mandible.
Relations
1. Lateral: It is separated from ramus of mandible by
lateral pterygoid muscle, sphenomandibular
ligament, maxillary artery, inferior alveolar vessels
and nerve, lingual nerve, part of parotid gland.
2. Medial: Tensor veli palatini, styloglossus,
stylopharyngeus and superior constrictor muscles.
Actions
1. Assist in elevation of mandible.
2. Along with lateral pterygoid muscle it causes
protrusion of mandible.
3. Helps in side to side movements of the jaw and
grinding of food between teeth of same side.
Lateral Pterygoid (Fig. 23.6)
It is the key muscle of the infratemporal fossa.
Origin: It is a short thick muscle which arises from two
heads:
1. Upper head: Lower part of infratemporal surface of
the greater wing of sphenoid and adjoining
infratemporal crest.
2. Lower head: It is larger and arises from lateral surface
of lateral pterygoid plate of sphenoid bone.
Insertion: Both heads converge as a single tendon to insert
on:

1. Pterygoid fovea in the anterior surface of neck of
mandible.
2. Adjoining articular disc and capsule of temporo-
mandibular joint.
Relations
1. Superficial: Ramus of mandible, masseter, superficial
head of medial pterygoid and tendon of temporalis
muscles.
2. Deep: Deep head of medial pterygoid muscle,
sphenomandibular ligament, maxillary and middle
meningeal arteries, mandibular nerve.
3. Superior border: Temporal and massetric branches
of mandibular nerve.
4. Inferior border: Lingual and inferior alveolar nerves.
5. Structures present between two heads: Buccal nerve
and maxillary artery.
Actions
1. Assists in depression of mandible to open jaw.
2. Protrusion of mandible alongwith medial pterygoid.
3. Helps in side to side movements of the jaw and
grinding of food between teeth of same side.
Masseter (Fig. 23.5)
It is quadrilateral in shape and has three layers:
superficial, deep and intermediate.
Origin
1. Lower border and inner surface of anterior 2/3rd of
zygomatic arch.
2. Adjoing posterior border of zygomatic bone.
Insertion
1. Large central area on outer surface of ramus of
mandible.
2. Adjoing surface of coronoid process of mandible.
Relations
1. Superficial: Skin, platysma, parotid gland, branches
of facial nerve and transverse facial branches of
superficial temporal vessels.
2. Deep: Ramus of mandible, temporalis muscle.
3. Anterior: Buccal pad of fat, buccal branch of
mandibular nerve, buccinator muscle.
4. Posterior: It is overlaped by parotid gland.
Actions
1. Elevation of mandible to approximate the teeth.
2. Retraction of mandible.
3. Superficial fibres help in protrusion of mandible.
Accessory Muscle of Mastication: Buccinator
(Figs 23.4 and 23.6)
The action of buccinator muscle helps to prevent
accumulation of food in the vestibule of the mouth during
Temporal and Infratemporal Regions 325
mastication. It helps to compress the cheeks against the
teeth and putting the food back between the occlusal
surfaces of teeth of upper and lower jaw. It is therefore
called as the accessory muscle of mastication.
Origin
1. Upper fibres: Outer surface of the alveolar process
of maxilla opposite the molar teeth.
2. Middle fibres: Pterygomandibular raphe.
3. Lower fibres: Outer surface of alveolar process of
mandible, opposite the molar teeth.
Insertion
1. Upper fibres pass straight to the skin and submucosa
of upper lip.
2. Lower fibres pass straight to skin and submucosa of
lower lip.
3. Middle fibres decussate and then pass to both the
upper and lower lips.
Nerve supply: Buccal branch of the facial nerve.
Actions
C H A P T E R-23
1. Flattens the cheek against the gum and teeth.
2. Prevents accumulation of food in the mouth.
3. Helps to expel the air between the lips from an
inflated vestibule, as in blowing a trumpet or whistle.
POINT TO REMEMBER
Buccal branch of mandibular nerve is sensory. It pierces
the buccinator muscle but does not supply it.
TEMPOROMANDIBULAR JOINT (Fig. 23.7 and 23.8)
It is the joint formed between the head of mandible and
the articular fossa of temporal bone.
Type: Condylar variety of synovial joint.
Articular Surfaces
1. Upper: Articular eminence of the mandibular fossa
of the temporal bone.
2. Lower: Condylar process of mandible.
The articular surfaces are covered by a fibrocartilage
and not hyaline cartilage which is present in most
synovial joints.
Articular disc: It is an oval fibrocartilaginous plate with
a concavo-convex superior surface and a concave inferior
surface, to accommodate the head of mandible. It is
thickend at the periphery to form an annulus which is
attached to the fibrous capsule. This divides the joint
cavity into two parts:
 326 Human Anatomy For Dental Students
Fig. 23.7: Temporomandibular jointDiagrammatic
representation
1. Upper menisco temporal compartment: Permits
gliding movements.
S E C T I O N-2
2. Lower menisco-mandibular compartment: Permits
rotatory as well as gliding movements.
Functions of Articular Disc of Joint
1. It reduces the friction between the two articular
surfaces. It allows free sliding movement of the
condyle preventing damage due to friction. This
function is at the cost of slight instability of the joint.
2. It aids in lubrication of the joint.
3. It divides the joint into two compartments which
helps to facilitate and increase the range of
movements simultaneously.
Ligaments (Figs 23.7 and 23.8)
1. Fibrous capsule: The capsule is attached above to
the anterior edge of mandibular fossa in front of
articular eminence and to the edges of the
mandibular fossa reaching posteriorly upto
squamotympanic fissure. It is attached below to the
margins of neck of mandible. The synovial membrane
lines the inner aspect of fibrous capsule but does not
extend onto the articular cartilages.
2. Lateral or temporomandibular ligament: It is a
broad ligament formed as a result of thickening of
the lateral part of the capsular ligament. It is attached
to the articular tubercle on the root of zygomatic bone
above and to the lateral aspect and posterior border
of the neck of mandible below. It is overlapped by
parotid gland at the neck.
Fig. 23.8: Ligaments of temporomandibular joint
Function of temporomandibular ligament is that it
supports the lateral aspect of the joint and limits the
movements of the condyle of mandible.
3. Sphenomandibular ligament: It extends from the
spine of sphenoid above, to the lingula of the
mandible below. It lies medially, on a deeper plane,
away from the joint capsule. The sphenomandi-bular
ligament represents the remanant of 1st branchial
arch or Meckels cartilage. It is seperated laterally
from the ramus of mandible by lateral pterygoid
muscle, maxillary artery, inferior alveolar vessels
and nerves.
4. Stylomandibular ligament: It is an accessory
ligament. It is a thick band which extends from the
tip and anterior surface of styloid process to the angle
of mandible.
Relations of Temporomandibular Joint
Anterior : Lateral pterygoid muscle, masseteric nerve
and vessels.
Posterior : Parotid gland, external auditory meatus,
superficial temporal vessels, auriculo-
temporal nerve.
Medial : Spine of sphenoid, sphenomandibular
ligament, auriculotemporal nerve, chorda
tympani nerve, middle meningeal artery.
Lateral : Skin, fasciae, parotid gland, facial nerve.
Superior : Middle cranial fossa.
Inferior : Maxillary artery and vein.
 Temporal and Infratemporal Regions 327

Nerve Supply of Temporomandibular Joint Lymphatics drain into upper cervical lymph nodes
It is supplied by branches of mandibular division of present around internal jugular vein.
trigeminal nerve namely:
1. Auriculotemporal nerve Movements of Temporomandibular Joint
2. Masseteric nerve
Two types of movements are permitted by the temporo-
mandibular joint:
Vascular and Lymphatic Supply of 1. Sliding movement: This movement takes place in
Temporomandibular Joint the upper joint compartment, where the attachment
It receives branches from: of capsular ligament is loose.
1. Superficial temporal artery 2. Rotation movement: This is a hinge type of
2. Maxillary artery movement, which takes place in the lower joint
Veins run along the arteries and drain into pterygoid compartment. The capsular ligament in this
plexus of veins. compartment is firmly attached allowing only

Movements Mechanism of movement Muscles involved (Bilateral action)

Depression Gliding movement in menisco Lateral pterygoids
temporal compartment and Suprahyoid muscles namely, geniohyoids,
rotatory movement in menisco mylohyoid and digastric
mandibular compartment
Elevation Reversal of depression Masseter

Protrusion Gliding movement in menisco
temporal compartment
Retraction Reversal of protrusion
Chewing Gliding movement in menisco
It involves vertical temporal compartment of one
and lateral move- joint and rotatory movement in
ments of the jaws menisco mandibular compartment
of other joint simultaneously
C H A P T E R-23
Medial pterygoid
Temporalis (middle and anterior fibres)
Medial pterygoids
Lateral pterygoids
Posterior fibres of temporalis
Geniohyoid and digastric
Alternate action of medial and lateral
pterygoids of each side

rotation of condyle of mandible within the annulus
of the articular disc.
The lower jaw can be depressed, elevated, protruded,
retracted and moved from side to side. These movements
take place in both the upper and lower compartment of the
joint and mostly involve both the joints simultaneously.
3. Muscles: Protrusion and retraction are limited by
the tension in temporalis and lateral pterygoid
muscles respectively.
4. The position of mandible is most stable when the
mouth is closed or slightly open.

Stability of the Joint CLINICAL AND APPLIED ANATOMY

The following factors maintain the stability of temporo-
mandibular joint.
1. Articular tubercles: These are present in front and
behind the mandibular fossa and prevent the
slipping of the condyle of mandible.
2. Lateral temporomandibular ligament: It gives
added strength to the capsule of joint posterolaterally
and prevents the backward dislocation of mandible.
Dislocation of temporomandibular joint: When the mouth
is widely open, the head of mandible glides forwards and
downwards and comes to lie below the articular tubercle.
In this position, the joint is highly unstable. Any blow on
head in this position may result in forward dislocation of
the head of mandible. The person will not be able to close
his mouth after such an injury.
 Chapter

24 Parotid and
Submandibular Regions
SALIVARY GLANDS
A number of salivary glands are scattered throughout
the oral cavity. There are three pairs of large salivary
glands:
1. Parotid, beside the ear.
2. Submandibular, below the mandible.
3. Sublingual, below the tongue.
The salivary glands are exocrine glands and secret
saliva. Saliva helps to keep the oral cavity moist and
clean. It also helps in mixing of food and swallowing
It is located by the side of the face and upper part
of neck on each side, below external acoustic meatus
extending from ramus of mandible in front to
mastoid process behind.
The parotid gland is pyramidal in shape with its
apex directed downwards. It weighs 25 gm.
The facial nerve and its branches divide the gland
into superficial and deep parts or lobes which are
connected by an isthmus.

C H A P T E R-24
and initiates digestion. Parotid-bed (Retromandibular Fossa) (Fig. 24.1): Parotid
gland is located in the parotid-bed which is bounded by:
PAROTID GLAND (G:PARA = NEAR, OTIS = EAR)
(Figs 24.1 to 24.6) Anteriorly : Posterior border of ramus of mandible,
laterally; masseter and medial ptery-
Parotid gland is the largest of the three pairs of goid muscles, medially.
salivary glands.

Fig. 24.1: Boundaries of parotid bed

 330 Human Anatomy For Dental Students
Posteriorly : Mastoid process, sternocleidomastoid
muscle, laterally.
Superiorly : External acoustic meatus, posterior part
of the temporomandibular joint.
Inferiorly : Posterior belly of digastric and stylo-
hyoid muscles.
Medially : Styloid process, styloglossus, stylo-
pharyngeus and stylohyoid muscles.
Anatomical Features (Fig. 24.2 to 24.5)
Parotid gland presents with following features:
1. Apex: It over hangs the posterior belly of digastric
and adjoining part of the carotid triangle.The
following structures pass through it:
a. Cervical branch of facial nerve.
b. Two (anterior and posterior) divisions of retro-
mandibular vein.
2. Superior surface or base: It is concave and is related
to the external acoustic meatus and posterior aspect
of the temporomandibular joint. The following
structures pass through it:
a. Temporal branch of facial nerve
S E C T I O N-2
b. Superficial temporal vessels
c. Auriculotemporal nerve
3. Superficial or lateral surface: It is covered from
without inwards by:
a. Skin.
b. Superficial fascia containing anterior branches
of great auricular nerve and pre-auricular
(superficial parotid) lymph nodes.
c. Platysma.
4. Anteromedial surface: It is deeply grooved by the
ramus of the mandible. It is related to:
a. Masseter.
b. Medial pterygoid.
Fig. 24.2: Shape, surfaces and borders of right parotid galnd
c. Posterior border of the ramus of mandible.
d. Lateral surface of the temporomandibular joint.
The following structures emerge from this surface:
a. Branches of facial nerve, from outer lip of
groove.
b. Transverse facial artery, from inner lip of groove.
5. Posteromedial surface: It is moulded on to the
mastoid and styloid processes and their covering
muscles. Thus it is related to:
a. Mastoid process, sternocleidomastoid and
posterior belly of digastric muscles.
b. Styloid process and styloid group of muscles
c. Deep to styloid process lies the internal carotid
artery, internal jugular vein and the last 4 cranial
nerves.
Structures that enter the gland through this surface:
a. External carotid artery, in its lower part.
b. Facial nerve trunk, in its upper part.
6. Anterior border: It is the thin border present
between the superficial and anteromedial surfaces.
The following structures emerge in a radiating
fashion at this border:
a. Zygomatic branch of facial nerve.
b. Transverse facial vessels.
c. Upper buccal branch of facial nerve.
d. Parotid duct.
e. Lower buccal branch of facial nerve.
f. Marginal mandibular branch of facial nerve.
7. Posterior border: It separates the superficial surface
from the posteromedial surface. Following struct-
ures emerge underneath this border:
a. Posterior auricular vessels
b. Posterior auricular branch of facial nerve
8. Medial border: It separates the antero-medial
surface from postero-medial surface. It is related to
the lateral wall of the pharynx.
Fig. 24.3: Cut surface of right parotid galnd
 Parotid and Submandibular Regions 331

C H A P T E R-24
Fig. 24.4: Structures related to parotid gland

Fig. 24.5: Relations of parotid glanddiagrammatic representation in cut section

Accessory parotid gland: Anteriorly, parotid gland
overlaps the masseter. A part of this forward extension
may be detached to lie between the zygomatic arch and
the parotid duct. This is named accessory parotid gland.
Processes of parotid gland: Parotid tissue may extend
occasionally at the following sites.
1. Facial process, present over the masseter.
2. Pterygoid process, lies between the ramus of the
mandible and medial pterygoid.
3. Glenoid process, lies between the external acoustic
meatus and tempromandibular joint.
 332 Human Anatomy For Dental Students
4. Pre and post-styloid processes, appear as anterior
and posterior extensions over the styloid process.
Capsules of Parotid Gland
1. False capsule: It is formed by the tough investing
layer of deep cervical fascia. The fascia splits into
two between the angle of mandible and the mastoid
process to enclose the gland. The superficial lamina
of capsule is thick and adherent to the gland while
the deep lamina is thin. The deep lamina between
the styloid process and angle of mandible is
thickened to form the stylomandibular ligament
which separates the parotid gland from the
submandibular salivary gland.
2. True capsule: It is formed by the condensation of
fibrous tissue of parotid gland.
Structures Present Within the Parotid Gland (Fig. 24.5)
1. Facial nerve and its branches: Facial nerve emerges
from the stylomastoid foramen and enters the gland
S E C T I O N-2
by piercing upper part of its posteromedial surface.
It then divides into two trunks:
a. Temporo-facial trunk: This gives rise to:
Temporal nerve
Zygomatic nerve
b. Cervico-facial trunk: This further divides into
three branches:
Buccal
Marginal mandibular
Cervical
The five terminal branches leave through the anterior
border of the gland in a radiating manner that
resembles the foot of a goose. Hence, this pattern is
known as pes anserinus
2. Retromandibular vein: It is formed within the
substance of parotid gland by union of superficial
temporal and maxillary veins, and lies below the
facial nerve.
3. External carotid artery: It occupies the deep part of
gland.
4. Deep parotid lymph nodes.
Structure of Parotid Gland
It is a compound tubulo-alveolar gland. The acini are
lined by seromucinous cells which open into collecting
ducts. A number of collecting ducts unite and form the
parotid duct.
The parotid duct: It is 5 cm long. It emerges from the
middle of the anterior border of the gland and runs
forwards over the masseter. At the anterior border of
masseter, it turns inwards to pierce four layers of the
cheek and opens into the vestibule of mouth opposite the
second upper molar tooth.
Structures pierced by the parotid duct, from
superficial to deep are:
1. Buccal pad of fat
2. Buccopharyngeal fascia
3. Buccinator muscle
4. Buccal mucosa
Arterial Supply of Parotid Gland
It is derived from branches of external carotid artery.
Venous Drainage of Parotid Gland
Veins drain into the external jugular vein.
Lymphatic Drainage of Parotid Gland
Lymphatics from the gland drain into:
1. Superficial parotid group of lymph nodes
2. Deep parotid group of lymph nodes
These ultimately end in the deep cervical lymph nodes.
Nerve Supply of Parotid Gland (Fig. 24.6)
1. Parasympathetic supply: It is carried by the
auriculotemporal nerve. The preganglionic fibres
arise from inferior salivatory nucleus and pass
successively through the glossopharyngeal nerve,
tympanic branch of glossopharyngeal nerve,
tympanic plexus and lesser petrosal nerve to relay
in the otic ganglion. Post-ganglionic fibres arise from
the cells of the ganglion and pass through
auriculotemporal nerve to supply the parotid gland.
It is secretomotor and results in secretion of watery
fluid.
2. Sympathetic supply: It is derived from the sympa-
thetic plexus around the external carotid artery
which is formed by the postganglionic fibres from
superior cervical sympathetic ganglion. It is
secretomotor and results in production of mucus
rich sticky secretion. It is also vasomotor to the
gland.
3. Sensory supply: It is derived from
a. Auriculotemporal nerve.
b. Great auricular nerve (C2, C3) C2 is sensory to
parotid fascia.

Fig. 24.6: Nerve supply to parotid gland
CLINICAL AND APPLIED ANATOMY
Mumps is caused by a viral infection. The virus has
special affinity for parotid glands and causes swelling
and inflamation of the gland which is painful. Pain is
severe as the gland is surrounded by a tough capsule.
Mastication may also be painful because the gland is
closely related to the tempromandibular joint. Mumps
is mostly bilateral. It is a self limiting infection and
requires only supportive care. Rarely, it can lead to
complications like bronchitis, orchitis and
pancreatitis.
Infection of parotid gland is mostly a consequence
of retrograde bacterial infection from mouth
through the parotid duct. Severe infection can lead
to formation of an abscess. It is drained by giving
a horizontal incision. A vertical incision is avoided
as it can lead to injury to branches of the facial
nerve.
Parotid and Submandibular Regions 333
C H A P T E R-24
SUBMANDIBULAR SALIVARY GLAND (Figs 24.7
to 24.11)
It is about half the size of the parotid gland and lies below
the mandible in the anterior part of the digastric triangle.
Anatomical Features
It consists of two parts, a large superficial part and
a smaller deep part, which lie superficial and deep
to the mylohyoid muscle respectively.
The two parts are continuous with each other at
the posterior border of mylohyoid muscle.
Superficial part: It fills the anterior part of the
digastric triangle and extends upwards deep to the
mandible upto the mylohyoid line. It has three
surfaces:
1. Superficial surface or inferior surface is covered
by the following structures from superficial to
deep:
a. Skin
 334 Human Anatomy For Dental Students
S E C T I O N-2

Fig. 24.7: Superficial and deep parts of submandibular gland with relations

Fig. 24.8: Deep part of submandibular gland and sublingual gland with relations

b. Superficial fascia containing platysma and 2. Lateral surface is related to:

cervical branch of facial nerve a. Submandibular fossa on the lower part of
c. Deep fascia inner aspect of the body of mandible.
d. Facial vein. b. Medial pterygoid muscle
e. Submandibular lymph nodes. c. Facial artery
 Parotid and Submandibular Regions 335

C H A P T E R-24
Fig. 24.9: Deep and superficial relations of submandibular gland (coronal section)

3. Medial surface can be divided into three parts: Capsule of Submandibular Gland
a. Anterior part is related to mylohyoid muscle
The investing layer of deep fascia splits to cover the
and mylohyoid nerve and vessels
inferior and medial surfaces of the superficial part of
b. Intermediate part is related to:
the gland. The superficial layer gets attached to base
Hyoglossus muscle
of mandible and deep layer to mylohyoid line on
Lingual and hypoglossal nerves
mandible.
Submandibular ganglion
c. Posterior part is related to:
Styloglossus muscle Structure of Submandibular Gland
Stylohyoid ligament It is made up of a number of lobes and lobules divided
Glossopharyngeal nerve by connective tissue septa derived from the capsule:
Deep part: It is small in size and lies on the Each lobule is made up of secretory units with pre-
hyoglossus deep to mylohyoid. Posteriorly, it is dominantly serous acini and few mucous tubules and
continuous with superficial part of the gland and acini. A number of acini open into small ducts which
anteriorly it extends upto the sublingual salivary join to form the submandibular duct.
gland.
Submandibular duct (Whartons duct) (Fig. 24.9 and
Relations of Submandibular Gland (Figs 24.8 and 24.9) 24.10): The submandibular duct is about 5 cm long. It
Medial : Hyoglossus muscle emerges at the anterior end of the deep part and runs
Lateral : Mylohyoid muscle forwards and medially on the hyoglossus muscle, under
Superior : Lingual nerve and submandibular ganglion mylohyoid. At the anterior border of hyoglossus it is
Inferior : Hypoglossal nerve crossed by the lingual nerve, from lateral to medial side.
 336 Human Anatomy For Dental Students

It continues running forward between the sublingual

gland and the genioglossus muscle. Here, it lies just deep
to the mucus membrane of the oral cavity. Finally, it
opens into oral cavity on the summit of a sublingual
papilla at the side of the frenulum of tongue.

Arterial Supply of Submandibular Gland

It is derived from:
1. Branches of facial artery
2. Branches of lingual artery
Venous Drainage of Submandibular Gland
Veins run along with corresponding arteries and drain
into the internal jugular vein.

Lymphatic Drainage of Submandibular Gland

Fig. 24.10: Opening of submandibular duct
Drains to submandibular lymph nodes and then into
jugulodigastric lymph nodes.
S E C T I O N-2

Fig. 24.11: Nerve supply to submandibular, sublingual and lingual glands

 Parotid and Submandibular Regions 337

Nerve Supply of Submandibular Gland (Fig. 24.11)
1. Parasympathetic supply (Secretomotor): Pregang-
lionic fibres arise from superior salivatory nucleus.
They pass successively through the facial nerve,
chorda tympani nerve, lingual nerve and relay into
the submandibular ganglion. Postganglionic fibres
arise from cells of the ganglion and directly supply
the gland. It is secretomotor and causes secretion
of watery fluid.
2. Sympathetic supply: It is derived from the sympa-
thetic plexus around facial artery formed by
postganglionic fibres from superior cervical
sympathetic ganglion. It is secretomotor and results
in secretion of mucus rich fluid. It is also vasomotor.
3. Sensory supply: Lingual nerve.
SUBLINGUAL SALIVARY GLAND (Fig. 24.8 and 24.10)
This is the smallest of the 3 pairs of salivary glands.
It lies immediately below the mucosa of the floor
of the mouth.
It is almond-shaped and rests in the sublingual fossa
on the inner aspect of the body of mandible.
It is separated from the base of the tongue by the
submandibular duct.
The gland pours its secretion by a series of ducts,
about 10 to 15 in number into the oral cavity on the
sublingual fold. Few ducts may also open into the
submandibular duct.
Vascular and Nerve Supply (Fig. 24.11)
It is similar to that of submandibular salivary gland except
that postganglionic parasympathetic fibres are carried
by lingual nerve.

Comparison Between the Large Salivary Glands

Features Parotid gland Submandibular gland Sublingual gland

Location
Development
Size
Shape
Site of opening of the
duct in oral cavity
Secretomotor nerve supply
Preganglionic fibres
Postganglionic fibres
Nature of secretion
Near the ear
Ectodermal
Largest, weighs 15 gm
Pyramidal shaped
Parotid duct opens into the
vestibule opposite the
second upper molar tooth
Lesser petrosal nerve.
Inferior salivatory nucleus.
Otic ganglion
Predominantly serous
Below the mandible
Endodermal
Smaller, weighs 7.5 gm
J-shaped
Submandibular duct opens
on the summit of sublingual
papilla at the side of
frenulum of the tongue
Chorda tympani nerve
Superior salivatory nucleus
Submandibular ganglion
Serous + mucus
C H A P T E R-24
Below the tongue
Endodermal
Smallest, weighs 3 to 4 gm
Almond shaped
Series of ducts open on
the sublingual fold
Chorda tympani nerve
Superior salivatory nucleus
Submandibular ganglion
Predominently mucus

SUBMANDIBULAR GANGLION (Figs 24.11 and 24.12) Medial : Submandibular gland

Above : Lingual nerve
It is the parasympathetic ganglion which provides a relay
Below : Submandibular duct
station for the secretomotor fibres that supply the
submandibular and sublingual salivary glands. Roots or Communications
Topographically it is connected to lingual nerve but
1. Parasympathetic root: It lies posteriorly and is
functionally it is connected to facial nerve through the
chorda tympani branchi. derived from the fibres of chorda tympani nerve
Size : Pin-head communicating with lingual nerve. Preganglionic
Shape : Fusiform parasympathetic fibres arise from the superior
Location : Submandibular region, on the outer salivatory nucleus and pass successively through
surface of hyoglossus muscle. It is the facial nerve, chorda tympani nerve and lingual
suspended from the lingual nerve by two nerve to relay in the submandibular ganglion.
roots or filaments. 2. Sympathetic root: It is derived from the
Relations sympathetic plexus around facial artery. It conveys
Lateral : Hyoglossus muscle postganglionic fibres from the superior cervical
 338 Human Anatomy For Dental Students

Fig. 24.12: Location of submandibular ganglion

ganglion of sympathetic trunk.They pass the submandibular gland. The fibres supplying
ganglion without relay. sublingual and anterior lingual glands are
3. Fibres from lingual nerve pass through the ganglion conveyed via the lingual nerve through the anterior
S E C T I O N-2

without relay. root of ganglion.

2. Postganglionic sympathetic fibres: These fibres are
Branches
vasomotor to the submandibular and sublingual
1. Postganglionic parasympathetic fibres: These arise
glands.
as 5 to 6 branches which directly supply the
 Chapter

25
Neck and its Triangles

INTRODUCTION 1. Cervical vertebrae and the associated skeletal

muscle framework consisting of:
Neck is that part of the body which connects the head to
the upper part of trunk. It is cylindrical in shape. a. Prevertebral muscles
b. Paravertebral muscles
Boundaries of Neck (Fig. 25.1) c. Postvertebral muscles
Spinal cord is present in the vertebral column.
Superior : Lower border of body of mandible. Line 2. Viscera of neckfrom posteroanterior they are:
joining angle of mandible to mastoid a. Pharynx, upper part of esophagus
process. Superior nuchal line. External b. Larynx, trachea

C H A P T E R-25
occipital protuberance
c. Thyroid and parathyroid glands
Inferior : Suprasternal notch of manubrium sterni.
3. Neurovascular bundle of neck-one bundle is
Upper surface of clavicle. Acromian process
present on each side and consist of:
of scapula. Line extending from the
a. Carotid artery
acromian process to spine of C7 vertebra.
b. Internal jugular vein
Neck is enclosed by skin, superficial fascia and deep
c. Vagus nerve and its branches
fascia. It houses the following important structures:

Fig. 25.1: Side of neck

 340 Human Anatomy For Dental Students

SKIN AND SUPERFICIAL FASCIA OF NECK The vein descends in the superficial fascia lateral
to the midline.
Superficial fascia is primarily made up of loose
It pierces the deep fascia near the lower end of
connective tissue, blood vessels, nerve and
sternocleidomastoid muscle and turns laterally to
lymphatics.
pass behind it and ends in the external jugular vein.
A thin sheet of muscle fibres known as platysma is
Above the sternal notch, in the suprasternal space,
present in this fascia.
the anterior jugular veins of both sides are united
by a transverse jugular venous arch.
Platysma (Fig. 19.6)

It is a quadrilateral shaped, striated muscle in the
anterior aspect of upper part of neck.
Origin: Arises from the fascia over the anterior surface
of deltoid and pectoralis major upto 2nd rib.
Insertion: The fibres lie over the superficial veins and
nerves and cover the sternocleidomastoid. The fibres are
mainly inserted into the lower border of body of
mandible. Few fibres extend above the angle of mandible
to angle of mouth.
Nerve supply: Cervical branch of facial nerve
Actions:
1. Its contractions mainly aid in the venous return
2. Depresses the mandible and pulls the angle of
S E C T I O N-2
EXTERNAL JUGULAR VEIN (Fig. 25.2)
External jugular vein is primarily the drainage
channel of face and scalp.
It is formed by the union of posterior division of
retromandibular vein and posterior auricular vein
just below the parotid gland, at angle of mandible.
It descends under platysma and over the deep fascia
covering sternocleidomastoid muscle.
It passes slightly obliquely to reach the root of neck
just posterior to the clavicular head of sternocleido-
mastoid muscle. Here, it pierces the deep fascia and
drains into subclavian vein.

mouth downwards and laterally. Tributaries

1. Posterior division of retromandibular vein
Vascular and Lymphatic Supply of Skin and Fascia 2. Posterior auricular vein
of Neck
3. Anterior jugular vein
Arterial supply is derived from branches of the following 4. Posterior external jugular vein
arteries: 5. Transverse cervical vein
1. Facial artery 6. Suprascapular vein
2. Occipital artery
3. Posterior auricular artery
4. Subclavian artery
The veins accompany the arteries and drain into
external jugular vein or facial vein (Fig. 25.2).
Lymphatics from skin and fascia of neck pass into
the superficial and deep cervical lymph nodes.

Cutaneous Nerve Supply of Neck (Fig. 25.17)

It is derived from the following branches of cervical
plexus:
1. Lesser occipital nerve, C2
2. Great auricular nerve, C2, 3
3. Transverse cutaneous nerve of neck, C2, 3
4. Supraclavicular neves, C3, 4
5. Medial branches of dorsal rami of C3, 4, 5 spinal
nerves.

ANTERIOR JUGULAR VEIN

It consists of a single or double channel of veins
which begin in the submandibular region by the
confluence of superficial veins near the hyoid bone. Fig. 25.2: External jugular vein

7. It communicates with internal jugular vein by an
oblique jugular vein
DEEP FASCIA OF NECK (DEEP CERVICAL FASCIA)
It is well developed in the neck and consists of three
layers. These are, from exterior to interior:
1. Investing layer
2. Pretracheal layer
3. Prevertebral layer
Investing Layer of Deep Cervical Fascia (Figs 25.3
and 25.4)
The investing layer of cervical fascia lies deep to the
subcutaneous tissue and platysma and surrounds the
neck completely like a collar.
Attachments
1. Superiorly: External occipital protuberance,
superior nuchal line, mastoid process, lower border
of zygomatic arch, lower border of body of
mandible upto symphysis menti
2. Inferiorly: Upper border of spine of scapula,
acromian process of scapula, upper surface of
clavicle, suprasternal notch of manubrium sterni.
Fig. 25.3: Horizontal disposition of deep cervical fascia
Neck and its Triangles 341
3. Posteriorly (from above downwards): Ligamentum
nuchae, spine of C7 vertebra.
4. Anteriorly (from above downwards): Symphysis
menti, hyoid bone, manubrium sterni.
Horizontal Extent of Deep Cervical Fascia (Fig. 25.3)
The fascia passes anteriorly from the ligamentum
nuchae on each side and splits to enclose the
trapezius.
It reunites at the anterior border of trapezius and
runs anteriorly. It splits again to enclose the
sternocleidomastoid.
At the anterior border of the muscle it reunites and
can be traced to the midline of neck where it
proceeds to the opposite side in same manner.
Vertical Extent of Deep Cervical Fascia (Fig. 25.4)
The investing layer when traced upwards encloses the
neck like a collar.
Features of Investing Layer of Deep Cervical Fascia
At its inferior attachments anteriorly, the deep
C H A P T E R-25
fascia is split at two sites which enclose the
following two spaces:
S E C T I O N-2 342 Human Anatomy For Dental Students
Fig. 25.4: Vertical disposition of deep cervical fascia
1. Suprasternal space or space of Burns: The
investing fascia splits over the manubrium
sterni into 2 layers. The superficial layer is
attached to anterior margin of suprasternal
notch and the deep layer gets attached to the
posterior margin to enclose the space.
Contents:
a. Sternal heads of sternocleidomastoid of both
sides.
b. Jugular venous arch
c. Interclavicular ligament
d. Occasionally, a lymph node
2. Supraclavicular space: This is formed over the
middle third of clavicle where the investing
layer splits into two and is attached to anterior
and posterior margins of upper surface of
clavicle.
Contents:
a. Terminal part of external jugular vein.
b. Supraclavicular nerves before they pierce the
deep fascia.
At the upper part the fascia splits to enclose the
submandibular gland, on each side. The superficial
layer attaches to the lower border of mandible and
the deeper layer is attached to the mylohyoid line
on mandible.
The rest is attached to the symphysis menti
anteriorly and angle of mandible posteriorly.
The fascia can be traced upwards till the zygomatic
arch.
At the lower pole of parotid gland it splits to enclose
the gland. The superficial layer is thick and merges
with the fascia on masseter. The deep layer is thin
and is attached to inferior border of tympanic part
and styloid process of temporal bone.
From the tip of the styloid process to angle of
mandible the fascia is thickened to form the
stylomandibular ligament.
Pretracheal Fascia (Figs 25.3 and 25.4)
The pretracheal layer of deep cervical fascia lies over
the trachea and is also known as pretracheal fascia.
Extent
From above downwards
It is attached above to the middle of the lower
border of body of hyoid bone extending to the
oblique line of thyroid cartilage.
When traced below it encloses the thyroid gland
Then it passes in front of trachea.
Finally, it enters the thorax and blends with the
fibrous pericardium.

From Medial to Lateral
The layer covers the anterior surface of trachea and
passes laterally on each side and merges with the fascia
deep to sternocleidomastoid muscle.
Prevertebral Fascia (Figs 25.3 and 25.4)
This layer of deep fascia lies anterior to the prevertebral
muscles. The nerve roots of cervical and brachial plexus
lie under it.
Extent
From above downwards
It is attached to base of skull above.
It covers the pre and para-vertebral muscles.
It extends below to the superior mediastinum and
is attached to the anterior longitudinal ligament till
T4 vertebra.
From medial to lateral side
The fascia passes anterior to prevertebral muscles
and runs laterally and backwards over the
paravertebral muscles.
Further posteriorly it blends with the fascia
underneath the trapezius.
Features of Prevertebral Fascia
1. The cervical plexus of nerves lie posterior to it.
2. In the lower part, the brachial plexus and
subclavian vessels lie deep to the prevertebral fascia
and carry with them a tubular extension from it into
the axilla. This forms the axillary sheath which may
extend upto the elbow.
Carotid Sheath (Fig. 25.3)
The deep cervical fascia forms a tubular sheath around
the major vessels of the neck, named the carotid
sheath on each side.
Extent
It extends from the base of skull above to the arch of
aorta below, on each side.
Contents of Carotid Sheath
1. Common carotid artery in lower part and internal
carotid artery in upper part.
2. Internal jugular vein.
3. Vagus nerve in between and posterior to artery and
internal jugular vein.
Features of Carotid Sheath
It is formed by the condensation of fibro-aerolar
tissue and is attached to the pretracheal and
prevertebral fascia.
Neck and its Triangles 343
Ansa cervicalis is embedded in its anterior layer.
Cervical sympathetic chain lies close to the posterior
layer in front of the prevertebral fascia.
Buccopharyngeal Fascia
It is deep fascia covering the superior constrictor muscle
of pharynx. It extends anteriorly over buccinator muscle
on each side.
Retropharyngeal Space
It is the potential space present between the fascia
covering the muscles of pharynx (buccopharyngeal
fascia) and the prevertebral fascia.
On each side it is limited by the carotid sheath.
Superiorly, the space is closed by the base of skull
while inferiorly it is continuous with superior
mediastium of thorax.
The space is divided into two parts by a median
fibrous septum that extends from the fibrous raphae
of pharynx to the prevertebral fascia.
C H A P T E R-25
Contents of Retropharyngeal Space
1. Loose aerolar tissue.
2. Retropharyngeal lymph nodes.
3. Pharyngeal plexus of nerves and vessels.
Functions: It allows the pharynx to expand during
deglutition.
Lateral Pharyngeal Space
It is a wedge shaped space present on either side of
pharynx with a broad base above formed by base
of skull and a narrow apex below extending upto
the level of hyoid bone in the neck.
Pharynx lies medially
It is limited laterally by the medial pterygoid muscle
covering the inner aspect of ramus of mandible
anteriorly and parotid gland with its fascia
posteriorly.
It is separated from the retropharyngeal space by
the carotid sheath.
Contents of Lateral Pharyngeal Space
1. Branches of maxillary nerve
2. Branches of maxillary artery
3. Fibro-fatty tissue
CLINICAL AND APPLIED ANATOMY
Thyroid gland moves on swallowing because the
pretracheal fascia which splits to enclose it is attached
to the hyoid bone and the thyroid cartilage.
 344 Human Anatomy For Dental Students

ANATOMICAL FEATURES OF NECK 1. Submental triangle

2. Digastric triangle
The neck and its contents are studied in two parts:
3. Carotid triangle
1. Side of neck
4. Muscular triangle
2. Back of neck
Side of neck: The side of neck encompasses the anterior
Submental Triangle (Figs 25.5 and 25.6)
and lateral surfaces of the neck. It is rectangular in shape
and is divided into two triangles by the sternocleido- This triangle is complete only when the neck is seen from
mastoid muscle namely: the front. Each half of the triangle is visible when viewed
1. Anterior triangle from side.
2. Posterior triangle
Boundaries
ANTERIOR TRIANGLE OF NECK (Figs 25.5 and 25.6) On each side : Anterior belly of digastric
Boundaries Base : Body of hyoid bone
Apex : Chin or symphysis menti
Anterior : Anterior midline of the neck extending Floor: It is formed by the mylohyoid muscles (these form
from symphysis menti above to the middle oral diaphragm) and geniohyoid muscles.
of suprasternal notch below. Contents of Submental Triangle
Posterior : Anterior border of sternocleidomastoid. 1. Submental lymph nodes.
Base : Lower border of the body of mandible and 2. Submental veins, anterior jugular veins.
line joining the angle of mandible with the
mastoid process. Digastric Triangle (Figs 25.5 to 25.7)
Apex : Suprasternal notch, at the meeting point Boundaries
S E C T I O N-2

between anterior border of sternocleido-

Antero-inferior : Anterior belly of digastric muscle.
mastoid and anterior midline (vide supra).
Postero-inferior : Posterior belly of digastric muscle.
Subdivisions of Anterior Triangle Base : Base of the mandible and an
The anterior triangle in subdivided by the digastric imaginary line joining the angle
muscle and superior belly of omohyoid into following of mandible to the mastoid
four parts: process.

Fig. 25.5: Triangles of neck

 Neck and its Triangles 345

C H A P T E R-25
Fig. 25.6: Submental, digastric, carotid, muscular triangles

Fig. 25.7: Contents of digastric triangle

Apex : Intermediate tendon of digastric Contents of Digastric Triangle

muscle bound down to hyoid
1. Submandibular salivary gland, along with facial
bone by a fascial sling.
vein and facial artery.
Floor: It is formed by mylohyoid muscle (anteriorly),
hyoglossus muscle and small part of middle constrictor 2. Submandibular lymph nodes.
(posteriorly). 3. Submental artery and vein, branches from facial
Roof: It is formed by the investing layer of deep cervical vessels.
fascia which splits to enclose the submandibular salivary 4. Mylohyoid nerve and vessels
gland. 5. Hypoglossal nerve
 346 Human Anatomy For Dental Students

6. External carotid artery Floor: It is formed by four muscles:

7. Carotid sheath with its contents 1. Thyrohyoid
8. Structures passing between the external and 2. Hyoglossus
internal carotid arteries: 3. Middle constrictor of pharynx
a. Styloid process 4. Inferior constrictor of pharynx
b. Styloglossus muscle Contents of Carotid Triangle
c. Stylopharyngeus muscle 1. Common carotid artery with its terminal branches:
d. Glossopharyngeal nerve a. Internal carotid artery
e. Lower end of parotid gland b. External carotid artery
2. Internal jugular vein
f. Pharyngeal branch of vagus nerve
3. Occipital vessels
4. Facial vessels
Carotid Triangle (Fig. 25.5, 25.6 and 25.8)
5. Lingual vessels
Boundaries 6. Superior thyroid vessels
Superior : Posterior belly of digastric and 7. Pharyngeal vessels
stylohyoid 8. Last three cranial nerves
Anterio-inferior : Superior belly of omohyoid a. Vagus nerve
Posterior : Anterior border of sternocleido- b. Spinal accessory nerve
mastoid c. Hypoglossal nerve
Roof : It is formed by investing layer of deep cervical 9. Sympathetic chain: Cervical part
fascia. 10. Cervical part of deep cervical lymph nodes
S E C T I O N-2

Fig. 25.8: Content of carotid triangle

 Neck and its Triangles 347

POINT TO REMEMBER 1. Sternal head: It is attached to the upper part of

The carotid triangle provides a good view of all vessels anterior surface of manubrium sterni.
2. Clavicular head: It is attached to the upper border
and nerves present in it only when the sternocleido-
and anterior surface of medial 1/3rd of clavicle.
mastoid is retracted slightly backwards.
Insertion: The fibers run upwards and backwards and
insert in two parts:
Muscular Triangle (Figs 25.5 to 25.7) 1. Lateral surface of mastoid, as a thick tendon.
Boundaries 2. Lateral half of superior nuchal line of occipital bone,
as a thin aponeurosis.
Anterior : Anterior midline of the neck from
hyoid bone to sternum. Important Relations of the Muscle
Antero-superior : Superior belly of the omohyoid. Superficial relations
Postero-inferior : Anterior border of sternocleido- 1. Skin, platysma
mastoid. 2. Superficial lamina of deep cervical fascia
Content of muscular triangle are the infrahyoid muscles. 3. Structures lying between superficial and deep
They also form the floor of the triangle and consist of fascia:
Superficial group a. External jugular vein
a. Sternohyoid b. Great auricular and transverse cervical nerves
4. Parotid gland, near its insertion
b. Omohyoid
Deep relations
Deep group 5. Near its origin it is related to:
c. Sternothyroid a. Sternoclavicular joint
d. Thyrohyoid b. Sternohyoid, sternothyroid and omohyoid
muscles

C H A P T E R-25
STERNOCLEIDOMASTOID MUSCLE (Fig. 25.5 c. Anterior jugular vein
and 25.9) d. Carotid sheath
Sternocleidomastoid muscle is an important, super- e. Subclavian artery
ficially placed muscle on each side of neck and is seen 6. Common carotid, internal carotid and external
as a prominent band passing from above downwards carotid arteries
in the neck, when the neck is turned to one side. It divides 7. Internal jugular, facial and lingual veins
the side of neck into anterior and posterior triangles. 8. Deep cervical lymph nodes
Origin: It arises from two heads: 9. Vagus nerve and ansa cervicalis

Fig. 25.9: Sternocleidomastoid muscle and its relations

 348 Human Anatomy For Dental Students

10. Posterior part of muscle is related to: towards ipsilateral shoulder. This results in turning
a. Splenius capitis, levator scapulae and scalene of face to the opposite side.
muscles. 2. Flexion of neck is brought about when muscles of
b. Cervical plexus, upper part of brachial plexus, both sides act together. Along with action of longus
phrenic nerve. colli, they bring about flexion of cervical part of
c. Transverse cervical and suprascapular arteries vertebral column.
11. Occipital artery 3. Extension of neck when bilateral fibres attached to
12. Near its insertion it is related to: superior nuchal line contract.
a. Mastoid process When upper end is fixed and lower end is contracting
b. Splenius capitis, longissimus capitis and 4. They aid in elevation of thorax during inspiration,
posterior belly of digastric muscle. when the head is fixed.
Nerve supply: It is supplied by spinal part of accessory
nerve. SUPRAHYOID MUSCLES OF ANTERIOR TRIANGLE
Actions OF NECK (Fig. 25.6)
When lower end is fixed and upper end is contracting Digastric muscle divides suprahyoid part of neck into
1. Acting one at a time, the muscle draws the head digastric and submental triangles. Mylohyoid muscle
forms the floor of these triangles.
Muscle Origin Insertion Action
1. Digastric: It has two a. Anterior belly: Fibres from anterior belly 1. Depression of chin
bellies joined by a central Digastric fossa present pass downwards and during opening of mouth.
tendon. lateral to the symphysis backwards while from 2. Draws the hyoid bone
Nerve supply: menti on the lower posterior belly pass upwards during
S E C T I O N-2

a. Anterior belly by border of mandible. downwards and forwards swallowing.

inferior alveolar nerve
b. Posterior belly by
facial nerve
2. Stylohyoid
a. Thin muscle sheet.
b. It accompanies the
posterior belly of digastric.
Nerve supply: Facial nerve.
3. Mylohyoid
Also called diaphragma
oris. Overlies the extrinsic
muscles of tongue
Nerve supply: Branch of
inferior alveolar nerve.
4. Geniohyoid
Ribbon shaped muscle,
lies deep to mylohyoid
Nerve supply: C1 fibres via
hypoglossal nerve.
b. Posterior belly:
Mastoid notch on the
temporal bone.
Middle of the posterior
surface of styloid process.
Mylohyoid line on inner
surface of body of
mandible.
Inferior genial tubercle on
symphysis menti.
towards a central tendon
which is connected by a
fascial sling to the junction
of body and greater cornu
of hyoid bone.
Junction of the body and Draws the hyoid bone
greater cornu of hyoid upwards and backwards.
bone anteriorly.
1. Body of hyoid bone. 1. Elevation of floor of
2. Median fibrous raphae mouth to push up the
which extends from the tongue during swallowing
symphysis menti to 2. Depression of mandible
centre of hyoid bone.
Body of hyoid bone in the Draws the hyoid bone
centre on either side upwards and forwards
of midline.

INFRAHYOID MUSCLES OF ANTERIOR TRIANGLE bone and thyroid cartilage. They result in the movement
OF NECK (Fig. 25.6) of these structures during speech, mastication and
swallowing. The muscles are tabulated below:
These are strap like muscles which attach to the hyoid

Muscle Origin Insertion Action

1. Sternohyoid 1. Upper part of posterior
Nerve supply: Ansa surface of manubrium sterni
cervicalis (C2 and C3 2. Posterior aspect of
fibers) medial end of clavicle
3. Capsule of sterno-
clavicular joint
1. Fibres of both sides Depression of hyoid bone
converge up to the lower
border of body of hyoid
bone
 Neck and its Triangles 349
(Contd....)

Muscle Origin Insertion Action

2. Omohyoid
It consists of 2 bellies
joined by a central tendon
Nerve supply:
a. Superior belly: C1 fibres
through hypoglossal
nerve
b. Inferior belly: Ansa
cervicalis
3. Sternothyroid
Nerve supply: Ansa
cervicalis (C2, C3)
4. Thyrohyoid
Nerve supply: Fibres of
C1 via hypoglossal nerve
a. Superior belly:
Intermediate tendon
beneath the sternomastoid.
This tendon is anchored
by a fascial sling to the
clavicle
b. Inferior belly: Upper
border of scapula near
the suprascapular notch
1. Posterior surface of
manubrium deep to
sternohyoid
2. Adjoining part of medial
end of 1st costal cartilage
Upper part of oblique line
on thyroid cartilage
a. Superior belly: Lower Depression of hyoid bone
border of body of hyoid
bone lateral to
sternohyoid
b. Inferior belly:
Intermediate tendon
Oblique line of thyroid Depression of larynx
cartilage below thyrohyoid
Lower border of greater Depression of hyoid bone
cornu of hyoid bone

COMMON CAROTID ARTERY (Fig. 25.10) 6. Superficial fascia

7. Skin

C H A P T E R-25
It is the chief artery supplying head and neck. There are
Posterior (From within outwards)
two common carotid arteries, one on right and one on
1. Carotid body at its upper end
left side.
2. Thoracic duct, on left side at the lower end
3. Inferior thyroid artery as it curves behind it from
Origin
lateral to medial side to end in the thyroid gland
The right common carotid artery originates from 4. Sympathetic nerve trunk
the brarchiocephalic trunk (innominate artery) 5. Vertebral artery
behind the right sternoclavicular joint in the neck. 6. Prevertebral muscles with fascia
The left common carotid artery arises in the thorax 7. Transverse processes of lower cervical vertebra
directly from the arch of aorta.
Termination: Each common carotid artery terminates Lateral
at the level of the intervertebral disc between C3 and C4 1. Vagus nerve: It lies posterolateral to the artery.
vertebra by dividing into its terminal branches. 2. Internal jugular vein.
Medial
Course 1. Thyroid gland
The left common carotid ascends upwards and 2. Recurrent laryngeal nerve
enters the neck behind the left sternoclavicular joint. 3. Trachea
In the neck both the arteries have a similar course. 4. Oesophagus
Each runs upwards from the sternoclavicular joint 5. Larynx and pharynx
to the upper border of lamina of thyroid cartilage
enclosed in the carotid sheath. Branches of Common Carotid Artery

Relations It gives of only two terminal branches namely:

1. External carotid artery
Anterior (From within outwards) 2. Internal carotid artery
1. Lateral part of thyroid gland overlaps the artery in
the lower half.
2. Infra-hyoid strap muscles Carotid Sinus (Fig. 25.11)
3. Sternocleidomastoid It is a dilatation at the terminal end of the common
4. Anterior jugular vein carotid artery or at the beginning of internal carotid
5. Deep fascia with platysma artery.
S E C T I O N-2 350 Human Anatomy For Dental Students

Fig. 25.10: Common carotid artery and external carotid artery with its branches

It has a rich innervation from the glossopharyngeal
and sympathetic nerves.
The carotid sinus acts as a baroreceptor (pressure
receptor) and regulates the blood pressure.
It is reddish-brown in colour and receives rich nerve
supply from glossopharyngeal, vagus and
sympathetic nerves.
It acts as a chemoreceptor and responds to the
changes in the oxygen and carbon dioxide contents
of the blood.

EXTERNAL CAROTID ARTERY (Fig. 25.10)

It is one of the terminal branches of the common carotid
artery. It supplies the structures present external to the
skull and those in front of the neck.
Origin: It arises from the common carotid artery at the
upper border of lamina of thyroid cartilage.
Termination: It ends by dividing into its terminal
branches at the level of the neck of the mandible and
behind the upper part of parotid gland.

Course
The external carotid artery ascends upwards in a
curved manner.
At the beginning it lies medial to the internal carotid
Fig. 25.11: Carotid sinus and carotid body
artery in an anterior plane.
Carotid Body (Fig. 25.11) It crosses over it anteriorly inclining backwards to
It is a small oval structure situated just behind the lie anterolateral to the internal carotid artery, before
bifurcation of the common carotid artery. the latter enters the skull.

It then runs upwards in the deep part of parotid
gland and ends at the neck of the mandible.
Relations
Anterior (From above downwards)
1. With in the deep part of parotid gland
a. Retromandibular vein
b. Facial nerve with its terminal branches
2. Stylohyoid muscle
3. Posterior belly of digastric muscle
4. Hypoglossal nerve
5. Lingual vein
Posterior (From below upwards)
1. Constrictor muscles of pharynx
2. Superior laryngeal nerve
3. Internal carotid artery
4. Styloid process: Intervenes at the upper end
between internal and external carotid arteries
5. Stylopharyngeus muscle
6. Glossopharyngeal nerve
7. Styloglossus muscle
8. Part of parotid gland
9. Pharyngeal branch of vagus nerve
Branches
The external carotid artery gives of 8 branches namely:
1. Ascending pharyngeal artery, arises from medial
aspect.
2. Superior thyroid artery, arises from anterior aspect.
3. Lingual artery, arises from anterior aspect.
4. Facial artery, arises from anterior aspect.
5. Occipital artery, arises from posterior aspect.
6. Posterior auricular artery, arises from posterior
aspect.
7. Maxillary artery, is the terminal branch.
8. Superficial temporal artery, is the terminal branch.
ASCENDING PHARYNGEAL ARTERY
It is a slender artery which arises from the medial aspect
of the external carotid artery near its lower end. It runs
vertically upwards between the side wall of the pharynx
and internal carotid artery upto the base of the skull.
It gives rise to the following branches:
1. Pharyngeal branches to muscles of pharynx, tonsil,
soft palate.
2. Meningeal branches which traverse foramina in the
base of the skull.
3. Inferior tympanic branch.
4. It ends as palatine branches which accompany
levator veli palatini muscle of the palate.
Neck and its Triangles 351
SUPERIOR THYROID ARTERY
It arises from the anterior aspect of the external
carotid artery just below the tip of the greater cornu
of the hyoid bone.
It runs downwards and forwards, parallel and
superficial to the external laryngeal nerve to reach
the upper pole of the thyroid gland.
Relationship of superior thyroid artery with the
external laryngeal nerve
The superior thyroid artery is close to the external
laryngeal nerve proximally and lies anterolateral to it.
It diverges from the nerve near the thyroid gland where
the artery lies superficial to the upper pole and the nerve
lies deep to it. Therefore in thyroidectomy to avoid
injury to the nerve the artery should be ligated as near
to the gland as possible.
Branches
1. Infrahyoid branch: This anastomoses with its
fellow of opposite side along the lower border of
C H A P T E R-25
hyoid bone.
2. Sternocleidomastoid branch, to the sternocleido-
mastoid muscle.
3. Superior laryngeal artery: It accompanies the
internal laryngeal nerve, passes deep to the
thyrohyoid muscle and pierces the thyrohyoid
membrane to supply the larynx.
4. Glandular branches, to the thyroid gland. Anterior
branch anastomoses with its fellow of the opposite
side along the upper border of the isthmus of the
gland and posterior branches anastomose with
branches of inferior thyroid artery.
LINGUAL ARTERY (Figs 25.10 and 27.9)
It arises from the anterior aspect of external carotid artery
opposite the tip of the greater cornu of the hyoid bone.
It is divided into three parts by the hyoglossus muscle.
1. First part, lies in the carotid triangle and forms a
characteristic loop with its convexity directed
upwards reaching above the greater cornu of the
hyoid bone. It is crossed superficially by the
hypoglossal nerve. This loop permits free
movements of the hyoid bone.
2. Second part, lies deep to the hyoglossus muscle,
along the upper border of the hyoid bone.
3. Third part (also called arteria profunda linguae
or deep lingual artery). First it runs upwards along
the anterior border of the hyoglossus and then
forwards on the under surface of the tongue where
it anastomoses with its fellow of opposite side.
 352 Human Anatomy For Dental Students
Branches
It primarily supplies the tongue
1. Suprahyoid branch: It arises from the first part and
anastomoses with its fellow of opposite side.
2. Dorsal lingual branches: These are usually two in
number and arise from the 2nd part. They supply
the dorsum of tongue and the tonsil.
3. Sublingual artery: It is given off from the 3rd part
and supplies the sublingual gland.
FACIAL ARTERY (Figs 25.10 and 19.8)
Origin: It arises from the anterior aspect of external
carotid artery just above the tip of greater cornu of hyoid
bone.
Termination: It ends at the nasal side of the eye as the
angular artery.
Course
It is divided into two parts namely:
1. Cervical part
S E C T I O N-2
The facial artery first ascends deep to the
digastric and stylohyoid muscles.
Then it passes deep to the ramus of mandible
where it grooves the posterior border of the
submandibular gland.
Here it makes an S-shaped bend, first, winding
downwards and forwards over the submandi-
bular gland and then passing up over the base
of the mandible.
2. Facial part
This part begins at the antero-inferior angle of
masseter as the facial artery winds around the
lower border of mandible and pierces the deep
fascia of neck.
From here it runs upwards and forwards to
reach a point inch lateral to the angle of the
mouth.
Then, it ascends by the side of the nose upto the
medial angle of the eye, where it terminates by
anastomosing with the dorsal nasal branch of
the ophthalmic artery.
The artery is tortuous and this allows it to move
easily over the facial muscles as they contract.
Important Relations of Facial Artery
In the neck
Anterior
1. Posterior belly of digastric muscle
2. Stylohyoid muscle
3. Lower part of ramus of mandible
Posterior
1. Stylopharyngeus muscle
2. Middle and superior constrictors of pharynx
In the Face
The facial vein lies above the facial artery.
Anterior
Branch of facial nerve.
Facial vein, in lower part.
Zygomaticus major and minor muscles.
Skin and superficial fascia.
Posterior
Mandible in lower part.
Buccinator muscle.
Levator anguli oris muscle.
Branches
From cervical part (in the neck)
1. Ascending palatine artery: Arises near the origin
of facial artery and ascends up to accompany the
levator palati. It passes over the upper border of
superior constrictor and supplies the palate.
2. Tonsillar artery (main artery of tonsil): It pierces
the superior constrictor and ends in the tonsil.
3. Glandular branches, to supply the submandibular
gland.
4. Submental artery: A large artery which runs
forwards on the mylohyoid muscle along with the
mylohyoid nerve. It supplies the mylohyoid muscle
and submandibular and sublingual salivary glands.
From the facial part (in the face)
1. Inferior labial artery: Supplies the lower lip.
2. Superior labial artery: Supplies the upper lip.
3. Lateral nasal artery: To the ala and dorsum of the
nose.
4. Angular artery: It is the terminal part of facial artery
which runs upto the medial palpebral ligament of
the eye lids, where it anastomoses with the branches
of the ophthalmic artery.
5. Small unnamed branches: These are small and
arise from the posterior aspect of the artery.
OCCIPITAL ARTERY
It arises from the posterior aspect of the external
carotid artery at the same level as the facial artery.
It runs backwards and upwards, under cover of
lower border of posterior belly of digastric,
superficial to internal carotid artery, internal jugular
vein and the last 4 cranial nerves.
Then it runs deep to the mastoid process grooving
the lower surface of temporal bone medial to the
mastoid notch.
 Neck and its Triangles 353

It crosses the superior obliquus and semispinalis It then runs vertically upwards crossing the root of
capitis muscles and the apex of sub-occipital zygoma in front of the tragus.
triangle to reach underneath the trapezius muscle. About 5 cm above the zygoma it divides into
It pierces the muscle 2.5 cm away from the midline anterior and posterior branches which supply the
and comes to lie just lateral to the greater occipital temple and scalp.
nerve.
It supplies most of the back of the scalp. Branches
1. Transverse facial artery: It runs forwards across
Branches
the masseter below the zygomatic arch.
1. Sternomastoid branches 2. Middle temporal artery: It runs on the temporal
2. Mastoid artery fossa deep to temporal muscles and supplies
3. Meningeal branches temporal muscles and fascia.
4. Muscular branches 3. Anterior and posterior terminal branches.
5. Auricular branch
6. Descending branches POINTS TO REMEMBER
7. Occipital branches
Pulsations of superficial temporal artery can be felt
in front of the tragus of the ear (where it crosses the
POINTS TO REMEMBER root of zygoma, the preauricular point)
The hypoglossal nerves hooks under the origin of The course of anterior terminal branch of the artery
occipital artery. on the forehead can clearly be seen in bald men
The upper sternocleidomastoid branch accompa- especially during outbursts of anger. It also becomes

C H A P T E R-25
nies the hypoglossal nerve and the lower crosses noticeably more tortuous with increasing age.
the hypoglossal nerve.
Occipital arteries cross the apex of the posterior MAXILLARY ARTERY (Fig. 23.3)
triangle of neck. (See page no. 322).

INTERNAL CAROTID ARTERY (Figs 25.10 and 25.12)

POSTERIOR AURICULAR ARTERY
It arises from the posterior aspect of the external
carotid artery a little above the occipital artery.
It crosses superficial to the stylohyoid muscle.
Then it runs upwards and backwards parallel to
the occipital artery under cover of the upper border
of posterior belly of digastric and deep to the parotid
gland.
It finally becomes superficial and lies on the base
of mastoid process behind the ear which it supplies.
It gives the following branches
1. Stylomastoid artery, which enters the styloma-
stoid foramen to supply the middle ear.
2. Auricular branch
3. Occipital branch
POINT TO REMEMBER
The posterior auricular artery can be accidentally cut
by incisions given during surgery on mastoid antrum.
SUPERFICIAL TEMPORAL ARTERY
It is the smaller but a more direct terminal branch
of the external carotid artery.
It begins behind the neck of mandible, deep to the
upper part of parotid gland.
The internal carotid artery is one of the two terminal
branches of the common carotid artery and is more
direct.
It is considered as the upward continuation of the
common carotid. It supplies structures lying within
the skull and in the orbit.
Origin: It begins at the upper border of the lamina of
thyroid cartilage (at the level of inter-vertebral disc
between C3 and C4) and runs upwards to reach the base
of skull, where it enters the carotid canal in the petrous
temporal bone.
Termination
It enters the cranial cavity by passing through the
upper part of the foramen lacerum.
In the cranial cavity it enters the cavernous sinus
and finally ends below the anterior perforated
substance of the brain by dividing into the anterior
cerebral and middle cerebral arteries.
Structures passing between external and internal
carotid arteries
1. Stylopharyngeus muscle
2. Glossopharyngeal nerve
3. Pharyngeal branch of vagus nerve
 354 Human Anatomy For Dental Students
4. Styloid process
5. Deep part of parotid gland.
Course and Branches
The internal carotid is divided into four parts
1. Cervical part
From its origin the artery ascends vertically
upwards and lies in front of the prevertebral
fascia over the transverse processes of upper
cervical vertebrae.
In neck, the artery is enclosed in the carotid
sheath along with internal jugular vein and
vagus nerve. The vein lies lateral to the artery
while the nerve is posterolateral to the artery.
In the lower part, the artery is superficial and
located in the carotid triangle, behind the
sternocleidomastoid muscle. The external
carotid artery lies anteromedial to it near the
origin.
S E C T I O N-2
Fig. 25.12: Internal carotid artery and its branches
In the upper part, it is deeply located and lies
deep to the posterior belly of digastric, styloid
process with the structures attached to it and
the parotid gland.
At the upper end, near the base of skull, the
internal jugular vein lies posterior to the internal
carotid artery. The last 4 cranial nerves (glosso-
pharyngeal, vagus, accessory and hypoglossal)
lie between the internal jugular vein and internal
carotid artery at this end.
Branches: The internal carotid artery gives no
branches in the neck
2. Petrous part
The internal carotid artery enters the petrous
part of the temporal bone in the carotid canal. It
first runs upwards and then turns forwards and
medially at a right angle.
It is surrounded by the sympathetic plexus of
nerves derived from superior cervical ganglion.

It lies posterior to tympanic cavity and below
the pharyngotympanic tube separated by a thin
bony wall. The trigeminal ganglion lies above
the roof of carotid canal.
It emerges in the posterior wall of foramen
lacerum and passes through its upper part to
enter the cranial cavity.
Branches
a. Carotico-tympanic branch to middle ear
b. Pterygoid branch, a small and inconstant branch
that enters the pterygoid canal.
3. Cavernous part
The internal carotid artery ascends towards
posterior clinoid process from the foramen
lacerum and enters below the cavernous sinus.
In the sinus it passes forwards along the side of
sella turcica in the floor and medial wall of the
sinus. It lies outside the endothelial lining of the
sinus and is related to the abducent nerve infero-
laterally.
In the anterior part of the sinus, the artery
ascends up and pierces the dural roof of the
sinus between the anterior and middle clinoid
processes to reach the undersurface of the
cerebrum.
Branches
a. Cavernous branches to the trigeminal ganglion.
b. Superior and inferior hypophyseal arteries, to
the hypophyseal cerebri (pituitary gland)
Fig. 25.13: Tributaries of internal jugular vein
Neck and its Triangles 355
4. Cerebral part
After emerging from the roof of the cavernous
sinus, the artery turns backwards in the
subarachnoid space along the roof of the
cavernous sinus and lies below the optic nerve.
It finally turns upwards by the side of the optic
chiasma and reaches the anterior perforated
substance of the brain located at the beginning
of the stem of lateral sulcus of the cerebral
hemisphere. Here it ends by dividing into
anterior and middle cerebral arteries.
Branches
a. Ophthalmic artery
b. Anterior choroidal artery
c. Posterior communicating artery
d. Anterior cerebral artery
e. Middle cerebral artery
OPHTHALMIC ARTERY (Fig. 20.3)
(See page no. 288).
C H A P T E R-25
INTERNAL JUGULAR VEIN (Fig. 25.13)
It is the main venous channel of head and neck.
Extent
It begins at the base of the skull in the jugular
foramen as a direct continuation of the sigmoid
sinus.
 356 Human Anatomy For Dental Students
It ends behind the sternal end of the clavicle by
joining the subclavian vein to form the brachio-
cephalic vein.
The vein presents with two dilatations:
a. Superior bulb: First dilatation is at its
commencement which lies in the jugular fossa
of the temporal bone. It is known as the superior
bulb and is related to the floor of the middle
ear.
b. Inferior bulb: Second dilatation lies close to its
termination, in the lesser supraclavicular fossa
between the sternal and clavicular heads of
sternocleidomastoid. This is the inferior bulb
Course
The vein passes vertically down from its origin
within the carotid sheath.
It lies lateral to the internal carotid artery above and
to the common carotid artery below.
The deep cervical lymph nodes are closely related
to the vein.
S E C T I O N-2
POINT TO REMEMBER
At the lower end both the internal jugular veins tend to
shift to the right, so that the right vein comes to lie further
from the right common carotid artery while the left vein
tends to overlap the left common carotid artery.
Tributaries of Internal Jugular Vein
1. Inferior petrosal sinus: It is usually the first
tributary and it connects the cavernous sinus with
the superior bulb of the internal jugular vein
2. Pharyngeal veins: From the pharyngeal plexus
3. Common facial vein: Formed by the union of facial
vein and anterior division of retromandibular vein.
4. Lingual vein: Formed by the union of two
superficial veins accompanying the hypoglossal
nerve called venae commitantes nervi hypoglossi
and two deep lingual veins accompanying the
lingual artery.
5. Superior thyroid vein: From upper part of the
thyroid gland.
6. Middle thyroid vein: From the middle of thyroid
gland. It is a short trunk passing in front of the
carotid sheath. It is the first vein to be ligated in
thyroidectomy (removal of thyroid gland) and
requires careful handling as it is more likely to slip.
7. Occipital vein (only sometimes).
POINTS TO REMEMBER
The thoracic duct opens at the angle of union
between left internal jugular vein and left
subclavian vein. The right lymphatic duct opens
at the angle of union between right internal jugular
vein and right subclavian vein.
In the upper part of neck, internal jugular vein
communicates with the external jugular vein by
the oblique jugular vein.
CLINICAL AND APPLIED ANATOMY
The internal jugular vein is important in various clinical
situations:
a. The internal jugular vein acts as a guide for
surgeons during removal of deep cervical lymph
nodes.
b. A thrill may be felt at the root of neck, in the
supraclavicular fossa, during systole. This occurs
in cases of mitral stenosis where there is an increase
in right atrial pressure because the blood cannot
completely flow into the right ventricle. During
atrial contraction the pressure wave gets
transmitted in a retrograde manner into the vein.
c. The vein can safely be cannulated in cases of cardio
vascular collapse by introducing a needle in
backward and upward direction in the triangular
space between the two heads of origin of
sternocleidomastoid. One should avoid the
puncture of cupola of pleura in this position as it
will lead to pneumothorax.
ANSA CERVICALIS (Figs 25.8 and 25.19)
The ansa cervicalis (ansa hypoglossi) is an U
shaped nerve loop present in the region of carotid
triangle.
It supplies all the infrahyoid muscles.
It has two roots.
1. Superior root(descendens hypoglossi)
It is formed by the descending branch of
hypoglossal nerve carrying the fibres of spinal
nerve C1 . It descends downwards over the
internal and common carotid arteries.
2. Inferior root (descending cervical nerve)
It is derived from C2 and C3 spinal nerves. This
root first descends and winds round the internal
jugular vein, then continues antero-inferiorly to
join the superior root in front of the common
carotid artery.
Distribution
It supplies the infrahyoid muscles of the neck.
POSTERIOR TRIANGLE OF NECK (Figs 25.14 to 25.17)
Boundaries
Anterior : Posterior border of sternocleidomastoid
muscle.
 Neck and its Triangles 357

Posterior : Anterior border of trapezius muscle. The prevertebral layer of deep cervical fascia covers
Base : Middle third of the clavicle. all the muscles of the floor thus forming a fascial carpet
Apex : Meeting point of sternocleidomastoid and of the posterior triangle.
trapezius on the superior nuchal line.
Sub-divisions of Posterior Triangle
Roof: It is formed by the investing layer of deep cervical
The triangle is divided into two parts by the inferior belly
fascia stretching between sternocleidomastoid and
of omohyoid over the scalenus medius.
trapezius muscles.
1. Occipital triangle: Larger, upper part. It lies above
Floor: It is muscular and is formed by the following
the inferior belly of omohyoid muscle.
muscles, from above downwards.
2. Subclavian/supraclavicular triangle: Smaller, lower
1. Semispinalis capitis
part. It lies between inferior belly of omohyoid
2. Splenius capitis
muscle and the clavicle.
3. Levator scapulae
4. Scalenus posterior
5. Scalenus medius Occipital Triangle
6. Outer border of 1st rib Contents (From above downwards)
1. Occipital artery at apex.
2. Spinal part of accessory nerve.
3. Four cutaneous branches of cervical plexus of
nerves emerge at upper part of posterior border of
sternolceidomastoid muscle and consist of:
a. Lesser occipital
b. Great auricular

C H A P T E R-25
c. Transverse cutaneous nerve of neck
d. Supra clavicular
4. Muscular branches of C3 and C4 nerves.
5. Upper part of brachial plexus.
6. Dorsal scapular nerve.
7. Superficial cervical vessels, branches of vertebral
vessels.
8. Lymph nodes.
Fig. 25.14: Boundaries of posterior triangle

Fig. 25.15: Muscles forming floor of posterior triangle Fig. 25.16: Contents of posterior triangle
S E C T I O N-2 358 Human Anatomy For Dental Students

Fig. 25.17: Contents of posterior triangle

Supraclavicular Triangle 2. General somatic efferent: Motor to sterno-

Contents cleidomastoid and trapezius.
1. Supraclavicular nerves.
2. Trunks of brachial plexus of nerves with their
Nuclear Origin
branches:
a. Dorsal scapular nerve 1. Cranial root: It arises from the lower part of nucleus
b. Long thoracic nerve ambiguus and dorsal nucleus of vagus in the
c. Nerve to subclavius medulla.
3. Subclavian artery: 3rd part 2. Spinal root: These fibres arise from an elongated
4. Subclavian vein, lies behind the clavicle motor nucleus extending from C1 to C5 spinal
5. Suprascapular vessels
segments which lies in the lateral part of anterior
6. External jugular vein
7. Supraclavicular lymph nodes grey column.

ACCESSORY NERVE (Fig. 25.18) Intracranial Course

It is the 11th cranial nerve. It is purely motor and consists
of two roots:
1. Cranial root: The fibres of this root are distributed
through vagus and hence it is termed as being
accessory to vagus.
2. Spinal root: It has an independent course and is
sometimes regarded as the true accessory nerve.
Functional Components
1. Special visceral efferent: Motor to muscles of soft
palate, pharynx and larynx.
Cranial Root
The cranial root arises by 4 or 5 rootlets from the
posterolateral sulcus of the medulla, between the
olive and inferior cerebellar peduncle. The rootlets
are attached in line with rootlets of the vagus nerve
above.
These rootlets unite together to form a single trunk
which runs laterally along with 9th and 10th cranial
nerves to reach the jugular foramen where it is
joined by the spinal root.

Fig. 25.18: Accessory nerve and its distribution
Spinal Root
The spinal root arises by a number of rootlets from
the lateral aspect of spinal cord along a vertical line
between the ventral and dorsal roots of the spinal
nerves.
These rootlets unite to form a single trunk which
ascend up in the vertebral canal and enters the
cranial cavity through foramen magnum.
The spinal root leaves the skull through the jugular
foramen where it fuses with the cranial root.
Extracranial Course
The combined trunk comes out of the cranial cavity
through the jugular foramen enclosed in a dural
sheath along with the vagus nerve.
Immediately after coming out of the cranial cavity
the two roots again separate. The cranial root joins
the vagus nerve just above its inferior ganglion. Its
fibres are distributed through the branches of the
vagus nerve to the muscles of the palate, pharynx
and larynx.
Neck and its Triangles 359
C H A P T E R-25
The spinal root of accessory nerve descends
vertically downwards between the internal jugular
vein and the internal carotid artery.
When it reaches a point midway between the angle
of mandible and the mastoid process, it turns
downwards and backwards, passing deep to the
styloid process at the upper end of carotid triangle.
It crosses in front of the transverse process of the
atlas under the posterior belly of digastric,
stylohyoid and occipital artery. It is then
accompanied by the upper sternomastoid branch
of the occipital artery.
The nerve pierces the sternocleidomastoid muscle
at the junction of its upper 1/4th with the lower
3/4th and supplies it.
It passes through the muscle and emerges through
its posterior border a little above its middle to enter
the posterior triangle of the neck. Here, it is related
to the superficial cervical lymph nodes.
It runs downwards and backwards underneath the
fascial roof of the posterior triangle, parallel to the
fibres of levator scapulae.
 360 Human Anatomy For Dental Students
It leaves the posterior triangle by passing along with
C2, C3 and C4 spinal nerves under the anterior
border of trapezius, 5cm above the clavicle.
The C2 and C3 spinal nerves supply proprioceptive
fibres to the sternocleidomastoid, while C3 and C4
supply proprioceptive fibres to the trapezius
muscle.
Branches
1. Muscular branches
a. To sternocleidomastoid along with C2 and C3
nerves.
b. Supplies trapezius along with C3 and C4 nerves.
2. Communicating branches: It communicates with
the following cervical spinal nerves.
a. C2, deep to sternocleidomastoid
b. C2,C3, in the posterior triangle
c. C3 and C4, deep to trapezius
CLINICAL AND APPLIED ANATOMY
S E C T I O N-2
Injury to the spinal accessory nerve can occur
during incisions given in the region of
Fig. 25.19: Cervical plexus
sternocleidomastoid for drainage of a superficial
abscess. It causes
a. Paralysis of the sternocleidomastoid -The neck
is flexed to the opposite healthy side and face
is turned to the same i.e. paralysed side due to
the unopposed action of the normal
sternocleidomastoid muscle. The condition is
called as a wry neck.
b. Paralysis of trapezius: The patient is unable to
straighten his shoulder against resistance.
Spasmodic torticollis may result from a central
irritation of the spinal accessory nerve leading to
clonic spasm of the sternocleidomastoid muscle.
CERVICAL PLEXUS (Fig. 25.19)
Cervical plexus of nerves supplies the skin and the
muscles of neck. It also gives rise to the phrenic nerve
which supplies the diaphragm.
The plexus is formed by the interconnection of
ventral rami of upper 4 cervical nerves.
Each nerve except C1 divides into two branches,
one upper and one lower.

The ventral ramus of C1 and the branches of ventral
rami of C2 to C4 join with each other to form three
loops. The first loop is directed forwards in front of
the transverse process of C1, while the other two
are directed backwards.
Important relations: The plexus lies on the levator
scapula and scalenus medius muscles under the
prevertebral fascia. The sternocleidomastoid muscle is
present anterior to this.
Branches of Cervical Plexus
1. Superficial cutaneous branches
a. Lesser occipital nerve: C2
b. Great auricular nerve: C2, 3
c. Transverse cervical nerve: C2, 3
d. Supraclavicular nerve: C3, 4
2. Deep muscular branches: They supply the muscles
directly or indirectly via communicating branches.
Direct branches:
a. Phrenic nerve: C 3, 4, 5: This supplies the
diaphragm.
b. Descendens cervicalis nerve: C2, 3: This joins
with descendans hypoglossi to form ansa
cervicalis in front of the carotid sheath. It
supplies sternohyoid, sternothyroid and inferior
belly of omohyoid.
c. Muscular branches.
Indirect branches:
1. Branch from C1 communicates with hypoglo-
ssal nerve to supply thyrohyoid, geniohyoid and
superior belly of omohyoid.
2. C2, 3, 4 communicates with the spinal root of acce-
ssory nerve to supply sternocleidomastoid (C2).
c. Communicating branches: Each ventral ramus of
the cervical nerve receives a grey rami communi-
cantes from the superior cervical ganglion of
sympathetic trunk.
PHRENIC NERVE
Origin
It arises from the ventral rami of C3, 4, 5 spinal nerves but
chiefly from C4.
Course
It runs vertically downwards on the anterior surface of
the scalenus anterior and crosses it obliquely from lateral
to medial side. Then it runs downwards on the cervical
pleura to enter the thorax behind the 1st costal cartilage.
Distribution: It provides the sole motor supply to the
diaphragm which is the main muscle of respiration. It
also provides sensory innervation to the diaphragmatic
pleura, pericardium and subdiaphragmatic pleura.
Neck and its Triangles 361
Accessory Phrenic Nerve
It is a branch from the nerve to subclavius
containing C5 fibres.
It runs lateral to the phrenic nerve and descends
behind the subclavian vein to join the main phrenic
nerve near the first rib.
SUBCLAVIAN ARTERY (Fig. 25.20)
The subclavian artery supplies the brain, neck, part of
thorax and continues as axillary artery to supply upper
limb.
Origin
Right subclavian artery arises from the brachio-
cephalic trunk behind the right sternoclavicular
joint at the root of neck.
Left subclavian artery arises from the arch of aorta
in the thorax.
Termination: At the outer border of first rib the artery
continues as the axillary artery.
Course
C H A P T E R-25
The right subclavian artery has a cervical part only
whereas the left subclavian has a thoracic and a
cervical part.
The left subclavian artery runs upwards on the left
mediastinal pleura and makes groove on the left
lung. It enters the neck by passing behind the left
sternoclavicular joint.
The cervical part of each subclavian artery takes a
similar course.
The artery extends from the sternoclavicular joint
to the outer border of the first rib taking a curved
course over the cervical pleura with convexity
facing upwards.
Parts and Relations of Subclavian Artery
Each artery is divided into three parts by the scalenus
anterior muscle.
1. First part extends from origin to medial border of
scalenus anterior. It has the following relations:
Anterior : Infrahyoid muscles, anterior
jugular vein.
On left side : Thoracic duct, phrenic nerve.
Posterior : Apex of lung covered with
cervical pleura, inferior cervical
ganglion of sympathetic trunk.
On right side : Right recurrent laryngeal nerve.
2. Second part, lies behind the scalenus anterior
muscle. It has the following relations:
Anterior : Scalenus anterior, subclavian
vein, sternocleidomastoid.
On right side : Phrenic nerve.
 362 Human Anatomy For Dental Students

Fig. 25.20: Subclavian and vertebral arteries

S E C T I O N-2

Posterior : Apex of lung and cervical pleura, POINT TO REMEMBER

lower trunk of brachial plexus, Sometimes dorsal scapular artery may arise from
scalenus medius. transverse cervical artery (a branch of thyro-cervical
3. Third part extends from lateral border of scalenus trunk). In that case there will be only 4 branches from
anterior to the outer border of first rib. It has the subclavian artery.
following relations:
Anterior : Skin, superficial fascia with VERTEBRAL ARTERY (Fig. 25.20)
platysma, deep fascia with
external jugular vein, clavicle in Origin
lower part. The vertebral artery arises from the upper aspect of the
Posterior : Lower trunk of brachial plexus, first part of the subclavian artery.
scalenus medius.
Below : Subclavian vein, upper surface of Course
1st rib. It runs vertically upwards to enter the foramen
transversarium of the transverse process of C6
Above : Upper trunk of brachial plexus,
vertebra.
inferior belly of omohyoid. Then it passes through the foramen transversaria
of upper six cervical vertebra.
Branches After it emerges from the foramen trasversarium
of C1, it winds backwards around the lateral mass
Usually the subclavian artery gives five branches: of the atlas and enters the foramen magnum to go
From first part into the cranial cavity.
1. Vertebral artery In the cranial cavity it unites with the vertebral
2. Internal thoracic artery artery of the other side at the lower border of the
3. Thyrocervical trunk pons to form the basilar artery.
4. Costocervical trunk (on left side only) Parts
From second part The vertebral artery is subdivided into 4 parts namely
5. Costo-cervical trunk (on right side only) 1. First part: It extends from the origin to the foramen
From third part transversarium of C6. This part lies in the scaleno-
6. Dorsal scapular artery vertebral triangle.

2. Second part (also called vertebral part): It lies
within the foramen transversaria of upper six
cervical vertebrae.
3. Third part: It extends from foramen transversarium
of C1 to the foramen magnum. This part lies with
in the suboccipital triangle.
4. Fourth part (also called intracranial part): It
extends from foramen magnum to the lower part
of the pons.
Branches
In the neck (Cervical branches)
1. Spinal branches, which enter the vertebral canal
through intervertebral foramen to supply the upper
5 or 6 cervical segments of the spinal cord.
2. Muscular branches, they arise from the 3rd part of
vertebral artery and supply muscles of suboccipital
triangle.
In the Cranial Cavity (Cranial branches)
1. Meningeal branches, they supply meninges of
posterior cranial fossa.
2. Posterior spinal artery (sometimes it may arise
from posterior inferior cerebellar artery). It passes
downwards and divides into anterior and posterior
branches. It first passes in front and later behind
the dorsal roots of the spinal nerves to supply the
spinal cord.
3. Posterior inferior cerebellar artery (largest branch
of the vetebral artery). It winds round the medulla
and takes a tortuous course. It supplies:
a. Lateral part of the medulla
b. Inferior vermis and infero-lateral surface of the
cerebellar hemisphere (see brain)
4. Anterior spinal artery
5. Medullar branches supply the medulla.
CLINICAL AND APPLIED ANATOMY
Subclavian steal syndrome: If there is obstruction of
subclavian artery proximal to the origin of vertebral
artery, some amount of blood from opposite vertebral
artery can pass in a retrograde fashion to the subclavian
artery of the affected side through the vertebral artery
of that side to provide the collateral circulation to the
upper limb on the side of lesion. Thus there is stealing
of blood meant for the brain by the subclavian artery
of the affected side.
INTERNAL THORACIC ARTERY (INTERNAL
MAMMARY ARTERY)
The internal mammary artery arises from the
inferior aspect of the first part of the subclavian
artery opposite the origin of thyrocervical trunk.
Neck and its Triangles 363
It passes downwards and medially in front of the
cupola of cervical pleura and enters the thorax
behind the sternoclavicular joint.
In the thorax it passes vertically downwards about
1.25 cm from the lateral border of the sternum and
at the level of 6th intercostal space divides into two
terminal branches:
1. Musculophrenic
2. Superior epigastric arteries.
THYROCERVICAL TRUNK
The thyrocervical trunk arises from the upper aspect of
the first part of subclavian artery lateral to the origin of
vertebral artery.
Branches of Thyrocervical Trunk
The thyrocervical trunk is very small and divides almost
at once into three branches:
1. Inferior thyroid artery: It passes upwards in front of
the medial border of scalenus anterior. Then arches
medially at the level of C7 vertebra to reach the lower
C H A P T E R-25
border of the lateral lobe of the thyroid gland and
ends by giving of ascending and descending
glandular branches. The ascending branch
anastomoses with the superior thyroid artery. It
supplies the thyroid and parathyroid glands.
Branches
a. Ascending cervical artery passes upwards,
infront of the transverse processes of cervical
vertebrae along the medial side of the phrenic
nerve
b. Inferior laryngeal artery accaompanies the
recurrent laryngeal nerve and supplies the
mucous membrane of the larynx below the vocal
cord.
c. Tracheal and oesophageal branches to trachea
and oesophagus respectively.
d. Glandular branches.
2. Superficial cervical artery: It passes laterally and
upwards across the scalenus anterior to reach the
posterior triangle where it lies in front of the trunks
of brachial plexus. The artery ascends beneath the
trapezius and anastomoses with the superficial
division of the descending branch of the occipital
artery.
3. Suprascapular artery: It passes laterally across the
scalenus anterior to lie in front of the third part of
subclavian artery and brachial plexus. Now, it
passes behind the clavicle to reach the supra-
scapular border of the scapula and passes above
the suprascapular ligament to enter the supra-
scapular fossa. It takes part in the formation of
arterial anastomosis around the scapula.
 364 Human Anatomy For Dental Students
COSTOCERVICAL TRUNK
It arises from the posterior aspect of:
a. First part of the subclavian artery on the left side
b. Second part of the subclavian artery on the right
side.
The artery arches backwards above the cupola of
the pleura and on reaching the neck of first rib
divides into deep cervical and superior intercostal
arteries.
The deep cervical artery passes backwards between
the transverse process of C7 vertebra and the neck
of the first rib. It then ascends between the
semispinalis capitis and semispinalis cervicis and
anastomoses with the deep division of the
descending branch of occipital artery.
DORSAL SCAPULAR ARTERY
It arises from the third part of the subclavian artery,
sometimes from the second part.
It passes laterally and backwards between the
trunks of brachial plexus to reach underneath the
levator scapulae.
Now, it descends along the medial border of the
S E C T I O N-2
scapula along with the dorsal scapular nerve, deep
to the rhomboids and takes part in the formation
of arterial anastomosis around the sacpula.
POINT TO REMEMBER
In 30% cases the dorsal scapular artery and superficial
cervical artery take a common origin from the
thyrocervical trunk under the name of transverse
cervical artery.
SUBCLAVIAN VEIN
It is the continuation of axillary vein.
Extent
It extends from the outer border of the first rib to the
medial border of scalenus anterior where it joins the
internal jugular vein to form the brachiocephalic vein.
Course
The subclavian vein forms an arch across the pleura
at a level below the arch of subclavian artery. The
two arches are separated from each other by
scalenus anterior muscle.
It does not extend much above the clavicle and is
provided with a pair of valves about 2 cm from its
termination.
Relations
Anterior : Clavicle, subclavius muscle.
Posterior : Phrenic nerve, scalenus anterior,
subclavian artery.
Inferior : 1st rib, cupola of pleura.
Tributaries
1. External jugular vein
2. Dorsal scapular vein
3. Thoracic duct on the left side and right lymphatic
duct on the right side
4. Anterior jugular vein
5. Cephalic vein
CLINICAL AND APPLIED ANATOMY
Structures that pierce the fascial roof of posterior
triangle are: The cutaneous branches of cervical
plexus: These nerves emerge in the posterior
triangle of the neck from under the posterior border
of sternocleidomastoid in its middle and run along
different directions to finally pierce the investing
layer of deep fascia and supply the respective areas
of skin. These are :
a. Lesser occipital nerve (C2)
b. Great auricular nerve (C2, C3)
c. Transverse cervical cutaneous nerve (C2, C3)
d. Supraclavicular nerve (C3, C4)
External jugular vein: It pierces the deep fascia
from without to drain into the subclavian vein.
 Chapter
26
Back of Neck and The Back
The back refers to the posterior aspect of trunk of body.
The musculoskeletal framework of back is responsible
for transmission of body weight, maintaining posture
of head and body and helping in movements of upper
limb.
SKIN AND FASCIA OF BACK
The skin over back is relatively thicker as compared to
anterolateral aspect of trunk. The superficial fascia of
back is also thicker and contains more fatty tissue than
the anterior and lateral aspects of the trunk. Deep fascia
of back is demarcated into two parts and consists of:
1. Deep cervical fascia: The investing layer of deep
cervical fascia is the deep fascia of back of neck. It
is attached to external occipital protuberance above
and tip of spine of C7 vertebra below and in between
to ligamentum nuchae (see page no. 519). It extends
bilaterally splits to enclose the trapezius muscle and
reunites to its anterior margin to continue anteriorly
over neck. Inferiorly, it is attached to the upper
border of spine of scapula and adjoning posterior
margin of acromion process along with trapezius.
2. Thoracolumbar fascia: In thorax: It is thin and
covers the deep muscles of the back. It is attached
to the tip of spines of thoracic vertebrae and
extends on each side, laterally to attach on the outer
surface of the corresponding ribs, from the neck to
the posterior angle of rib. It lies anterior to extrinsic
muscle of back namely, serratus posterior superior,
rhomboideus major and minor, trapezius and
serratus posterior inferior. These muscles lie under
the superficial fascia of thoracic back.
In lumbar region, thoracolumbar fascia has three
layers. Outer layer is most superficial and is
attached to tip of spines of lumbar vertebrae and
sacrum and the intervening supraspinous liga-
ment. Middle layer is attached from above
downwards to lower border of twelfth rib, tip of
transverse processes of lumbar vertebrae,
intertransverse ligaments, posterior part of ventral
segment of iliac crest. Anterior layer of thora-
columbar fascia is attached from above
downwards to apex and adjoining inferior border
of 12th rib, anterior surface of transverse processes
of lumbar vertebrae, lateral to attachment of psoas
major.
The posterior layer covers the erector spinae
muscles of lumbar region, giving origin to
latissimus dorsi superficial to it. The posterior and
middle layer meet at the lateral margin of erector
C H A P T E R-26
spinae muscle. Further laterally they are joined by
the anterior layer and they provide for the
aponeurotic origin of transversus abdominis
muscle. The thoracolumbar fascia is continuous
with anterolateral muscles of the anterior
abdominal wall and there is no distinct deep fascia
in the anterior abdominal wall.
SKELETAL FRAMEWORK OF BACK
It primarily consists of vertebral column, the lower part
of back of skull, posterior aspects of ribs and scapulae
and iliac bones are also part of skeletal framework of
back. They provide attachment to superficial or extrinsic
muscles of back.
Vertebral Column and its ligaments and joints are
described in chapter 4 page no. 64 .
MUSCULATURE OF BACK (Fig. 26.1)
Muscles of back are arranged in layers and are divided
mainly into extrinsic or superficial group and intrinsic
or deep group.
Extrinsic Group of Muscles of Back
These lie under the posterior lamina of deep cervical
fascia in neck while they lie superficial to the
thoracolumbar fascia in thorax. In lumbar area, where
the thoracolumbar fascia is distinguished into three
layers, the muscles lie between the posterior and middle
layers of the fascia. They attach the vertebral column to
skull, ribs, bones of upper limb namely, clavicle, scapula
 366 Human Anatomy For Dental Students
and humerus and are involved in movements of upper
limb. These include:
1. Trapezius
2. Latissimus dorsi
3. Rhomboideus major
4. Rhomboideus minor
5. Levator scapulae
6. Muscles over posterior surface of scapula namely,
supraspinatus, infraspinatus, teres major and teres
minor.
7. Muscles on posterolateral aspect of back namely,
posterior most parts of serratus anterior, external
intercostals and external oblique muscles.
8. Serratus posterior.
They are innervated by ventral rami of spinal nerves.
The various muscles mentioned above are described in
upper limb (see page no. 48).
Serratus Posterior
It lies in thoracic region and consists of two parts namely:
1. Serratus posterior superior: It is a thin, quadri-
lateral muscle.
S E C T I O N-2
Origin: It originates by a thin aponeurosis from
lower part of ligamentum nuchae, spines of C7 and
T 1 and T 2 vertebrae and the corresponding
supraspinous ligament.
Insertion: It presents four digitations which
descend laterally and downwards to attach to
upper border and adjacent external surface of 2nd
to 5th ribs, lateral to their angles.
Nerve supply: It is supplied by T2 to T5 intercostal
nerves.
2. Serratus posterior inferior: It is a thin quadrilateral
muscle.
Origin: It arises from spines of T11, T12, L1 and L2
vertebrae and the supraspinous ligament.
Insertion: It presents four digitations which pass
upwards and laterally to attach to inferior border
and adjacent external surface of 9th to 12th ribs,
lateral to the angles of the ribs.
Nerve supply: It is supplied by ventral rami of T9
to T12 thoracic spinal nerves.
Intrinsic or Deep Muscles of Back
They develop along the vertebral column and extend
from skull to iliac bone in central part of back. They are
supplied by the dorsal rami of spinal nerves.
The intrinsic group of muscle are further arranged
in superficial and deep layers.
1. The superficial layer has splenius group of muscles
in neck and upper thorax and erector spinae group
in thorax and lumbar regions.
2. The deep group consists of suboccipital group in
neck and transversospinal group of muscles
extending from lower aspect of skull to sacrum.
Splenius Group
This is the outermost group and consists of splenius
capitis which lies deep to trapezius and serratus
posterior superior muscles and splenius cervicis which
lies deep to levator scapulae.
1. Splenius capitis
Origin: Lower of ligamentum nuchae and spines
of C7 to T3 vertebrae.
Insertion: Fibers pass upwards and laterally to
attach to mastoid process and adjoining area of
occipital bone just below lateral 1/3rd of superior
nuchal line.
2. Splenius cervicis
Origin: Spines of T3 to T6 vertebrae.
Insertion: Posterior tubercles of transverse
processes of C1 and C2 vertebrae.
Nerve supply of splenius group of muscles: Splenius
group of muscles are supplied by dorsal rami of middle
cervical spinal nerves.
Actions of splenius capitis and cervicis:
1. Contraction of both splenius capitis and cervicis of
both sides results in extension of neck.
2. Contraction of splenius capitis and cervicis of one
side results in rotation of neck to the same side.
Erector Spinae
It is a large muscle extending from back of the sacrum
and ilium upto the skull. It lies under the splenius
muscles. It consists of 3 longitudinally arranged muscles
namely, spinalis, medially; longissimus, intermediate
in position and Iliocostocervicalis, laterally.
1. Spinalis group: It is ill-defined in the neck and is
identifiable as a thin slip of muscle in thoracic
region.
a. Spinalis capitis: It extends from lower cervical
spines to occipital bone and blends with
semispinalis capitis.
b. Spinalis cervicis: It extends from lower part of
ligamentum nuchae and spine of C7 vertebra to
the spine of axis vertebra.
c. Spinalis thoracic: It is attached to spines of T11,
T12, L1 and L2 vertebrae and extends above to
attach to spines of T4 to T8 vertebra.
2. Longissimus group
a. Longissimus capitis: It is attached below to the
transverse processes of upper four thoracic
vertebrae and articular processes of lower three
to four cervical vertebrae. It extends up to attach
to the posterior margin of mastoid process of
temporal bone deep to splenius capitis.
b. Longissimus cervicis: It extends from
transverse proceses of upper four thoracic
vertebrae to the posterior tubercles of transverse
processes of C2 to C6 vertebrae.
c. Longissimus thoracis: It is attached below to
the posterior surfaces and accessory processes
 Back of Neck and the Back 367

C H A P T E R-26

Fig. 26.1: Muscles of the back

 368 Human Anatomy For Dental Students
of lumbar vertebrae and middle layer of thoraco
lumbar fascia. It extends up to attach to the
transverse process of T1 to T12 vertebrae and the
outer surface of lower ten ribs just medial to the
posterior angle.
3. Iliocostalis group
a. Iliocostalis cervicis: It extends from the inferior
borders of angles of third to sixth ribs to the
posterior tubercles of transverse processes of
fourth to sixth cervical vertebrae.
b. Iliocostalis thoracis: It extends from the upper
borders of angles of lower six ribs to the upper
borders of angles of upper six ribs.
c. Iliocostalis lumborum: The lowest attachment
of erector spinae group of muscles is from the
median sacral crest, spines of lumbar and lower
thoracic vertebrae, supraspinous ligament and
posterior iliac crest. The fibres extend up to
attach to the inferior borders of angles of lower
six ribs.
Nerve supply of erector spinae group of muscles: They
S E C T I O N-2
are supplied by dorsal rami of lower cervical spinal
nerve.
Actions of erector spinae group of muscles :
1. This group is the chief extensor of the neck.
2. Longissimus capitis extends the head and aids in
turning the face to the same side.
Transverso-spinalis Group of Muscles
They are the deepest group of muscles lying obliquely
between the transverse processes and spines of the
vertebrae. They are further divided into:
1. Semispinalis: It is most superficial in position and
consists of three parts:
a. Semispinalis capitis
Origin: Transverse processes of upper six to
seven thoracic vertebrae and the C7 vertebra,
Articular processes of C4 to C6 vertebrae.
Insertion: Medial part of area between superior
and inferior nuchal lines on the external surface
of occipital bone.
b. Semispinalis cervicis
Origin: Transverse processes of upper five to
six thoracic vertebrae.
Insertion: Spines of C2 to C5 vertebrae.
c. Semispinalis thoracis:
Origin: Transverse process of T6 to T10 vertebrae.
Insertion: Spines of lower two cervical vertebrae
and upper four thoracic vertebrae.
2. Multifidus: This group is intermediate in position.
It consists of fleshy fasciculi of muscle fibres
between adjacent vertebra and extends from the
sacrum, ilium, transverse processes of thoracic
vertebrae and articular processes of cervical
vertebra as short oblique bundles of fibres.
Origin: Transverse process of lower cervical
vertebra.
Insertion: Spine of vertebra at the higher level.
3. Rotatores: They are the deepest group of muscles
and are best developed in thoracic region. They
consist of slips of muscle fibres which extend from
the transverse process of one vertebra to the lamina
of the vertebra above its origin. They consist of three
parts:
a. Rotatores thoracis
b. Rotatores cervicis
c. Rotatores lumborum
4. Other deep muscles
a. Interspinalis
b. Inter transversii
c. Suboccipital muscles
Nerve supply of transverso-spinalis group of msucles:
It is by the dorsal rami of corresponding cervical spinal
nerves.
Actions of transverso-spinalis group of muscle: They
help in extension of neck for maintaining posture of head
and neck.
Movements of Vertebral Column
Following movements occur at the vertebral column
1. Flexion
2. Extension
3. Lateral flexion
4. Rotation
5. Circumduction
These movements are restricted by limited
deformation of the intervertebral discs and shape of
articular facets in different regions of vertebral column.
Movement Muscles responsible
Flexion Longus cervicis, scalene, sternocleido-
mastoid and rectus abdominus of both side.
Extension Erector spinae, splenius and semispinalis
capitis, trapezius of both side.
Lateral flexion Longissimus, iliocostocervicalis, oblique
abdominal muscles and flexors.
Rotation Small rotators, multifidus, splenius
cervicis and oblique abdominal muscles.

Fig. 26.2: Muscles of the back of neck (at level of C5)
BACK OF NECK (Figs 26.1 and 26.2)
The posterior aspect of neck is primarily muscular.
Ligamentum nuchae divides the back of neck into two
halves. Each half of neck is covered by muscles which
lie between the deep cervical fascia and posterior aspect
of cervical vertebrae. The muscles of the back of neck
are arrnaged in layers and consist of the extrinsic group
and the intrinsic group of muscles.
1. Extrinsic group: These are placed superficially and
are primarily involved in the movements of upper
limb. They consist of the following muscles and are
discussed in the respective chapter:
a. Trapezius
b. Levator scapulae
c. Rhomboideus major and minor
2. Intrinsic group: The intrinsic group of muscles of
back of neck are responsible for maintaining the
Fig. 26.3: Left suboccipital triangle showing contents right suboccipital triangle showing boundaries
Back of Neck and the Back 369
upright posture of head. They are further arranged
in three groups from superficial to deep namely,
splenius group of muscles, erector spinae,
transversospinalis group of muscles. They have
already been described above.
C H A P T E R-26
Actions of muscles of back of neck
1. The main function of these muscles is to maintain
posture.
2. Erector spinae are chief extensors of the neck.
3. Semispinalis casuses extension of head.
4. All three groups are also rotators of the vertebral
column.
Suboccipital Triangles (Fig. 26.3)
These are a pair of muscular triangles situated deep in
the suboccipital region one on either site of midline and
are bounded by 4 suboccipital muscles.
 370 Human Anatomy For Dental Students

Boundaries 2. Dorsal ramus of C1 (suboccipital nerve).

Superomedial : Rectus capitis posterior major,
supplemented by rectus capitis
posterior minor.
Superolateral : Obliquus capitis superior.
Inferior : Obliquus capitis inferior.
Roof : It is formed by dense fibrous
tissue which is covered by semi-
spinalis capitis medially and
longissimus capitis laterally.
Floor : It is formed by posterior arch of
atlas and posterior atlanto-
occipital membrane.
Contents of Suboccipital Triangle
1. Third part of vertebral artery.
3. Suboccipital plexus of veins.
Suboccipital Muscles
These are a group of small muscles situated in the upper
most part of back of neck below the semispinalis capitis.
They connect occipital bone to the first and second
cervical vertebra. They form the boundaries of sub-
occipital triangle which is present on each side of the
midline.
Nerve supply: Dorsal ramus of C1 spinal nerve.
Actions
1. They primarily act in extension of neck at atlanto
occipital joints.
2. The recti muscles along with obliquus capitis
inferior rotate the face to the same side.

Suboccipital Muscles
Muscles Origin Insertion
S E C T I O N-2

Rectus capitis posterior major
Rectus capitis posterior minor
Obliquus capitis superior
Obliquus capitis inferior
Spine of axis vertebra Lateral part of inferior nuchal line and
the area below it.
Posterior tubercle of arch of atlas Medial part of inferior nuchal line and
the area below it.
Upper surface of transverse process Lateral part of the area between
of atlas superior and inferior nuchal lines.
Lateral surface of spine of and Posterior aspect of transverse process
adjacent lamina of axis vertebra of atlas vertebra.
 Chapter

27
Oral Cavity

INTRODUCTION Oropharyngeal Isthmus

Oral cavity is the first part of digestive tract. It is adapted Boundaries:
to receive food (ingestion) and break it down to small Superiorly : Soft palate
pieces (mastication) for easy swallowing. It also helps Inferiorly : Tongue
in speech and respiration. It is divided into two parts: On each side : Palatoglossal arches
1. Oral cavity proper Palatoglossal arches are folds of mucus membrane
2. The vestibule running vertically down from each side of soft palate to
the corresponding lateral aspect of tongue.
ORAL CAVITY PROPER (Figs 27.1 and 27.2)

C H A P T E R-27
It is the larger part of the oral cavity. VESTIBULE (Fig. 27.2)
The vestibule of mouth is a narrow space that lies
Boundaries outside the teeth and gums and inside the lips and
Anteriorly : Alveolar arches with teeth and gums on cheeks.
each side. When the mouth is open, it communicates with the
Roof : Hard and soft palate. oral cavity proper but when the mouth is closed,
Floor : Two mylohyoid muscles and other soft i.e., when the teeth are occluded it communicates
tissues. with the oral cavity through a small gap behind
the third molar tooth The vestibule is lined by
Posteriorly : Palatoglossal arch.
mucous membrane except in the area of teeth.
Contents: It is largely occupied by the tongue posteriorly.
Openings in the Vestibule of the Mouth
Communication
1. Opening of parotid duct: The parotid duct opens
The oral cavity communicates posteriorly with the into the lateral wall of vestibule opposite the crown
pharynx through the oropharyngeal isthmus also called of upper second molar tooth.
isthmus of fauces. 2. Openings of labial and buccal mucous glands.
3. Openings of 4 to 5 molar glands (mucous) situated
on the buccopharyngeal fascia.

LIPS AND CHEEKS

Lips
Lips are a pair of mobile musculo-fibrous folds that
surround the opening of the mouth.
Upper and lower lips meet laterally on each side at
an angle called angle of mouth.
The lips are lined externally by skin and internally
by mucous membrane. The mucocutaneous
junction lies at the edge of the mucosal surface and
is normally visible.
The center of upper lip presents with a depression
known as philtrum which is limited by ridges of
Fig. 27.1: Oral cavity the skin.
 372 Human Anatomy For Dental Students
Fig. 27.2: Sagittal section through oral cavity
The internal aspect of each lip is connected to the
S E C T I O N-2
corresponding gum by a median fold of the mucous
membrane called frenulum of the lip.
Structure: Each lip is largely composed of
orbicularis oris muscle. In addition it contains labial
(mucous) glands and blood vessels. It is lined
externally by skin which contains sweat glands and
sebaceous glands with hair follicles (The hairs are
thicker and more numerous in adult males). They
are lined internally with mucus membrane. The
mucocutaneous junction appears as a reddish pink
area visible externally. It is lined by thinly
keratinized stratified squamous epithelium
overlying a highly vascular dermis which is
responsible for the colour. It does not have any hair.
Arterial supply of lips is derived from superior and
inferior labial arteries, branches of facial artery.
Lymphatics of lips drain into the following lymph
nodes:
a. Submandibular lymph node: Drain upper lip
and lateral halves of lower lip.
b. Submental lymph nodes: Drain centre portion
of lower lip.
Skin of lips is innervated by branches of infraorbital
nerve (upper lip) and mandibular nerve (lower lip).
Muscles are supplied by facial nerve.
Cheeks
Cheeks are the fleshy flaps which lie over maxilla
and mandible and form a large part of the face.
Each cheek is continuous in front with the lip. The
junction between the two is marked by the naso-
labial sulcus or the furrow which extends from the
side of the nose to the angle of the mouth.
Like the lips the cheeks are lined externally by skin
and internally by mucous membrane.
Structure: The cheek is largely composed of the
buccinator muscle. In addition it also contains
buccal glands, blood vessels and nerves. The
buccinator muscle overlies the buccal pad of fat
(best developed in infants) and is internally lined
by buccopharyngeal fascia.
Layers of the cheek: From superficial to deep:
1. Skin
2. Superficial fascia containing muscles of facial
expression
3. Buccinator
4. Buccal pad of fat
5. Buccopharyngeal fascia
6. Submucosa, containing buccal (mucous) glands
7. Mucous membrane
The last five layers of the cheek are pierced by the
parotid duct.
Arterial supply of cheeks is derived from buccal
branch of maxillary artery.
Lymphatics from cheek drain into submandibular
and preauricular lymph nodes.
Skin of cheek is innervated by zygomaticofacial and
infraorbital branches of maxillary nerve, mucus
membrane is supplied by buccal branch of mandi-
bular nerve. Muscles are supplied by facial nerve.
Oral Mucosa
The mucosal lining of oral cavity continues with
the skin of lips anteriorly and mucosa of oropharyx
posteriorly.
It can be divided into three types according to the
anatomical location and function:
1. Lining mucosa: It consists of non-keratinized
stratified squamous epithelium. It lines the inner

aspect of lips and cheeks, covers soft palate,
ventral surface of tongue, floor of mouth and
lower part of upper and lower alveolar
processes (jaws). It overlies a loose layer of
lamina propria and has submucosa which
contains fat and minor salivary glands.
2. Masticatory mucosa: It is the mucosa that lines
the upper part of alveolar process, neck of teeth
and the hard palate. It consists of keratinized
stratified squamous epithelium with minimal
lamina propria that has connective tissue fibers
which adhere the epithelium to the underlying
bone. There is no submucosa. This modification
allows the epithelium to bear the stress of
mastication.
3. Specialised mucosa: It is the mucosa which
covers the dorsal surface of tongue. It consists
of stratified squamous non-keratinized epithe-
lium which is directly adherent to the under-
lying muscles. There is no submucosa. It gives
rise to a number of projections called lingual
papillae which are described ahead with
tongue.
Gingiva (Gum)
Gingiva is the masticatory mucosa that covers the
alveolar processes of maxilla (upper jaw) and mandible
Fig. 27.3: Structure of a tooth
Oral Cavity 373
(lower jaw) and surrounds the neck of teeth. It can be
divided into two parts:
1. Attached gingiva: It is firmly bound to the
periosteum of the alveolar bone and tooth.
2. Free or unattached gingiva: It is the distal 1 mm
margin of gingiva that surrounds the neck of the
tooth and is not attached to the bone.
Gingival sulcus is a shallow space between the
inner aspect of gingiva and the alveolar bone.
Interdental gingiva is the mucosal extension
which fills the space between two adjacent teeth.
The gingival tissues derive their blood supply
from branches of maxillary artery (supplies the
buccal and labial surfaces) and lingual artery
(supplies the lingual surfaces).
Lymphatics from gingivae drain into submandi-
bular lymph nodes.
Gingivae of upper jaw are supplied by branches
of maxillary nerve while of lower jaw are
supplied by branches of mandibular nerve.
TEETH (Fig. 27.3)
C H A P T E R-27
Teeth are mineralized or horny structures projecting
from the jaws.
Study of teeth, strictly speaking, forms the subject
of odontology and the science concerned with
diagnosis and treatment of diseases of the teeth and
 374 Human Anatomy For Dental Students
associated structures is called dentistry (L.dens,
dentis, = tooth)
Anatomical Features
Each tooth consists of the following three parts :
1. Crown: The part which projects above the gum.
2. Root: It is the part which is embedded within the
socket of jaw beneath the gum.
3. Neck: It is the constricted part of tooth present
between the crown and root. Neck of tooth is
encircled by the gum.
Structure of a Tooth
Each tooth is composed of the following:
1. Pulp cavity: It is the inner soft tissue core containing
blood vessels, nerves and lymphatics in a
specialized connective tissue called pulp. The pulp
is covered by a layer of tall columnar cells called
odontoblasts.
2. Dentine: It is the calcified material surrounding the
pulp cavity. It is produced by odontoblasts and
forms a major part of the tooth. It is avascular and
is mainly made up of mineral crystals arranged in
S E C T I O N-2
spiral tubules radiating from the pulp cavity. Each
tubule is occupied by a protoplasmic process from
the odontoblast. The calcium and organic matter
of dentine is in the same proportion as seen in the
bone.
3. Enamel: It consists of densely calcified white,
material covering the crown of the tooth. It is the
hardest substance in the body. It is primarily made
up of crystalline mineralised crystals which are
arranged as prisms. The prisms lie at right angles
to the surface of the tooth.
4. Cementum: It is the bone like covering over the
neck and root of the tooth. It is also avascular and
lacks nerves. It commonly overlaps the lower part
of the enamel.
5. Periodontal membrane: It is present between the
cementum and the socket of a tooth. It acts as the
periosteum. It holds the tooth in the socket and is
therefore often termed as periodontal ligament.
Arterial Supply of Teeth
The upper teeth are supplied by posterior superior,
middle superior and anterior superior alveolar
arteries which are branches from the maxillary
artery.
The lower teeth are supplied by the inferior alveolar
artery, a branch of maxillary artery.
Nerve Supply of Teeth
The upper teeth are supplied by the superior dental
plexus of nerves formed by posterior superior,
middle superior and anterior superior alveolar
nerves. These are branches of the maxillary division
of fifth cranial nerve.
The lower teeth are supplied by the inferior
alveolar nerve or dental nerve, branch of posterior
division of the mandibular division of fifth cranial
nerve.
POINTS TO REMEMBER
Blood vessels and nerves supplying the tooth enter
the pulp cavity of the tooth through the apical
foramen.
The pulp and periodontal membrane have the
same nerve supply as the tooth while the gums
receive a different nerve supply.
Functions of the Teeth
Teeth help to incise and grind the food material
during mastication.
They perform (sometimes) the role of weapon of
defense or attack.
Teeth provide beauty to the face and means for
facial expression.
CLINICAL AND APPLIED ANATOMY
Dental caries is the disintegration of one of the
calcified structures covering the pulp cavity. The
most important cause is inadequate oral hygiene.
It leads to inflammation and pain in the involved
tooth due to exposure of the pulp cavity.
Gingivitis: It is the inflammation of gums. It can
be due to
a. Improper oral hygiene. This results in
deposition of layer of bacteria and later minerals
known as plaque along the gum margins. The
plaque causes inflammation and infection of the
gums.
b. Deficiency of vitamins specially vitamin C
which is associated with swollen and bleeding
gums. This condition is called scurvy.
c. Altered pH of mouth as seen in pregnancy.
Osteomyelitis of the jaw after tooth extraction,
though rare, is more commonly seen in lower jaw
than upper jaw. This is because, the lower jaw is
supplied by a single inferior alveolar artery.
Therefore, damage to this artery during extraction
produces bone necrosis. The upper jaw on the other
hand receives segmental supply by 3 arteries
namely, posterior superior, middle superior and
anterior superior alveolar arteries. Therefore
ischaemia does not occur following injury to an
individual artery.
 Oral Cavity 375

TYPE OF TEETH Teeth Time of Eruption

The teeth are classified into four groups:
Lower central incisors 6 months
1. Incisors: There are 4 incisors in each jaw, two on
Upper central incisors 7 months
each side of the median plane. They are arranged
in two groups- two medial incisors and two lateral Lateral incisors 8 to 9 months
incisors. The upper incisors are present on the First molar 12 months (1 year)
premaxillary portion of the upper maxilla. As the Canines 18 months (1 year)
name suggests incisors cut food by their cutting Second molars 24 months (2 years)
edges. They are chisel like. The upper and lower
incisors overlap each other like blades of a pair of 2. Eruption of permanent teeth: The approximate age
scissors. of eruption of permanent teeth are as follows:
2. Canines: There are two canines in each jaw, one on
each side, present lateral to the incisors. They are Teeth Time of Eruption
so named because they are prominent in dogs. First molar 6 years
Canines are long and have conical and rugged
Medial incisors 7 years
crowns that help in holding and tearing food. They
Lateral incisors 8 years
are sometimes referred to as cuspids or eye-teeth.
First premolar 9 years
They are usually the last deciduous teeth to be lost.
Second premolar 10 years
3. Premolars: There are four premolars in each jaw,
two on each side of the canines. The premolars assist Canines 11 years
in crushing of food. They have two cusps and Second molars 12 years
therefore are also called as bicuspid teeth. Third molar (Wisdom tooth) 17 to 25 years
4. Molars (L. molar(s)= grinders): There are six molars

in each jaw, 3 on each side of the premolars. They
help to crush and grind the food. They possess 3 to
5 tubercles on their crowns. While the rest of teeth
have a single root, the upper molars have 3 roots
and the lower molars have 2 roots.
POINTS TO REMEMBER
The first premolars are usually the largest teeth.
The third molar is often known as the wisdom
tooth. Now a days the 3rd molars may appear very
late or become impacted in the jaw. This is because
there has been a gradual decrease in size of the
jaw of humans over a period of time.
The permanent molars have no deciduous
predecessors.
ERUPTION OF TEETH
Most of the teeth in an adult are successional that is,
they have succeeded the corresponding number of milk
teeth. The permanent molars however are accessional
that is they have been added behind the milk teeth
during development.
1. Eruption of deciduous teeth
The deciduous teeth begin to erupt at about 6
months of age. A complete set erupts by the end
of 2nd year.
The teeth of lower jaw erupt somewhat earlier
than the corresponding teeth of upper jaw.
Timing of eruption: The approximate age of
eruption are as follows:
C H A P T E R-27
TONGUE (Figs 27.4 and 27.6)
Tongue is a mobile muscular organ present in the oral
cavity. It is associated with the following functions:
1. Receives bolus of food
2. Mastication (chewing of food).
3. Deglutition (swallowing of food)
4. Peripheral apparatus of taste
5. Speech
6. Facial expression
7. Paste postage stamp
8. Pattern of papillae has medicolegal importance
Anatomical Features
The tongue consists of two parts namely:
1. Oral part: Anterior 2/3rd.
2. Pharyngeal part: Posterior 1/3rd.
It is conical in shape and presents with following
features:
1. Tip: It is the anterior end of the tongue and lies in
contact with the incisor teeth.
2. Base: It is formed by the posterior 1/3rd of tongue.
3. Root: The part of tongue attached to the floor of
mouth is called the root. The lower fibres of genio-
glossus attach it to the mandible and hyoid bone.
4. Lateral margins, present on either side of tongue,
are free and in contact with the teeth and gums.
The palatoglossal fold merges with these margins
at the junction of anterior 2/3rd with posterior
1/3rd on each side.
5. Two surfaces: Dorsal surface and ventral surface.
 376 Human Anatomy For Dental Students
Fig. 27.4: Dorsum of the tongue
S E C T I O N-2
Dorsal Surface of Tongue (Fig. 27.4)
The surface is lined by non-keratinized stratified
squamous epithelium.
It is convex on all sides and is divided into two parts
by an inverted V-shaped sulcus known as sulcus
terminalis.
The apex of the sulcus is directed backwards and is
marked by a shallow depression called foramen
caecum which represents the site of the embryo-
logical origin of thyroid gland.
The two parts are:
a. Presulcal or oral part
It constitutes anterior 2/3rd of the dorsal
surface and is placed in the floor of mouth.
The mucus membrane lining this part is
adherent to the underlying muscles by
lamina propria.
Numerous papillae of different types are
present on this surface. They bear the taste
buds.
A median furrow representing the bilateral
origin of tongue is seen.
b. Post sulcal or pharyngeal part
Mucus membrane of this part overlies loose
submucosa containing numerous mucus and
serous glands.
A large number of lymphoid follicles known
as lingual tonsils are present.
There are no papillae on this part.
The mucosa passes laterally over the palatine
tonsils and pharyngeal wall. It passes
posteriorly and is connected to the epiglottis
by three folds of mucus membrane. These are:
i. Median glosso-epiglottic fold
ii. Right lateral glosso-epiglottic fold
iii. Left lateral glosso-epiglottic fold
On either side of the median fold a shallow
depression is present between it and the lateral
folds. This is called vallecula.
Papillae of Tongue (Fig. 27.4)
They are surface projection of epithelium with a core of
lamina propria. They are of five types:
1. Vallate papillae: They are largest, 1 to 2mm, in
diameter and 8 to 12 in number. They are situated
in a single row adjacent to and in front of the sulcus
terminalis. Each papilla is seen as a truncated
conical projection surrounded by a circular sulcus
at its base.
2. Fungiform papillae: These are numerous rounded
reddish elevations present near the tip and margins
of the tongue.
3. Filiform papillae: They are most numerous and
cover most of the presulcal area of the dorsum of
tongue. They impart a valvety appearance to the
tongue. Filiform papillae provide the tongue with
a rough surface to help in grasping of food.

4. Foliate papillae: These are present as 3 or 4
vertically arranged mucus folds on the lateral
margin of the tongue, in front of sulcus terminalis.
5. Papillae simplex: These are not surface projections
and can be seen only under the microscope.
Taste Buds (Fig. 27.5)
All papillae except filiform papillae contain taste
buds.
The taste buds are modified epithelial cells. The cells
are arranged as spherical (barrel shaped) masses
made up of slender spindle shaped cells containing
central gustatory cells surrounded by supporting
cells. They converge apically and open on the
surface of tongue by a gustatory pore.
The base of each bud is penetrated by the afferent
gustatory fibres.
Taste buds are present at the following sites
a. Anterior 2/3rd of dorsum of tongue
b. Inferior surface of soft palate
c. Palatoglossal arches
d. Posterior surface of epiglottis
e. Posterior wall of oropharynx
Four type of taste sensations are projected on to
the tongue:
1. Salt
2. Sweet
3. Sour
4. Bitter
Taste pathway: (see page no. 387 to 388)
Fig. 27.5: Structure of taste bud
Ventral or Inferior Surface of Tongue (Fig. 27.6)
The ventral surface is lined by a thin mucus
membrane which gets reflected on to the floor of
the mouth.
It does not contain papillae.
Oral Cavity 377
Fig. 27.6: Ventral surface of tongue
It presents with the following features:
1. Frenulum linguae: It is a median fold of mucus
C H A P T E R-27
membrane connecting the tongue to the floor
of mouth.
2. Lingual veins: These are seen under the mucus
membrane, on either side of the frenulum. The
lingual nerve and artery lie medial to the veins
on each side but are not visible.
3. Plica fimbriate: It consists of a fringe like fold
of mucus membrane present lateral to the
lingual vein and is directed forwards and
medially towards the tip of tongue.
4. Sublingual papilla: It is present on each side of
the base of frenulum linguae, as an elevation. It
presents with the opening of the duct of
submandibular gland at its summit.
Muscles of the Tongue (Fig. 27.7 and 27.8)
The tongue is divided into two symmetrical halves by a
median fibrous septum. Each half contains 4 intrinsic
and 4 extrinsic muscles. Intrinsic muscles alter the shape
of the tongue while the extrinsic muscles alter the
position of the tongue. All muscles are supplied by
hypoglossal nerve and lingual artery.
1. Intrinsic muscles (Fig. 27.7): They occupy mostly
the upper part of tongue and are present bilaterally.
They are arranged in an interlacing pattern which
helps in the change of shape of tongue. They are
attached to the submucus layer and the median
fibrous septum.
 378 Human Anatomy For Dental Students

Intrinsic muscle (present in pairs) Attachments Actions

1. Superior longitudinal Originate from the posterior part Shorten the tongue
Lie beneath the mucus of median septum, run anteriorly Make the dorsum concave
membrane of dorsum of and laterally to diverge and attach
tongue to the margin of the tongue

2. Inferior longitudinal Originate from the posterior sides Shorten the tongue
Lie on the ventral surface of tongue and run anteriorly to Make the dorsum convex
of tongue above the mucus converge medially on the medial
membrane septum.

3. Transversus linguae Extend transversely from the median Decrease the width of tongue and
septum to the margins of the tongue elongate it.

4. Verticalis linguae Extend from lamina propria of Increase the width of tongue to flatten it.
dorsum of tongue and run vertically
downwards to sides of tongue.
S E C T I O N-2

Fig. 27.7: Intrinsic muscles of the tongue

Fig. 27.8: Extrinsic muscles of the tongue

 Oral Cavity 379

2. Extrinsic muscles (Fig. 27.8): These attach the tongue

to surrounding bones. They help in change of
position of tongue.

Extrinsic muscles Origin Insertion Action

(present in pairs)
1. Hyoglossus Upper surface of greater Fibres run straight up to Depresses the sides of the
Thin quadrilateral cornu of hyoid bone the sides of the tongue tongue
muscle Adjacent part of body between styloglossus Makes the dorsal surface
of hyoid laterally and inferior convex
longitudinal muscle medially

2. Genioglossus Inner surface of symphysis Fibres radiate and insert Protrudes the tip of tongue
Fan shaped menti from the superior throughout the tongue Makes the dorsum concave
Forms the bulk genial tubercles or spines from apex to root of Prevents the tongue from
of the tongue of mandible tongue. Lowest fibres are falling back and obstructing
attached to superior border the oropharynx. Hence, called
of body of hyoid bone as saftey muscle.

3. Styloglossus Tip of styloid process Fibres run downwards and Draws the tongue
Present as an Adjacent part of insert along the entire upwards and backwards
elongated slip stylomandibular ligament length of side of tongue Is antagonist to genioglossus

4. Palatoglossus Oral surface of palatine It lies under the palatog- Pulls up the curve of the

Present as a aponeurosis lossal arch and inserts to
slender slip the side of tongue at the
junction of its oral and
pharyngeal parts
C H A P T E R-27
tongue
Approximates the palato-
glossal arches to decrease
width of oropharyngeal
isthmus.

Relations of Hyoglossus Muscle (Figs 27.9 and 24.7) mylohyoid muscles, lingual nerve, submandibular
1. External or superficial surface is related to: Tendon ganglion, sublingual gland, deep part of sub-
of digastric muscle, stylohyoid, styloglossus and mandibular gland with its duct, hypoglossal nerve
and lingual vein.

Fig. 27.9: Relations of hyoglossus muscle

 380 Human Anatomy For Dental Students
2. Internal or deep surfaces is related to: Genio-
glossus, inferior longitudinal muscle of tongue,
middle constrictor of pharynx, lingual artery is
present between it and the middle constrictor
muscle of pharynx, stylohyoid ligament, and
glossopharyngeal nerve.
Posterior border is related to glossopharyngeal
nerve, stylohyoid ligament and lingual artery.
Nerve Supply of Tongue
Motor Supply of Tongue
1. Somato-motor
a. Hypoglossal nerve: Supplies all extrinsic and
intrinsic muscles of tongue except palatoglossus.
b. Cranial part of accessory nerve (via vagus nerve)
supplies palatoglossus.
2. Secretomotor to lingual glands
a. Preganglionic fibres arise in superior salivatory
nucleus and pass to the submandibular ganglion
via facial nerve, chorda tympani and lingual
nerve.
b. Postganglionic fibres are conveyed via lingual
S E C T I O N-2
nerve.
3. Vasomotor: Is derived from the sympathetic plexus
around lingual artery. Fibres are derived from
superior cervical ganglion.
Sensory Supply of Tongue (Fig. 27.10)
1. Lingual nerve: Receives general sensation from
anterior 2/3rd of the tongue.
2. Chorda tympani: Receives taste sensations from
anterior 2/3rd except from vallate papillae.
Fig. 27.10: Sensory supply of tongue
3. Glossopharyngeal nerve
Conveys all general sensations from posterior
1/3rd of the tongue.
Carries taste sensation from vallate papillae.
4. Internal laryngeal branch of superior laryngeal
nerve from vagus conveys taste sensation from
posterior most part of tongue and vallecula.
Arterial Supply of Tongue
1. Lingual artery, branch of external carotid arterty is
the chief artery of tongue.
2. Ascending palatine artery, branch of facial artery.
3. Tonsillar artery, branch of facial artery.
Venous Drainage of Tongue
1. Superficial veins: Drain the tip and undersurface
of tongue. Pass along with hypoglossal nerve over
the hypoglossus muscle.
2. Deep vein of tongue: It is the principal vein that
runs along with the lingual artery under the
hyoglossus muscle.
These veins unite at the posterior border of hyoglossus
to form the lingual vein which terminates into the
internal jugular vein.
Lymphatic Drainage of Tongue (Fig. 27.11)
The drainage zones of tongue can be grouped into
three:
1. Tip and inferior surface of tongue drains into
submental lymph nodes.

Fig. 27.11: Lymphatic drainage of tongue
2. Anterior 2/3rd of dorsum of tongue
a. Each half drains into ipsilateral submandibular
lymph nodes and then to lower deep cervical
lymph nodes.
b. Few lymphatics from the central region, with
in inch of midline, drain bilaterally into
submandibular lymph nodes.
3. Posterior 1/3rd of dorsum of tongue drains
bilaterally into the upper deep cervical lymph nodes
including the jugulo-digastric.
CLINICAL AND APPLIED ANATOMY
Congenital anomalies of the tongue can be:
1. Aglossia: It is the complete absence of the tongue,
due to total developmental failure.
2. Bifid tongue, due to non fusion of lingual
swellings.
3. Lingual thyroid: The median thyroid rudiment
fails to grow caudally and thyroid tissue persists
within the substance of the tongue.
Oral Cavity 381
C H A P T E R-27
4. Tongue tie: This occurs due to shortening of the
frenulum linguae and can interfere in speech. It
can be easily excised.
HYPOGLOSSAL NERVE (Fig. 27.12)
It is the 12th cranial nerve. It is purely motor (nerve of
the occipital myotomes).
Functional Component
General somatic efferent: Motor to the muscles of the
tongue, both extrinsic and intrinsic which are derived
from occipital myotomes.
Nuclear Origin
The hypoglossal nerve arises from the hypoglossal
nucleus present in the posterior part of medulla
oblongata. The fibres run forward through the substance
of the medulla, lateral to the medial lemniscus to emerge
on the ventral aspect of the medulla oblongata (Fig. 50.6).
S E C T I O N-2 382 Human Anatomy For Dental Students
Fig. 27.12: Hypoglossal nerve and its distribution
Intracranial Course
The hypoglossal nerve arises in the form of 10 to 15
rootlets from the ventral aspect of medulla in the
anterolateral sulcus between the pyramid and the
olive.
The rootlets of the hypoglossal nerve run laterally
and pass behind the vertebral artery where they
merge to form 2 bundles of nerve fibres.
The two roots pierce the dura mater and pass
through the anterior condylar canal (hypoglossal
canal) in the occipital bone to come out of the cranial
cavity. In the canal, the two roots unite to form a
single trunk.
POINT TO REMEMBER
It is of interest to note that rootlets of the hypoglossal
nerve are attached in line with the rootlets of the
ventral root of the first cervical spinal nerve.
Extracranial Course (Figs 25.7 and 25.8)
After coming out of the cranial cavity the nerve lies
deep to the internal carotid artery and the 9th, 10th
and 11th cranial nerves.
It then passes downwards and laterally over the
accessory nerve and the vagus nerve to reach the
interval between the internal carotid artery and
internal jugular vein.
It descends vertically in this interval in front of the
vagus nerve and passes below the posterior belly
of digastric to reach the upper end of carotid
triangle at the level of angle of mandible.
Here, the nerve curves downwards and forwards
crossing over the internal and external carotid
arteries and over the 1st part of lingual artery to
reach the posterior margin of hyoglossus muscle.
It passes over the hyoglossus and reaches the
digastric triangle, lying deep to the tendon of
posterior belly of digastric and stylohyoid .
Then, it runs upwards and forwards lying below
the submandibular ganglion, submandibular gland
and its duct along with the lingual nerve (Fig. 27.9).
At the anterior margin of hyoglossus it crosses over
the 3rd part of lingual artery and pierces the
genioglossus to reach the tip of tongue.
Finally, it ends by dividing into its terminal
branches.

Branches of Hypoglossal Nerve
1. Muscular branches: These are branches of the
hypoglossal nerve proper and supply all the
muscles of the tongue except palatoglossus which
is supplied by the cranial root of accessory nerve
via the pharyngeal plexus.
2. Branches of the hypoglossal nerve containing C1
fibres:
a. Meningeal branch: It arises from the nerve as
it passes through the hypoglossal canal and
supplies the duramater of posterior cranial
fossa.
b. Descendens hypoglossi or upper root of ansa
cervicalis: It arises from the nerve as it crosses
the internal carotid artery. It runs downwards
to join the inferior root of ansa cervicalis at the
level of cricoid cartilage.
c. Nerve to thyrohyoid: It crosses the greater cornu
of the hyoid bone to reach the thyrohyoid
muscle.
d. Nerve to geniohyoid: It arises at a level above
the hyoid bone and supplies the geniohyoid
muscle.
3. Communicating branches: The hypoglossal nerve
communicates with the following:
a. Superior cervical ganglion of sympathetic trunk.
b. Inferior ganglion of vagus nerve.
c. Loop of fibres of C1 and C2 spinal nerves
d. Pharyngeal plexus.
e. Lingual nerve: The hypoglossal nerve conveys
fibres for proprioceptive sensations from lingual
muscles to the lingual nerve which further is a
part of the trigeminal nerve.
CLINICAL AND APPLIED ANATOMY
If the hypoglossal nerve is cut on one side there will be
a lower motor neuron type of paralysis of muscles of
the tongue on that side. On asking the patient to protude
his tongue, it will deviate to the paralysed side due to
unopposed action of the muscles of the healthy side.
Fig. 27.13: Mylohyoid muscle and its relations
Oral Cavity 383
There will be associated atrophy of paralysed muscles.
In supranuclear lesions involving corticonuclear fibres,
in addition to paralysis of the muscles there will also
be fasciculations in tongue on the affected side and
mucous membrane will show wrinkling.
FLOOR OF ORAL CAVITY
It is the region below the anterior part of tongue. It
is bounded anteriorly by the lower jaw and is
shaped similar to it, i.e., in the form of a horse-shoe.
The mucous lining is pinkish blue and presents with
following features:
a. The lower surface of the tongue is connected to
the floor of the mouth by a median fold of the
mucous membrane called frenulum linguae
(Fig. 27.6). It extends from ventral surface of
tongue across the floor of mouth to inner surface
of alveolar part of mandible.
b. On each side of the lower end of frenulum, there
is an elevation called sublingual papilla (Fig.
27.6). Duct of submandibular gland of each side
open at the summit of this papilla.
C H A P T E R-27
c. Sublingual fold: This is a prominent elevation
in the mucous membrane on each side of the
frenulum. It overlies the ducts of submandibular
gland and sublingual salivary glands.
Muscles of floor of mouth present under the mucosa
are mylohyoid and geniohyoid.
Mylohyoid (Figs 27.13 and 27.14)
It is a triangular sheet of muscle. The two mylohyoids
form the muscular diaphragm of floor of mouth.
Origin: It arises from the mylohyoid line of the mandible.
Insertion: The anterior and middle fibers of the muscle
of each side meet in the center and form a median fibrous
raphe that extends from symphysis menti to the hyoid
bone. The posterior fibers pass downwards and medially
to attach to the lower border of anterior surface of hyoid
bone.
 384 Human Anatomy For Dental Students
Fig. 27.14: Mylohyoid muscle and its relations
Relations
Inferiorly : Platysma, anterior belly of digastric
muscle, superficial part of submandi-
S E C T I O N-2
bular gland, facial vessels, mylohyoid
vessels and nerve.
Superiorly : Geniohyoid, hyoglossus and stylo-
glossus muscles, hypoglossal and lingual
nerves, submandibular ganglion, deep
part of submandibular gland, sub-
lingual gland and lingual vessels.
Nerve supply: It is supplied by branch of inferior
alveolar nerve.
Action : It elevates the floor of mouth during deglutition.
Geniohyoid (Fig. 27.2)
It is a narrow muscle present on the medial aspect of
mylohyoid muscle.
Origin: It arises from the lower genial tubercle or mental
spine, on the inner expect of symphysis menti.
Insertion: The fibers run backwards and downwards to
attach to anterior surface of body of hyoid bone.
Nerve supply: It is supplied by C1 through hypoglossal
nerve.
Action: It elevates and draws the hyoid bone forwards.
PALATE (Figs 27.2 and 27.15)
It is an osteomuscular partition between nasal and oral
cavities. It also separates nasopharynx from oropharynx.
The palate consists of two parts:
1. Hard palate: It forms the anterior 2/3rd of the
palate.
2. Soft palate: It forms the posterior 1/3rd of the
palate.
Hard Palate
The hard palate forms a partition between the nasal
and oral cavities.
The anterior 3/4th is formed by the palatine
processes of the maxillae and the posterior 1/4th
by the horizontal plates of the palatine bones.
The superior surface of hard palate forms the floor
of nasal cavity and is lined by the ciliated pseudo-
stratified columnar epithelium.
The inferior surface of hard palate forms the roof
of oral cavity and is lined by masticatory mucosa.
It presents with a median palatine raphe.
Anteriorly and laterally, the hard palate becomes
continuous with the alveolar arches and gums.
The posterior margin of hard palate is free and
provides attachment to the soft palate.
The inferior surface presents with irregular
horizontal folds of mucosa with a connective tissue
core, running laterally from the median raphe.
The neurovascular bundle runs anteroposteriorly,
along the lateral margins, in the submucosa of the
palate.
Arterial supply of hard palate is dervied from
greater palatine artery, branch of maxillary artery
and ascending palatine branch of facial artery. The
veins drain into pterygoid plexus of veins.
Nerve supply of hard palate is derived from greater
palatine and nasopalaine branches of maxillary
nerve through pterygopalatine ganglion.
Soft Palate
The soft palate is a mobile muscular fold suspended
from the posterior border of the hard palate like a
curtain or velum.
 Oral Cavity 385

It is lined by nonkeratinized stratified squamous i. Palatoglossal fold

epithelium which encloses muscles, vessels, nerves,
lymphoid tissue and mucous glands. It appears red
in comparision with the hard palate which is pink.
It separates the nasopharynx from oropharynx. Soft
palate presents following external features:
a. Anterior (oral) surface: It is concave and
marked by a median raphe. The lining epithe-
lium has taste buds on the surface.
b. Posterior surface: It is convex and continuous
with the floor of the nasal cavity.
c. Superior border: It is attached to the posterior
border of hard palate.
d. Inferior border: It is free and forms the anterior
boundary of the pharyngeal isthmus. A conical,
small tongue like projection hangs from its
middle and is called the uvula.
e. On each side, from the base of uvula, two curved
folds of mucous membrane extend laterally and
downwards along the lateral wall of oropharynx.
These are:
It is the anterior fold which merges
inferiorly with the sides of the tongue at
the junction of its oral and pharyngeal
parts.
The palatoglossal fold contains the
palatoglossal muscle.
It forms the lateral boundary of the
oropharyngeal isthmus and the anterior
boundary of tonsillar fossa.
ii. Palatopharyngeal fold
It lies posterior to the palatoglossal fold
and merges inferiorly with the lateral wall
of the pharynx.
The palatopharyngeal fold contains the
palatopharyngeus muscle and forms the
posterior boundary of the tonsillar fossa.
Muscles of the Soft Palate (Fig. 27.15)
The soft palate consist of five pairs of muscles. These
are tabulated below:

C H A P T E R-27
Muscle Origin Insertion Actions

1. Tensor veli palatini a. Anterolateral aspect The fibers converge to a. Acts bilaterally to tighten
Thin triangular muscle of the auditory tube form a tendon which the soft palate
b. Adjoining part of the winds round the pterygoid b. Helps in opening the
greater wing of hamulus. The muscles of both auditory tube
sphenoid from sides join to from the palatine
scaphoid fossa and aponeurosis. It is attached to
spine of sphenoid a. Posterior border of the
hard palate
b. Inferior surface of the
hard palate behind the
palatine crest.
2. Levator veli palatini a. Medial aspect of the The muscles from both sides a. Elevates the soft palate
Cylindrical muscle lying auditory tube run downwards and medially to close the pharyngeal
deep to tensor palati b. Adjoining part of the and spread out to be isthmus
petrous temporal bone inserted on the upper b. Helps in opening the
surface of the palatine auditory tube
aponeurosis
3. Musculus uvulae a. Posterior nasal spine The fibers insert under the Pulls the uvula
Longitudnal muscle strip b. Superior surface of mucous membrane of the forwards to its own side
present one on either side palatine aponeurosis uvula
of median plane, within
the palatine aponeurosis
4. Palatoglossus Oral surface of the Descends into the a. Pulls up the root of the
palatine aponeurosis palatoglossal arch and tongue
inserts into the side of the b. Approximates the
tongue at the junction of its palatoglossal arches to
oral and pharyngeal parts close the oropharyngeal
isthmus
 386 Human Anatomy For Dental Students
(Contd......)

Muscle Origin Insertion Actions

5. Palatopharyngeus: It a. Anterior fasciculus, Descends in the Raises the wall of pharynx

consists of two fasciculi from posterior border palatopharyngeal arch and and larynx during
which are separated by of hard palate is inserted into the swallowing
the levator palati b. Posterior fasciculus a. Median fibrous raphe
from palatine of pharyngeal wall
aponeurosis b. Posterior border of
lamina of thyroid cartilage.
S E C T I O N-2

Fig. 27.15: Muscles of soft palate (seen from posteroinferior aspect)

Palatine aponeurosis: It is thin, fibrous aponeurosis Venous Drainage of Soft Palate

formed by the expanded tendons of tensor veli palatini
muscles of each side. It receives insertion of levator veli
palatini and encloses musculus uvulae. It provides
strength to the soft palate.
Functions of the Soft Palate
1. Separates the oropharynx from nasopharynx
during swallowing so that food does not enter the
nose.
2. Isolates the oral cavity from oropharynx during
chewing so that breathing is unaffected.
3. Helps to modify the quality of voice, by varying
the degree of closure of the pharyngeal isthmus.
Arterial Supply of Soft Palate
It is supplied by the following arteries:
1. Ascending palatine artery, branch of facial artery.
2. Palatine branch of ascending pharyngeal artery.
3. Greater palatine artery, branch of maxillary artery.
Veins drain into the pterygoid plexus of veins.
Lymphatic Drainage of Soft Palate
Lymphatics from soft palate drain into the following
nodes:
1. Retropharyngeal nodes.
2. Deep cervical lymph nodes.
Nerve Supply of Soft Palate
1. Motor supply: All muscles of palate are supplied
by cranial part of accessory nerve via pharyngeal
plexus except tensor veli palati which is supplied
by nerve to medial pterygoid, a branch of
mandibular nerve.
2. Secretomotor Supply to Palatine Glands
a. Preganglionic fibres arise in superior salivatory
ganglion and reach the pterygopalatine
ganglion via facial nerve and nerve of pterygoid
canal.

b. Post-ganglionic fibres run in the greater and
lesser palatine nerves to supply the palatine
glands.
3. Sensory supply: The afferents pass to
a. Greater and lesser palatine nerves
b. Sphenopalatine nerves
c. Glossopharyngeal nerves
CLINICAL AND APPLIED ANATOMY
Fusion of the various processes that form the
external part of the face may occasionally be
incomplete and give rise to various congenital
anomalies of the face as follows:
a. Cleft upper lip
i. Median cleft lip is rare and occurs if the
philtrum fails to develop from the
frontonasal process. The upper lip of hare
normally has a median cleft. Therefore, this
defect is called as hare-lip.
ii. Lateral cleft is more common. It may be on
one or both sides of the philtrum.
Unilateral cleft lip occurs if maxillary
process of one side fails to fuse with the
corresponding frontonasal process.
Bilateral cleft occurs if both the maxillary
processes fail to fuse with frontonasal
process.
The cleft may be a small defect in the upper lip
or may extend into the nostril splitting the
upper jaw. It may rarely extend to the side of
nose along the nasolacrimal groove as far as the
orbit (medial angle of the eye). The later is called
as oblique facial cleft. The nasolacrimal duct
is not formed in these cases.
b. Cleft lower lip: It is always median and rare. It
occurs when the two mandibular processes do
not fuse with each other. The defect usually
extends into the lower jaw.
c. Macrostomia (big mouth): This occurs due to
inadequate fusion of the mandibular and
maxillary processes with each other. The lack
of fusion may be unilateral. This leads to the
formation of lateral facial cleft. Too much
fusion of mandibular and maxillary processes
may result in the small mouth or microstomia.
Cleft palate: The defective fusion of various
segments of the palate gives rise to clefts in the
palate. These vary considerably in degree, leading
to varieties of cleft palate.
Varieties of cleft palate:
i. Complete cleft palate: Complete cleft palate
can be of the following types:
Unilateral complete cleft palate occurs if the
maxillary process of one side does not fuse
with the corresponding premaxilla. It is
always associated with cleft lip.
Oral Cavity 387
Bilateral complete cleft palate occurs if both
the maxillary processes fail to fuse with the
premaxila.
ii. Incomplete or partial cleft: Incomplete cleft
palate can be of the following types:
Bifid uvula: The cleft involves only uvula.
It is of no clinical importance.
Cleft of soft palate: Cleft involves uvula and
soft palate.
Cleft of soft palate extending into the hard
palate.
Paralysis of muscles of soft palate due to lesion
of vagus nerve produces:
a. Nasal regurgitation of liquids.
b. Nasal twang in voice.
c. Flattening of the palatal arch on the side of
lesion.
d. Deviation of uvula, opposite to the side of
lesion.
Pathway of Taste (Fig. 27.16)
The sense organs for taste are taste buds which are
C H A P T E R-27
present in between the epithelial cells of tongue.
Microvilli extend from gustatory cells to the pores
which sense the changes in chemical in the saliva.
Each taste bud is innervated by about 50 nerve
endings and each nerve fiber receives input from
upto 5 taste buds.
Taste buds are present over fungiform and vallate
papillae of the tongue (no taste buds are present on
filiform papillae) and are distributed in the mucosa
of epiglottis, palate and oropharynx.
The ingested substances responsible for taste
sensations are dissolved in saliva and presented to
the microvilli of gustatory receptor cells. This leads
to opening up of H + or Na + channels in the
chemoreceptors leading to alteration in polarization
of cell membrane and setting up of action potentials
in the nerve endings.
Sensory fibers from taste buds on anterior 2/3rd of
tongue except circumvallate papillae travel in
chorda tympanic nerve while from circumvallate
papillae travel in glossopharyngeal nerve. The
sensations from palate, pharynx and epiglottis are
carried by internal laryngeal nerve a branch of
vagus nerve.
These fibers project on the nucleus of tractus
solitarius in medulla oblongata. Second order
neurons from here cross to other side and ascend
in the dorsomedial part of medial lemniscus and
terminate in the venteroposterolateral nucleus of
thalamus. Axons of 3rd order neurons pass to the
taste projection area in the post-central gyrus of
cerebral cortex (area no. 43). Fibres from thalamus
have connection with hypothalamus which further
connects to limbic system. This explains the
emotional factors involved in taste sensation.
S E C T I O N-2 388 Human Anatomy For Dental Students

Fig. 27.16: Pathway of taste

There are four basic taste modalities appreciated by
humans, these are; sweet, sour, bitter and salt. The
threshold for bitter substances is the lowest while it
is highest for sweet (except saccharin) substances.
The concentration of a substance needs to be changed
by more than 30% for the change in intensity of taste
to be appreciated at the cortical level.
Adaptation to taste of a substance occurs when it is
placed continuously in one part of mouth.
 Chapter
28
Nose and Paranasal Sinuses
INTRODUCTION
Nose is the most proximal part of the upper respiratory
tract and serves as a passage for air. It consists of external
nose and nasal cavity.
Functions of Nose
1. The mucosa of nasal cavity is highly vascular and
this helps in air conditioning (warming/cooling)
and humidification of the inspired air.
2. Mucous secretions and hairs at the entrance of nasal
cavity help in entrapement of foreign particles,
preventing their entry into the respiratory tract.
3. Olfactory epithelium has receptors for sense of
smell. It helps in assessing palatibility of food and
in defence thus aids in the survival and existence
of the body.
Fig. 28.1: External nose
EXTERNAL NOSE (Fig. 28.1)
External nose forms a pyramidal projection in the middle
of the face. It presents with the following features:
1. Tip (or apex): It is the lower free end of the nose.
2. Root: The upper narrow part attached to the
forehead is the root of nose.
3. Nostrils or anterior nares: These are two piriform
shaped apertures present at the broad, lower part
of the nose, which open on the face. These are
C H A P T E R-28
separated by the lower border of nasal septum.
4. Lateral surfaces: These meet superiorly to form the
dorsum of nose which is a rounded border between
the tip and root of nose. Inferiorly, they curve to
form alae nasai and pass medially to meet in
midline below the septum of the nose.
 390 Human Anatomy For Dental Students
Cutaneous covering of external nose
Skin over the nose is thin in most areas.
It is thick and adherent to the underlying cartilage
at the apex and the alae. It has numerous sebaceous
glands in this region.
Arterial supply is derived from branches of facial,
ophthalmic and infraorbital arteries. The veins
mainly drain into facial vein on each side. From
root of nose they pass into the ophthalmic veins.
Lymphatic drainage from external nose is into
submandibular lymph nodes. Lymphatics from
root of nose drain into parotid lymph nodes.
Cutaneous nerve supply is derived from branches
of nasociliary and infraorbital nerves. Muscles of
nose are supplied by buccal branch of facial nerve.
Skeleton of External Nose
The skeleton of external nose is formed by the following
bones and cartilages:
1. Bony framework comprises of the following:
a. Two nasal bones: They form bridge of nose.
b. Frontal processes of maxillae
S E C T I O N-2
2. Cartilaginous framework (Fig 28.1): It comprises
of 5 main cartilages and several additional tiny once
on each side. These are:
a. Two lateral nasal or superior nasal cartilages:
They are triangular in shape as shown in figure.
The lateral cartilages articulate superiorly, with
the margins of nasal bone and the frontal process
of maxilla. Inferiorly, they are joined to the major
alar cartilages by fibrous tissue. Medially they
join to form a bridge over the septal cartilage.
b. A single median septal cartilage
c. Two major alar or inferior nasal cartilages:
Each major alar cartilage comprises of a medial
and a lateral crus. The medial crura of two sides
meet in the midline below the septal cartilage
to form the lowest part of the nasal septum
including the mobile columella. The lateral crus
is attached above to the corresponding lateral
nasal cartilage and extends into the ala of the
nose but does not reach the bony margin (nasal
notch of maxilla). The gap is filled by fibrous
tissue and minor alar cartilages.
NASAL CAVITY
Nasal cavity extends from the nostrils or anterior nares
in front to the posterior nasal aperture or choanae
behind. It is subdivided into two parts by a nasal septum.
Each half is again called as the nasal cavity. Each nasal
cavity presents with the following boundaries:
a. Roof
b. Floor
c. Medial wall or nasal septum
d. Lateral wall
Roof
It is very narrow and is mainly formed by the
cribriform plate of the ethmoid bone.
The anterior part of roof slopes downwards and is
formed by the nasal bones (Fig. 28.2).
The posterior part is formed by the anterior and
inferior surfaces of sphenoid bone. It presents with
opening of sphenoidal air sinuses on each side of
midline.
It is lined by the olfactory epithelium.
Floor
It is almost horizontal and is formed by the upper surface
of hard palate (formed by palatine processes of maxillae
and horizontal plates of palatine bones).
Medial Wall or Nasal Septum (Fig. 28.2)
It is formed by various bones and cartilages.
The bones are:
1. Anterosuperior part of septum is formed by
perpendicular plate of ethmoid bone and adjoin-
ing surfaces of nasal spine of frontal bone and
frontal crest of nasal bone.
2. Postero superior part is formed by sphenoidal crest.
3. Posteroinferior part of the septum is formed by
vomer.
4. Nasal crest lies in the lower most part. It is formed
by fusion of the two palatine processes of maxilla
and the two horizontal plates of palatine bone.
The cartilages are:
1. Septal cartilage: Its forms the major anterior part
of the septum.
2. Septal processes of major alar cartilages.
3. Jacobsons cartilage: It lies between the vomer and
septal cartilage.
Most of the septum on each side is lined by mucous
membrane except at the lower mobile part which is lined
by the skin.
Arterial Supply of Nasal Septum (Fig. 28.3)
The nasal septum is supplied by the following arteries:
1. Septal branch of anterior ethmoidal artery, branch
of ophthalmic artery.
2. Septal branch of sphenopalatine artery, branch of
maxillary artery.
3. Septal branch of greater palatine artery, branch of
maxillary artery.
4. Septal branch of superior labial artery, branch of
facial artery.
The area on the antero-inferior part of the nasal
septum is highly vascular. In this area the septal
 Nose and Paranasal Sinuses 391

Fig. 28.2: Nasal septum

C H A P T E R-28
Fig. 28.3: Arterial supply of nasal septum

Fig. 28.4: Nerve supply of nasal septum

 392 Human Anatomy For Dental Students
branches of anterior ethmoidal, sphenopalatine, greater
palatine and superior labial arteries anastomose to form
a plexus known as Kesselbachs plexus.
Nerve Supply of the Nasal Septum (Fig. 28.4)
1. Olfactory nerves, about 15 to 20 in number supply
the olfactory zone. These nerves pierce the
cribriform plate of ethmoid and enter the cranial
cavity to end in the olfactory bulbs of the forebrain.
2. Inter nasal branch of anterior ethmoidal nerve, from
nasociliary nerve supplies the anterosuperior part.
3. Medial posterior superior alveolar nerve, branch
of pterygopalatine ganglion supplies the inter-
mediate part.
4. Nasopalatine nerve supplies the posterior part.
5. Nasal branch of greater palatine nerve also supplies
the posterior part.
6. Anterior superior alveolar nerve, branch of
maxillary nerve supplies the antero-inferior part.
7. External nasal nerve, branch of anterior ethmoidal
nerve, supplies the lower mobile part.
CLINICAL AND APPLIED ANATOMY
S E C T I O N-2
The area of Kesselbachs plexus is named as the
Littles area. It is the most common site of epistaxis
or bleeding from nose in children due to nose
picking or presence of foreign body.
The central septum of the nose may be deviated
in some to the right or to the left side leading to
varying degrees of obstruction of the respective
nasal cavity. The deviation commonly involves the
cartilaginous part and occasionally the bony part
Fig. 28.5: Lateral wall of nose
of septum. It can lead to recurrent attacks of nasal
blockage and sinusitis. This condition is treated
surgically by submucous resection of the deviated
part of the septum.
Olfactory epithelium is present in relation to the
roof of nasal cavity, the nasal bones and superior
conchae. It is present over an area of 2.5 cm2 and
is supplied by olfactory nerves.
Lateral Wall of the Nasal Cavity
It is also formed by bones and cartilages (Fig. 28.5).
The bones are:
Anteriorly
1. Nasal bone
2. Frontal process of maxilla
3. Lacrimal bone
4. Superior and middle conchae
5. Uncinate process of ethmoid, below the middle
concha
6. Inferior concha
Posteriorly
7. Perpendicular plate of palatine
8. Medial pterygoid plate of sphenoid
The bony part is lined by mucus membrane
The cartilages are
1. Lateral nasal cartilage (upper nasal cartilage)
2. Major alar cartilage (lower nasal cartilage)
3. 3 or 4 tiny alar cartilages
Main Features of the Lateral Wall (Fig. 28.6)
1. Conchae: There are three curved bony projections
directed downwards and medially from the lateral
wall. They are:
 Nose and Paranasal Sinuses 393

a. Superior concha: It is the smallest concha. Subdivisions of the Lateral Wall of Nasal Cavity
b. Middle concha: It covers the maximum number (Fig. 28.6)
of openings. The lateral wall can be subdivided into three parts
The superior and middle conchae are small namely:
projections that arise from the ethmoidal 1. Anterior part: It presents a small depressed area
labryrinth. called the nasal vestibule, bounded by medial and
c. Inferior nasal concha: It is the largest concha lateral ala of major alar cartilage. It is lined by skin
and is an independent bone. It articulates with which contains sebaceous glands and numerous
nasal surface of maxilla and adjoining surface short, stiff and curved hairs called vibrissae.
of perpendicular palate of palatine bone. 2. Middle part: It is occupied by the atrium of middle
2. Meatuses: These are the passages, present beneath meatus.
the overhanging conchae. 3. Posterior part: It presents the conchae and the
a. Inferior meatus: It is the largest and lies spaces separating them called meatuses.
underneath the inferior nasal concha.
b. Middle meatus: It is present underneath the Openings in the Lateral Wall of the Nose (Fig. 28.6)
middle concha. It presents the following Site Opening/Openings
features.
Ethmoidal bulla, a rounded elevation Sphenoethmoidal recess Opening of sphenoidal air
produced by the underlying middle ethmo- sinus
idal sinuses. Superior meatus Openings of posterior eth-
moidal air sinuses
Hiatus semilunaris, a deep semicircular
Middle meatus
sulcus below the bulla ethmoidalis.
a. On bulla ethmoidalis Openings of middle ethmo-
Infundibulum, a short passage at the anterior

C H A P T E R-28
idal air sinus
end of middle meatus. b. In hiatus semilunaris
c. Superior meatus: It is the smallest meatus and Anterior part Opening of frontal air sinus
lies below the superior concha. Middle part Opening of anterior ethmo-
3. Spheno-ethmoidal recess: It is a triangular idal air sinus
depression, above and behind the superior concha. Posterior part Opening of maxillary air
4. Atrium of middle meatus: It is a shallow sinus
depression present in front of the middle meatus Inferior meatus Opening of nasolacrimal
and above the vestibule of the nose. It is limited duct (at the junction of
above by a faint ridge, the agger nasi. The curved anterior 1/3rd and post-
muco-cutaneous junction between the atrium and erior 2/3rd)
the vestibule of nose is called as limen nasi.

Fig. 28.6: Openings in lateral wall of nose

 394 Human Anatomy For Dental Students

Arterial Supply of the Lateral Wall (Fig. 28.7)
It is supplied by the following arteries:
1. Anterior ethmoidal artery, branch of ophthalmic
artery. It supplies the antero-superior quadrant.
2. Branches of facial artery, supply the antero-inferior
quadrant.
3. Sphenopalatine artery, branch from maxillary
artery supplies the postero-superior quadrant.
4. Greater palatine artery: It gives off branches which
pierce the perpendicular plate of palatine bone and
supply the postero-inferior quadrant, while the
terminal branches supply the antero-inferior
quadrant.
Nerve Supply of the Lateral Wall (Fig. 28.8)
1. Olfactory nerve, supplies the upper part just below
the cribriform plate upto the superior concha.
2. Anterior ethmoidal nerve, branch of ophthalmic
nerve supplies the antero-superior quadrant.
S E C T I O N-2
3. Anterior superior alveolar nerve, branch of maxillary
nerve supplies the antero-inferior quadrant.
4. Posterior lateral nasal branches of pterygopalatine
ganglion, from maxillary nerve supplies postero-
superior part.
5. Anterior palatine branches of pterygopalatine
ganglion, from maxillary nerve supplies postero-
inferior part.
Venous Drainage of Nasal Cavity
1. The veins of nasal cavity form a submucous plexus
and drain into pterygoid plexus of veins via the
sphenopalatine vein.
2. Anteriorly, they drain into ophthalmic vein or facial
vein.

Fig. 28.7: Arterial supply of lateral wall of nose

Fig. 28.8: Nerve supply of lateral nasal wall


Lymphatic Drainage of Nasal Cavity
1. Most of the nasal cavity is drained by retropharyn-
geal and deep cervical lymph nodes.
2. Lymphatics of anterior part drain into submandi-
bular lymph nodes.
Mucosa and Epithelium of Nasal Cavity
The vestibule and anterior part of nasal cavity is
lined by skin that is keratinized stratified squamous
epithelium which has sebaceous and sweat glands
and presents with stiff, short hairs.
The middle part is lined by nonkeratinized
stratified squamous epithelium while the posterior
part is lined by pseudo stratified ciliated columnar
epithelium which has goblet cells (respiratory
epithelium).
Respiratory epithelium lines most of the cavity and
covers conchae, meatuses, floor and roof of cavity.
The roof of nasal cavity is lined by olfactory
epithelium.
The mucosa has numerous seromucinous glands
in the lamina propria which secrete sticky mucus.
The secretions contain lysozymes, lactoferrin and
immunoglobulin.
The mucosa is adherent to the underlying cartilages
and bones of the nasal cavity.
OLFACTORY NERVE (Fig. 28.9)
It is the nerve for sensation of smell.
Functional Component
Special somatic afferent (SSA): For sense of smell.
Origin
The fibres arise from the central processes of bipolar
neurons in the olfactory epithelium present in the upper
Fig. 28.9: Olfactory nerve
Nose and Paranasal Sinuses 395
part of nasal cavity, over superior nasal conchae and the
upper part of nasal septum.
Course
The fibres run upwards and unite to form about 20
small nerve bundles or filaments which are
collectively known as olfactory nerves. Each nerve
bundle is enclosed by the three meninges.
The olfactory nerves pierce the cribriform plate of
ethmoid to enter the cranial cavity and end in the
olfactory bulb of the frontal lobe of brain lying
immediately above the cribrifrom plate.
Olfactory pathway is described in chapter no. 7 as part
of limbic system.
CLINICAL AND APPLIED ANATOMY
Lesion of olfactory nerves results in the loss of sense of
smell called anosmia. The sense of smell also plays an
important role in the finer appreciation of taste.
C H A P T E R-28
PARANASAL AIR SINUSES (Fig. 28.10)
Paranasal air sinuses are air filled spaces within the bones
around the nasal cavity. They communicate with the
nasal cavity through various narrow channels. They are
lined by mucous membrane consisting of pseudo-
stratified ciliated columnar epithelium which is
continuous with the mucous membrane of nasal cavity
Functions of Paranasal Sinuses
1. The mucosal lining of paranasal sinuses help add
humidity and adjust the temperature of the inspired
air thus serving as air-conditioning chambers.
2. The air filled spaces help to make the skull lighter.
3. They help to add resonance to the voice.
All paranasal sinuses are arranged in pairs except
the ethmoidal sinuses which are arranged in three
groups.
The paranasal sinuses are named as follows:
1. Frontal
2. Ethmoidal
3. Maxillary
4. Sphenoidal
Frontal Air Sinuses (2 in number) (Figs 28.10 and
28.11)
The frontal air sinuses are contained in the frontal bone
deep to supraciliary arches. They are triangular in shape.
The right and left sinuses are usually unequal in size.
Each sinus drains into the anterior part of the hiatus
semilunaris of the middle meatus through the
frontonasal duct.
S E C T I O N-2 396 Human Anatomy For Dental Students

Fig. 28.10: Coronal section of head showing paranasal air sinuses (Diagramatic representation)

Measurements Parts of Maxillary Sinus and their Relations

Vertical : 3 cm
Maxillary sinus is pyramidal in shape. It has the follow-
Transverse : 2.5 cm
ing parts:
Antero-posterior : 1.8 cm
1. Roof, formed by floor of the orbit.
Relations
2. Floor (is very small), formed by the alveolar process
Anterior : Supraciliary arch of forehead.
of the maxilla. It lies about 1.25 cm below the floor
Postero-superior : Frontal lobe of the brain.
of the nasal cavity. This level corresponds to the
Inferior : Roof of nose, roof of orbit (medial
level of ala of nose.
part), ethmoidal air cells.
3. Base, formed by the nasal surface of body of
Blood supply: It is supplied by branches of supraorbital
maxilla. It presents with the opening or ostium of
vessels.
the sinus in its upper part which communicates
Lymphatics drainage: It drains into submandibular
with the middle meatus.
lymph nodes.
In the disarticulated skull the medial surface of
Nerve Supply: It is supplied by supraorbital nerve. body of maxilla presents a large opening, the
maxillary hiatus. The hiatus is reduced in size by
Maxillary Sinus (Antrum of Highmore) the following bones when all the skull bones are
This is the largest air sinus. It is present in the body of articulated.
maxilla, one on either side of the nasal cavity. It drains a. Uncinate process of ethmoid bone, from above.
into the hiatus semilunaris of the middle meatus in the b. Descending process of lacrimal bone, from
posterior part. above.
c. Ethmoidal process of inferior nasal concha, from
Measurements below.
Vertical : 3.5 cm d. Perpendicular plate of palatine bone from behind.
Transverse : 2.5 cm 4. Apex, extends into the zygomatic process of
Antero-posterior : 3.25 cm maxilla.

5. Anterior wall is related to infraorbital plexus of
nerves. Within this wall runs the anterior superior
alveolar nerve in a bony canal called the canalis
sinuosus.
6. Posterior wall forms the anterior boundary of
infratemporal fossa. It is pierced by the posterior
superior alveolar nerves.
Arterial supply: It is supplied by branches of anterior,
middle and posterior superior alveolar arteries, branches
of maxillary artery.
Venous drainage: It is drained by tributaries of:
1. Facial vein.
2. Pterygoid plexus of veins.
Lymphatic drainage: It drains into submandibular
lymph nodes.
Nerve supply: It is supplied by branches of:
1. Anterior, middle and posterior superior alveolar
nerves, branches of maxillary nerve.
2. Infraorbital nerve.
CLINICAL AND APPLIED ANATOMY
Maxillary sinus is the commonest site of infection
amongst all sinuses. The infection is called maxillary
sinusitis and can occur from the following sources:
1. Infection in the nose
2. Caries of upper molar teeth
3. Being the most dependant part it acts as a
secondary reservoir of pus from frontal air sinuses
through fronto-nasal duct and hiatus semilunaris.
The opening of the sinus is unfortunately present in
the upper part of its medial wall. This results in
inefficient drainage and persistence of infection leading
to collection of pus in acute cases or formation of
mucosal polyps in chronic cases. Surgical evacuation
of maxillary sinus is performed in two ways:
1. Antral puncture: The medial wall of the sinus is
punctured by passing a trocar and cannula in the
inferior meatus in an outward and backward
direction to create a separate opening of the sinus
at a lower level.
2. Caldwell Luc operation: An opening is made
through the gingivo-labial fold and the sinus is
approached via the anterior wall at the canine fossa.
3. Endoscopic surgery using fiber optic instrument is
the most preferred method of removal of polyps at
present.
Nose and Paranasal Sinuses 397
Ethmoidal Sinuses
The ethmoidal air sinuses are made up of a number of
air cells present within the labyrinth of ethmoid bone.
They are located between the upper part of the lateral
nasal wall and the orbit. They are divided into following
three groups:
a. Anterior group consisting of upto 11 cells.
b. Middle group consisting of 1 to 7 cells.
c. Posterior group also consisting of 1 to 7 cells.
The first two groups of air sinuses drain into middle
meatus, the anterior group opens in the hiatus
semilunaris while the middle group opens on bulla
ethmoidalis. The posterior group opens into the posterior
part of superior meatus.
Blood supply: It is derived from:
1. Anterior ethmoidal vessels
2. Posterior ethmoidal vessels
Lymphatic drainage: They drain into:
1. Submandibular lymph nodes (anterior sinuses)
2. Retropharyngeal lymph nodes (posterior sinuses)
C H A P T E R-28
Nerve supply: They are supplied by branches of:
1. Anterior ethmoidal nerve.
2. Posterior ethomidal nerve.
3. Orbital branch of pterygopalatine ganglion.
Sphenoidal Sinuses (Fig. 28.11)
The right and left sphenoidal sinuses lie within the body
of sphenoid above and behind the nasal cavity. They
are separated from each other by a septum. The two
sinuses are usually asymmetrical. Each sinus drains into
spheno-ethmoidal recess of the nasal cavity.
Measurements
Vertical : 2 cm
Transverse : 1.5 cm
Antero-posterior : 2 cm
Fig. 28.11: Sagittal section of head and neck showing
sphenoidal and frontal air sinuses
 398 Human Anatomy For Dental Students

Relations Venous drainage: It drains into posterior ethmoidal

Above : Pituitary gland and optic chiasma. vein. which further drains into ophthalmic vein. Hence,
Below : Roof of nasopharynx. it is connected to cavernous sinus.
Lateral : Cavernous sinus and internal carotid
artery (in one line).
Lymphatic drainage: The lymphatics drain into retro-
Behind : Pons and medulla oblongata.
In front : Spheno-ethmoidal recess. pharyngeal lymph nodes
Arterial supply: It is derived by branches of:
1. Posterior ethmoidal artery, branch of ophthalmic Nerve supply: It is supplied by branches of:
artery. 1. Posterior ethomidal nerve.
2. Sphenopalatine artery. 2. Orbital branch of pterygopalatine ganglion.
S E C T I O N-2
 Chapter

29
Pharynx

INTRODUCTION Measurements
Length : 12 to 14 cm
Pharynx is a musculo-fascial tube extending from the Width : Upper part, 3.5 cm
base of skull to the oesophagus (at level of C6 vertebra). Lower part, 1.5 cm
It is situated infront of the prevertebral fascia covering Subdivisions: The pharynx is divided into three parts.
the cervical vertebrae (C1 to C6). It lies behind the nose, From above downwards these are:
1. Nasopharynx
mouth and larynx and communicates with them. It acts
2. Oropharynx
as a common channel for both deglutition and 3. Laryngopharynx
respiration (Fig. 29.1).

C H A P T E R-29

Fig. 29.1: Sagittal section of head and neck showing pharynx

S E C T I O N-2 400 Human Anatomy For Dental Students
Fig. 29.2: Diagrammatic representation of pharynx as seen from posterior aspect
NASOPHARYNX (Figs 29.1 and 29.2)
Nasopharynx is the part of pharynx which lies
above the soft palate. It acts as a respiratory passage.
Superiorly, it is limited by the body of sphenoid
and basi-occiput which form the roof of
nasopharynx.
Inferiorly, it communicates with the oropharynx at
the pharyngeal (nasopharyngeal) isthmus.
Pharyngeal isthmus: It is an opening bounded
anteriorly by the soft palate and posteriorly by the
posterior wall of the pharynx. It separates
oropharynx from nasopharynx.
Soft palate forms the floor of nasopharynx when it
is elevated during swallowing and prevents entry
of food from oropharynx.
Nasopharynx communicates anteriorly with the
nasal cavities through posterior nasal apertures.
Posteriorly the pharyngeal wall is made up of the
mucosa which covers basi-occiput, pharyngobasilar
fascia and superior constrictor muscle. Beneath this
it is related to C1 (atlas) vertebra.
The lateral wall are muscular and the cavity of
nasopharynx is always patent.
Two important structures lie in the nasopharynx.
These are:
a. Nasopharyngeal (pharyngeal) tonsil: It is a
collection of lymphoid tissue present in the
midline, beneath the mucous membrane of the
roof (basi-occiput) and the adjoining posterior
wall of this region.
b. Orifice of the pharyngotympanic tube or
auditory tube (Eustachian tube): It presents the
following features in the lateral wall of
nasopharynx.
The tubal opening lies 1.2 cm behind the level
of inferior nasal concha, in the lateral wall of
nasopharynx, on each side.
The upper and posterior margins of this
opening are bounded by a tubal elevation
which is produced by the collection of
lymphoid tissue called the tubal tonsil.
Two mucous folds extend from this elevation,
namely:
1. Salpingopharyngeal fold: This extends
vertically downwards and fades on the
side wall of the pharynx. It contains the
salpingopharyngeus muscle
2. Salpingopalatine fold: This extends
downwards and forwards to the soft
palate. It contains the levator palati
muscle.
There is a deep depression behind the tubal
elevation which is known as the pharyngeal
recess or fossa of rosenmuller.

CLINICAL AND APPLIED ANATOMY
Adenoids: The nasopharyngeal tonsils are prominent
in children and usually undergo atrophy at puberty.
Enlargement of nasopharyngeal tonsils, usually due to
repeated upper respiratory tract infections, is known
as adenoids. Enlarged adenoids may block the posterior
nares and cause discomfort to the child as he will have
to breath through the mouth. It is a common cause of
snoring in children.
OROPHARYNX (Figs 29.1 and 29.2)
The oropharynx extends from the soft palate above
(pharyngeal isthmus) to the tip of epiglottis below.
It continues inferiorly with the laryngopharynx at
the upper border of epiglottis.
It communicates anteriorly with the oral cavity
through the oropharyngeal isthmus.
Boundaries of oropharyngeal isthmus
Superiorly : Soft palate
Inferiorly : Dorsal surface of the posterior
third of the tongue.
Laterally
(on each side) : Palatoglossal arch, containing the
palatoglossus muscle.
The oropharyngeal isthmus closes during degluti-
tion to prevent regurgitation of food from pharynx
into the mouth.
Posteriorly, oropharynx lies over the C2 and C3
vertebrae separated from them by the retro-
pharyngeal space and its contents.
The lateral wall on each side presents with:
a. Tonsillar fossa: It is a triangular fossa which
lies between the palatoglossal and palato-
pharyngeal arches. It lodges the palatine tonsil.
b. Palatoglossal arch: It is the fold of mucus
membrane which extents down from each side
of soft palate and merges with the lateral aspect
of dorsal part of tongue. It forms the anterior
wall of the fossa. It overlies the palatoglossus
muscle.
c. Palatopharyngeal arch: It is the fold of mucus
membrane which extents from soft palate on
each side and merges with the lateral
pharyngeal wall. It forms the posterior wall of
the fossa. It overlies the palato-pharyngeus
muscle.
Palatine Tonsil (Fig. 29.3)
Palatine tonsil is a collection of lymphoid tissue situated
in the tonsillar fossa, one on each side, in the lateral wall
of the oropharynx. Tonsillar fossa is a triangular fossa
which has the following features:
Pharynx 401
Fig. 29.3: Palatine tonsils
1. Anterior wall: It is formed by palatoglossal arch.
2. Posterior wall: It is formed by palatopharyngeal
arch.
3. Apex is formed by meeting of both arches at their
upper end.
4. Base is formed by the dorsal surface of posterior
1/3rd of tongue.
5. Tonsillar bed or floor of the tonsillar fossa is formed
by superior constrictor and partly by palato-
C H A P T E R-29
pharyngeus muscles. It is separated from the tonsil
by the tonsillar capsule which is a thick conden-
sation of pharyngobasilar fascia. The capsule is itself
separated from the superior constrictor muscle by
a film of loose areolar tissue.
External Features of Tonsil
Shape: Almond-shaped.
Medial surface is covered by stratified squamous
epithelium and presents with 12 to 15 crypts. The
largest of these is called the intratonsillar cleft,
sometimes wrongly termed as supratonsillar fossa.
Lateral surface is covered by fibrous capsule
formed by the condensation of pharyngobasilar
fascia. It is separated from the superior constrictor
muscle by a loose connective tissue.
Anterior border is related to the palatoglossal arch
with its muscle.
Posterior border is related to the palatopharyngeal
arch with its muscle.
Upper pole is related to the soft palate.
Lower pole is related to the dorsal surface of
posterior 1/3rd of tongue.
Arterial Supply of Tonsil (Fig. 29.4)
Tonsil has a rich arterial supply which is derived from:
1. Tonsillar branch of facial artery: It is the principal
artery of tonsil and enters the gland via its lower
pole.
2. Dorsalis linguae artery, branch of lingual artery.
3. Ascending palatine artery, branch of facial artery.
 402 Human Anatomy For Dental Students
Fig. 29.4: Arterial supply of palatine tonsil
4. Ascending pharyngeal artery, branch of external
carotid artery.
5. Greater palatine artery, branch of maxillary artery.
Venous Drainage of Tonsil
The veins drain into the pharyngeal plexus of veins
through the paratonsillar vein. The paratonsillar vein
descends from the soft palate across the lateral aspect of
the tonsillar capsule and pierces the superior constrictor
to drain into the pharyngeal plexus of veins.
S E C T I O N-2
Lymphatic Drainage of Tonsil
Lymphatics from tonsil drain into the jugulo-digastric
lymph nodes. It is often called as the tonsillar lymph
node. It usually enlarges in infections of the tonsil
(tonsillitis).
Nerve Supply of Tonsil
Tonsils are supplied by glossopharyngeal nerve of the
respective side.
CLINICAL AND APPLIED ANATOMY
Tonsils are larger in children upto puberty and
atrophy by adulthood. They are known to increase
in size in childhood due to repeated infections
causing tonsillitis which is treated by antibiotics.
Tonsillectomy, i.e., surgical removal of tonsils is
necessary if they become a site of repeated
infections or there is a tonsillar abscess or they
enlarge so much that they block the passage. Injury
to paratonsillar vein during surgery is an important
cause of haemorrhage which is usually controlled
by applying pressure.
Waldeyers Lymphatic Ring (Fig. 29.5)
It consists of collections of lymphoid tissue around the
commencement of air and food passages in the
submucosal layer. The lymph nodules are arranged in a
ring like pattern. From posterior to anterior it is made
up of the following:
Fig. 29.5: Inner Waldeyers ring
1. Pharyngeal (nasopharyngeal) tonsils: Lie postero-
superiorly under the mucus membrane of the roof
and adjoining posterior wall of nasopharynx.
2. Tubal tonsils: Present on each side around the
opening of eustachian tube into nasopharynx.
3. Palatine tonsils: Present in the tonsillar fossa on
each side of the oropharyngeal isthmus.
4. Lingual tonsil: This is present anteroinferiorly and
lies in the submucosa of posterior 1/3rd of dorsum
of tongue.
This ring of lymphatics prevents invasion of micro-
organisms into the air and food passages. The lymph
from the Waldeyers ring drains into the superficial and
deep cervical group of lymph nodes which form the
external ring of Waldeyer.
LARYNGOPHARYNX (Figs 29.1 and 29.2)
Laryngopharynx extends from upper border of the
epiglottis to the lower end of pharynx, i.e., upto
inferior border of cricoid cartilage. It continues
inferiorly as the oesophagus at the level of C6
vertebra.
The junction of laryngopharynx with oesophagus
is named pharyngo-oesophageal junction and is the
narrowest part of GIT after appendix.
In its upper part, it communicates anteriorly with
the laryngeal cavity through the laryngeal inlet.
Below the inlet, its anterior wall is formed by the
posterior surface of lamina of cricoid cartilage.
Posteriorly, it overlies the bodies of C4, C5 and C6
vertebra separated from them by the retro-
pharyngeal space.
Laryngopharynx presents two important features:
1. Laryngeal inlet: It is the opening into the larynx
which communicates posteriorly with laryngo-
pharynx. The inlet slopes from above downwards
and is bounded by:
Anteriorly and superiorly : Epiglottis.
Laterally : Aryepiglottic folds.
Inferiorly and posteriorly : Arytenoid cartilages
and interarytenoid
fold.
The laryngeal inlet closes during deglutition to
prevent entry of food into the laryngeal cavity. This

is brought about by the approximation of the two
aryepiglottic folds in the midline and bending of
epiglottis posteriorly over the inlet.
2. Piriform fossa: It is a deep recess seen in the inner
aspect of the anterior part of lateral wall of
laryngopharynx, on each side of the laryngeal inlet.
These recesses are produced due to inward bulging
of the lamina of thyroid cartilage on each side of
midline into this part of pharynx.
Boundaries of Piriform Fossa
Medial : Aryepiglottic fold.
Lateral : Mucous membrane covering the medial
surface of the lamina of thyroid
cartilage and thyrohyoid membrane.
Important feature of piriform fossa: The internal
laryngeal nerve and superior laryngeal vessels
pierce the thyrohyoid membrane and traverse
underneath the mucous membrane of the floor of
the piriform fossa to reach the medial wall of
pharynx.
CLINICAL AND APPLIED ANATOMY
Piriform fossa is a depressed area. Occasionally,
ingested food particles can get stuck in this depression.
If adequate care is not taken during the removal of such
foreign bodies especially hard structures like fish bones,
it may cause damage to the internal laryngeal nerve
leading to anaesthesia in the supraglottic part of the
larynx.
STRUCTURE OF PHARYNX
The wall of the pharynx consists of the following layers,
from within outwards these are:
1. Mucosa
2. Submucosa
3. Muscular coat
4. Loose areolar sheath or the buccopharyngeal fascia
Mucosa: The mucosa of pharynx is made up of stratified
squamous epithelium except, in the region of
nasopharynx where it is lined by ciliated columnar
epithelium. The mucosal lining continues with lining of
nasal cavity, mouth, eustachian tube and larynx.
Submucosa: The submucosa is thick and fibrous. It is
called the pharyngobasilar fascia. The pharyngobasilar
fascia is thickest at two points
1. In the upper part, where it fills the gap between
the upper border of superior constrictor and the
base of the skull.
2. Posteriorly, in the midline, where it forms the
pharyngeal raphe.
Pharynx 403
Muscular coat (Figs 29.6 and 29.7): The muscular coat
consists of striated muscles which are arranged in an
outer circular layer and an inner longitudinal layer. The
circular layer comprises of 3 pairs of constrictors:
1. Superior constrictor
2. Middle constrictor
3. Inferior constrictor
The longitudinal coat comprises of 3 pairs of
longitudinal muscles:
1. Stylopharyngeus
2. Palatopharyngeus
3. Salpingopharyngeus
Loose Areolar Sheath of Pharynx: A loose areolar
membrane also called the buccopharyngeal fascia
covers the outer surface of the muscular coat of pharynx.
It extends anteriorly across the pterygomandibular
raphe to cover the outer surface of the buccinator also.
Constrictor Muscles of the Pharynx (Figs 29.6 and 29.7)
Constrictor muscles form the main bulk of the
C H A P T E R-29
muscular coat of pharyngeal wall.
They arise from the posterior openings of the nose,
mouth and larynx. The fibres pass backwards in a
fan-shaped manner into the lateral and posterior
walls of the pharynx and get inserted into the
median fibrous pharyngeal raphe on the posterior
aspect of the pharynx. This raphae extends from
the base of the skull, from pharyngeal tubercle of
occipital bone, to the oesophagus.
The three constrictor muscles are arranged like
flower pots placed one inside the other but are open
in front for communication with the nasal, oral and
laryngeal cavities. Thus, the inferior constrictor
muscle overlaps the middle constrictor which in
turn overlaps the superior constrictor muscle.
Fig. 29.6: Arrangement of constrictor muscles of pharynx
S E C T I O N-2 404 Human Anatomy For Dental Students

Fig. 29.7: Constrictor and longitudinal muscles of the pharynx

Nerve supply: The muscles are supplied by pharyngeal
branches of cranial root of accessory nerve carried by
the vagus nerve. These fibres form a pharyngeal plexus
along with branches from glossopharyngeal nerve and
superior cervical sympathetic ganglion over the middle
constrictor. The latter are sensory to the pharynx and
are responsible for the swallowing reflex. The inferior
constrictor is in addition supplied by the external
laryngeal and recurrent laryngeal nerves.
Action: Each muscles constricts the corresponding part
of pharynx and acting together they aid in deglutition
by the coordinated contractions.

Constrictor Muscles of the Pharynx (Fig. 29.6 and 29.7)

Muscle Origin Insertion

Superior constrictor 1. Pterygoid hamulus 1. Pharyngeal tubercle on the base of skull
2. Pterygomandibular raphe 2. Median fibrous raphe
3. Medial surface of the mandible at
the upper end of mylohyoid line
4. Side of the posterior part of the tongue
Middle constrictor 1. Lower part of stylohyoid ligament Median fibrous raphe
2. Lesser cornu of hyoid
3. Upper border of greater cornu of hyoid
Inferior constrictor
a. Thyropharyngeus 1. Oblique line on lamina of thyroid Median fibrous raphe
cartilage
2. Tendinous band between inferior
thyroid tubercle and cricoid cartilage.
b. Cricopharyngeus Lateral side of cricoid cartilage. Median fibrous raphe
 Pharynx 405

C H A P T E R-29
Fig. 29.8: Structures passing between the constrictor muscles of pharynx

Structures passing between the constrictors of pharynx (Fig. 29.8)

Gap Structures

1. Between the base of skull and upper concave 1. Auditory tube

border of superior constrictor - 2. Levator palati muscle
Sinus of Morgagni 3. Ascending palatine artery
4. Palatine branch of ascending pharyngeal artery

2. Between the superior and middle constrictors 1. Stylopharyngeus muscle

2. Glossopharyngeal nerve

3. Between the middle and inferior constrictors 1. Internal laryngeal nerve

2. Superior laryngeal vessels

4. Between lower border of inferior constrictor and 1. Recurrent laryngeal nerve

the oesophagus (in the tracheo-oesophageal groove) 2. Inferior laryngeal vessels

Longitudinal Muscles of the Pharynx (Fig. 29.7) Actions: They elevate the larynx and shorten the
These muscles run longitudinally from above down- pharynx during swallowing. At the same time
wards to form the longitudinal muscle coat of pharynx. palatopharyngeal sphincter closes the pharyngeal
They are tabulated below: isthmus.
 406 Human Anatomy For Dental Students

Longitudinal Muscles of Pharynx (Fig. 29.7)

Muscle
1. Stylopharyngeus
2. Palatopharyngeus
3. Salpingopharyngeus
Origin
Medial surface of the base
of styloid process.
Arises as two fasciculi,
anterior and posterior from
the upper surface of
palatine aponeurosis.
Lower part of cartilaginous
part of pharyngotympanic
tube.
Insertion
Posterior border of lamina
of thyroid cartilage.
Few fibres merge with
superior constrictor muscle.
Posterior border of lamina
of thyroid cartilage.
Posterior border of lamina
of thyroid cartilage.
Nerve supply
Glossopharyngeal nerve
via the pharyngeal plexus.
Cranial root of
accessory nerve (XI)
via the pharyngeal plexus.
Cranial root of accessory
nerve (XI) via the
pharyngeal plexus.

Passavants ridge: Some fibres of palatopharyngeus, Nerve Supply of Pharynx

arising from the palatine aponeurosis sweep horizontally
backwards forming a U-shaped loop within the wall
of pharynx underneath the mucosa. This is seen as a
raised area called the Passavants ridge. This U-shaped
muscle loop acts as the palato-pharyngeal sphincter.
Tissue Spaces of Pharynx
These are potential soft tissue spaces located in the
S E C T I O N-2
The sensory and motor nerve supply of pharynx is
derived from pharyngeal plexus.
1. Motor supply: All the pharyngeal muscles are
supplied by the cranial root of accessory nerve via
pharyngeal branch of vagus and pharyngeal plexus
except the stylopharyngeus which is supplied by

following area: the glossopharyngeal nerve.

1. Retropharyngeal space: It is the space between the
posterior wall of pharynx and prevertebral fascia.
It extends from base of skull till root of neck.
2. Parapharyngeal space: It is the space between the
lateral wall of pharynx on each side and the
pterygoid muscles. It continues behind with the
retropharyngeal space.
3. Intrapharyngeal space: It lies between the mucosa
and inner aspect of constrictor muscles of pharynx.
4. Peritonsillar space: It lies between the lateral wall
of tonsil and the mucosal wall of tonsillar fossa
between the pillars of fauces.
Arterial Supply of Pharynx
It is derived from the following branches of external
carotid artery:
1. Ascending pharyngeal artery. It is the primary
supply.
2. Facial artery.
3. Maxillary artery.
4. Lingual artery.
2. Sensory supply: It is derived from the following:
1. Nasopharynx is supplied by pharyngeal branch
of the pterygopalatine ganglion which carries
fibres from maxillary division of trigeminal
nerve.
2. Oropharynx is supplied by glossopharyngeal
nerve.
3. Laryngopharynx is supplied by the internal
laryngeal nerve.
Pharyngeal Plexus of Nerves
The pharyngeal plexus of nerves lies between the
buccopharyngeal fascia and the muscular coat of middle
constrictor. It is formed by the following nerves:
1. Pharyngeal branch of vagus carrying fibres from
cranial part of the accessory nerves.
2. Pharyngeal branch of the glossopharyngeal nerve.
3. Pharyngeal branch from superior cervical
sympathetic ganglion.

Venous Drainage of Pharynx Functions of Pharynx

Pharyngeal veins form a plexus under the submucosa
and pass into the internal jugular vein on each side.
Lymphatic Drainage of Pharynx
Lymphatics from pharynx pass to the retropharyngeal
and deep cervical group of lymph nodes.
Nasopharynx and Oropharynx provide passage for
air and helps to maintain the warmth and humidity
of the air.
Oropharynx and Laryngopharynx provide passage
for food.
 Pharynx 407

Nasopharyngeal, tubal and palatine tonsils form a
part of Waldeyers ring (see page no. 582). They
guard the respiratory and food passages.
Pharynx acts as a resonating passage and aids in
phonation.
GLOSSOPHARYNGEAL NERVE (Fig. 29.9)
It is the 9th cranial nerve. It is a mixed nerve containing
both motor and sensory fibres. It is the nerve of the 3rd
branchial arch.

C H A P T E R-29

Fig. 29.9: Glossopharyngeal nerve and its distribution

 408 Human Anatomy For Dental Students
Functional Components of Glossopharyngeal Nerve
Functional
1. Special visceral efferent (SVE)
2. General visceral efferent (GVE)
3. Special visceral afferent (SVA)
4. General visceral afferent (GVA)
5. General somatic afferent (GSA)
Nuclear Origin
The fibres of glossopharyngeal nerve are connected to
the following four nuclei in the medulla oblongata.
1. Nucleus ambiguus: The special visceral efferent
fibres originate from this nucleus.
2. Nucleus of tractus solitarius: It receives afferent
fibres of:
a. Taste sensation from posterior 1/3rd of tongue.
b. General visceral sensations from the pharynx,
tonsils and tongue and tympanic cavity.
3. Inferior salivatory nucleus: It gives rise to
preganglionic secretomotor fibres for the parotid
S E C T I O N-2
gland.
4. Nucleus of spinal tract of trigeminal nerve: The
afferent fibres from stylopharyngeus and skin of
the auricle terminate in this nucleus.
After arising from the nuclei the fibres pass forwards
and laterally between the inferior olivary nucleus and
inferior cerebellar peduncle and finally emerge from the
upper part of lateral aspect of medulla.
Intracranial Course
The nerve arises from the upper lateral part of the
medulla groove between olive and inferior
cerebellar peduncle in the form of 3 to 4 rootlets.
These unite to form a single trunk that runs
forwards and laterally towards the jugular foramen.
The nerve is associated with two ganglia in this
region:
1. Superior ganglion: This is smaller and lies at the
upper end of jugular foramen. Has no branches.
2. Inferior ganglion: It is the larger of the two and
is present just below the jugular foramen. It
forms a triangular depression on the inferior
surface of the petrous part of temporal bone. It
contains the cell bodies of most of the sensory
fibres of the nerve.
Extracranial Course
The glossopharyngeal nerve emerges out of the
jugular foramen at the base of the skull along with
the 10th and 11th cranial nerves.
Component
Motor to stylopharyngeus muscle
Secretomotor to parotid gland
For taste sensations from posterior 1/3rd of the
tongue including vallate papillae
Sensory to mucous membrane of the soft palate
posterior 1/3rd of the tongue, tympanic cavity
For proprioceptive impulses from stylopharyngeus
and skin of the auricle
It lies between the internal carotid artery and
internal jugular vein at this point, in front of the
vagus nerve
Then, it passes forwards and downwards between
the internal and external carotid arteries to reach
the medial aspect of the styloid process
It runs along with the stylopharyngeus, lying
superficial to it and enters the triangular gap
between the superior and middle constrictors of the
pharynx (Fig. 29.8)
Now it curves upwards around the lower aspect of
stylopharyngeus to emerge deep to the stylohyoid
ligament and posterior edge of hyoglossus muscle
Here, it finally breaks up into its terminal lingual
and tonsillar branches
Branches of Glossopharyngeal Nerve
1. Communicating branches
a. Twig to the ganglion of vagus nerve.
b. Twig to auricular branch of vagus nerve.
c. Communicate with facial nerve.
2. Tympanic branch: It conveys the secretomotor
fibres from the inferior salivaratory nucleus and
enters the middle ear. It joins with fibres of the
sympathetic plexus around internal carotid artery
to form the tympanic plexus over the promontory
of middle ear. Branches from the tympanic plexus
are:
a. Lesser petrosal nerve: The secretomotor fibres
pass through lesser petrosal nerve to relay in
the otic ganglion.
b. Twigs to tympanic cavity, auditory tube and
mastoid air cells.
3. Carotid nerve: It supplies the carotid sinus and body.
4. Pharyngeal branch: It joins the pharyngeal
branches of the vagus and the cervical sympathetic
chain to form the pharyngeal plexus on the middle
constrictor of the pharynx.
5. Branch to stylopharyngeus, arises as the nerve
winds round the stylopharyngeus muscle.
6. Tonsillar branches, supply the tonsil.
7. Lingual branches: Convey taste and common
sensations from the posterior 1/3rd of the tongue
and vallate papillae.

CLINICAL AND APPLIED ANATOMY
A potential gap is present posteriorly in the pharynx
between the thyropharyngeus and the crico-
pharyngeus muscles. It is called pharyngeal dimple
or Killiens dehiscence because this is the weakest
part of the pharynx. A pharyngeal pouch may
occasionally occur due to invagination of the
mucosa and submucosa of this region. This is
attributed to the neuromuscular incoordination in
this region which may be due to the fact that the
two parts of the inferior constrictor have different
nerve supply. The propulsive thyropharyngeus is
supplied by the pharyngeal plexus while the
sphincteric cricopharyngeus receives supply from
the recurrent laryngeal nerve. If the crico-
pharyngeus fails to relax when the thyro-
pharyngeus contracts, the bolus of food is pushed
further backwards to press on the mucosa and
submucosa of the pharynx which bulges outwards
through this weak area to form a pouch.
Complete lesion of the glossopharyngeal nerve
results in the following:
a. Loss of taste and common sensations over the
posterior 1/3rd of the tongue.
b. Difficulty in swallowing.
c. Loss of salivation from the parotid gland.
d. Unilateral loss of gag-reflex which is normally
produced by stimulating the posterior
pharyngeal wall.
Complete lession of the glossopharyngeal nerve is
rare in isolation. There is often the associated
involvement of the vagus nerve.
Mechanism of Deglutition (Swallowing)
Deglutition is a process by which the food is transferred
from the mouth to the stomach. It consists of three
successive stages:
a. First stage (in the mouth): Voluntary
b. Second stage (in the pharynx): Involuntary
c. Third stage (in the oesophagus): Involuntary
First Stage
The anterior part of tongue is raised to push the
masticated food to the posterior part of the oral
cavity.
The soft palate closes down on to the back of tongue
to help form a bolus of food.
Now the hyoid bone moves up and food is pushed
from the oral cavity into the oropharynx through
the oropharyngeal isthmus.
Pharynx 409
Second Stage
The nasopharyngeal isthmus is closed by elevation
of the soft palate and contraction of Passavants
ridge to prevent entry of food into the nose.
The laryngeal inlet is closed by approxination of
the aryepiglottic folds to prevent entry of food into
the larynx.
Now the pharynx and larynx are elevated behind
the hyoid bone by the longitudinal muscles of the
pharynx. The bolus of food is pushed down over
the posterior surface of epiglottis by gravity and
contraction of superior and middle constrictors and
it passes from the oropharynx to laryngopharynx.
Third Stage
By the propulsive action of thyropharyngeus
followed by relaxation of cricopharyngeus food
passes from laryngopharynx to the oesophagus.
It finally enters into the stomach by the peristaltic
movements in the oesophageal wall.
PHARYNGOTYMPANIC TUBE (AUDITORY TUBE)
C H A P T E R-29
(Fig. 29.10)
The auditory tube is an osseo-cartilaginous channel
which connects the lateral wall of nasopharynx with
the middle ear (tympanum).
It maintains the equilibrium of air pressure on either
side of tympanic membrane.
It is 4 cm long and is directed downwards, forwards
and medially.
Features: The tube comprises of two parts:
a. Osseous or bony part: Forms lateral 1/3rd of
the tube. It extends from the tympanic cavity
downwards and forwards towards the anterior
border of petrous temporal which articulates
with the greater wing of sphenoid.
b. Cartilaginous part: Forms anterior 2/3rd of the
tube. It lies in the sulcus tubae, formed by
articulation of petrous temporal and greater
Fig. 29.10: Pharyngotympanic tube
 410 Human Anatomy For Dental Students
wing of sphenoid on undersurface of skull and
runs downwards, forwards and medially to
open into the lateral wall of nasopharynx above
the superior constrictor. It is made up of a
triangular plate of elastic fibrocartilage bent in
such a way so that it forms the superior and
medial wall of the tube. The infero-lateral gap
is filled by a fibrous membrane.
Functions of Auditory Tube
The eustachian tube opens into the nasopharynx and it
helps to equalise air pressure in middle ear cavity. This
helps in conduction of sound waves and facilitates
hearing.
S E C T I O N-2
CLINICAL AND APPLIED ANATOMY
The eustachian tube extends from middle ear to
nasopharynx and helps to equalize pressure
between the middle ear and the external ear.
Infection in nasopharynx can cause swelling and
blockage of the tube. This leads to decrease in
pressure in the middle ear and the tympanic
membrane is pulled towards it. There is a feeling
of fullness in the ear and loss of hearing.
Infection can also spread from the pharynx to
middle ear via the tube. This is more common in
children as the tube is short and straight. Hence it
is important to check the ears in children presenting
with complaints of nasal congestion or tonsillitis.
 Chapter

30
Larynx

INTRODUCTION Epiglottis (Fig. 30.2)

Larynx is that part of upper respiratoy tract which is
located in the neck. It also acts as the organ of phonation.
It is a membrano-cartilaginous passage which comm-
unicates above with the laryngopharynx and below with
the trachea (Fig. 30.1 and 30.4).
Extent: It extends from the upper border of epiglottis to
the lower border of cricoid cartilage, i.e., C3 to C 6
vertebral levels.
It is a leaf like structure that extends upwards
behind the hyoid bone and the base of the tongue.
It has an upper and a lower end, an anterior and
posterior surface with two lateral borders.
The upper broad end is free while the narrow lower
end is connected to the posterior surface of the
thyroid angle by the thyroepiglottic ligament, just
below the thyroid notch.

SKELETON OF THE LARYNX
The skeletal framework of larynx is made up of 9 cartila-
ges which are connected to one another by ligaments
and membranes. It is lined by mucus membrane and
covered externally by muscles of larynx.
C H A P T E R-30
The anterior surface is also connected below to the
hyoid bone by the hyo-epiglottic ligament.
The posterior surface of epiglottis is concave and
presents a tubercle in its lower part.
Both the surfaces are covered with mucus
membrane.
The mucus membrane from anterior surface of
epiglottis reflects over the base of tongue and forms
one median and two lateral glosso-epiglottic folds.
The depression on each side of the median fold is
called as vallecula.
The lower part of the lateral border provides
attachment to aryepiglottic folds on each side.

Thyroid Cartilage (Figs 30.1 and 30.2)

It consists of two quadrilateral laminae which are
fused anteriorly at an angle called the thyroid angle.
It is deficient posteriorly.
Each lamina has four borders namely upper, lower,
Fig. 30.1: Cartilages of larynx (anterior view) anterior and posterior and two surfaces, outer and
inner.
Anterior borders of each lamina are fused together
CARTILAGES OF LARYNX (Fig. 30.1)
in lower 2/3rd to form thyroid angle. In upper
It has three paired and three unpaired cartilages. 1/3rd the border are separated by the thyroid notch
or incisure. The angle measures 90 in males and
Paired cartilages Unpaired cartilages 120 in females.
They are small and They are large and comprise of
The thyroid angle is more prominent in males. It
comprise of (from above downwards) forms a prominence on the front of neck which is
1. Arytenoid 1. Epiglottis named Adams apple.
2. Corniculate 2. Thyroid Upper border, from before backwards is convexo-
3. Cuneiform 3. Cricoid concave and gives attachment to the thyrohyoid
membrane.
 412 Human Anatomy For Dental Students
The lower border is straight anteriorly and curves,
with concavity downwards, on each side in the
posterior part. A conical fibrous band named, the
median cricothyroid ligament, extends from
anterior part of lower border to the cricoid cartilage.
The rest of the border provides insertion to
cricothyroid muscle on each side.
The posterior border of each lamina is free and
extends above and below as the superior and
inferior horns. Superior horn is long and provides
a conjoined insertion to stylopharyngeus, palato-
pharyngeus and salpingopharyngeus muscles. The
lower horns are shorter and thicker and curve
downwards to articulate with cricoid cartilage on
each side along their medial aspect.
Inner surface of the thyroid cartilage is covered with
mucus membrane. In the median plane it provides
attachment to the following structures on each side
of midline, from above downwards:
1. Thyroepiglottic ligament
2. Vestibular ligaments
3. Vocal ligaments.
Outer surface of each lamina presents an oblique
S E C T I O N-2
line extending from base of superior horn to the
inferior border, in front of inferior horn. It provides
attachment to the following 3 muscles:
1. Thyrohyoid, in front.
2. Sternothyroid, in middle part.
3. Inferior constrictor (thyropharyngeus part only),
below and behind the line.
Cricoid Cartilage (Figs 30.1 to 30.3)
The cricoid cartilage is situated at the level of C6
vertebra and completely encircles the lumen of the
larynx.
Fig. 30.2: Cartilages of larynx (posterior view)
This is shaped like a signet ring with a narrow
anterior arch and a broad posterior lamina.
At the outer surface of junction of the two parts, on
each side, the cricoid bears an oval facet which
articulates with the corresponding inferior horn of
thyroid cartilage.
The inner surface of cartilage is lined by mucus
membrane consisting of ciliated columnar
epithelium.
Upper border gives attachment to cricothyroid
membrane and lower border gives attachement to
cricotracheal ligament.
The posterior ends of the upper border of cricoid
lamina present on each side with a smooth, oval
and convex articular shoulder that articulates with
the base of arytenoid cartilages.
The posterior surface of the lamina presents a
median ridge for attachment of oesophageal
ligament (longitudinal layer of muscularis externa
of esophagus). Two depressed areas on each side of
this ridge give origin to posterior cricoarytenoid
muscle.
Arytenoid Cartilages (Figs 30.2 and 30.3)
Each arytenoid cartilage is pyramidal in shape and
presents, an apex, a base, 2 processes-muscular and
vocal and 3 surfaces: anterolateral, medial and
posterior.
The apex is directed upwards while the base is
directed below and is concave. The base articulates
with the corresponding lateral end of upper border
of lamina of cricoid cartilage.
The medial surface is smooth, flat and is directed
towards the cavity. It is lined by mucus membrane.
Fig. 30.3: Cricoid and arytenoid cartilages of larynx (anterior view)

Posterior surface is smooth and concave while
anterolateral surface is rough and convex.
The muscular process projects laterally and
backwards while the vocal process is directed
forwards.
Corniculate Cartilages (Figs 30.2 and 30.3)
These are tiny cartilages lying in the posterio-inferior
part of the aryepiglottic folds, above the apex of the
arytenoid cartilage.
Cuneiform Cartilages (Fig. 30.4 and 30.5)
These are tiny rods of cartilage situated in the
aryepiglottic fold anterosuperior to the corniculate
cartilages.
LIGAMENTS AND MEMBRANES OF THE LARYNX
(Fig. 30.4)
The cartilages of larynx are interconnected to each other
by various membranes and ligaments. These can be
divided into extrinsic and intrinsic membranes.
Intrinsic Ligaments and Membranes of Larynx
Extrinsic Ligaments and Membranes of Larynx
1. Hyoepiglottic ligament: This extends from
posterior aspect of body of hyoid bone to the upper
part of anterior surface of epiglottis.
2. Thyrohyoid membrane
Fig. 30.4: Sagittal section of larynx showing cartilages, ligaments and membranes of larynx
Larynx 413
It is a fibroelastic membrane that extends from
the upper border of thyroid cartilage to upper
border of body and adjacent greater horn of
hyoid bone.
Between the posterior aspect of hyoid and this
membrane, lies the subhyoid bursa.
The membrane is thickened anteriorly to form
one median thyrohyoid ligament and
posteriorly to form lateral thyrohyoid ligaments
on each side. The lateral ligaments may contain
a small nodule of cartilage called cartilage-
triticea.
The membrane is pierced by superior laryngeal
vessels and internal laryngeal nerve.
3. Thyroepiglottic ligament: It extends from the lower
narrow end of epiglottis to the posterior surface of
thyroid angle below thyroid notch and above the
vestibular ligament.
4. Cricotracheal ligament: It connects the lower
border of anterior arch of cricoid cartilage with the
first tracheal ring.
C H A P T E R-30
1. Cricothyroid membrane/Crico-vocal membrane
It is made up of yellow elastic tissue.
It is attached to the upper border of anterior arch
of cricoid cartilage and extends upwards.
The upper edge is free. Its anterior end is
attached to the posterior surface of thyroid angle
 414 Human Anatomy For Dental Students

in the middle. The posterior end diverges on from a point on posterior surface of the angle of
each side and is attached to the vocal process of thyroid to the lateral surface of the arytenoid
the arytenoid cartilage. This upper edge is cartilage on each side.
slightly thickened to form the vocal ligament.
Vocal ligaments: They are two in number and CAVITY OF THE LARYNX (Fig. 30.5)
are made up of yellow elastic tissue. Each
extends anteroposteriorly from a point on the It extends from the inlet of larynx to the lower border of
lower part of posterior surface of thyroid angle cricoid cartilage. The anterior wall of laryngeal cavity is
to the vocal process of arytenoid cartilage on longer than the posterior wall.
each side. Laryngeal inlet: It is obliquely placed and slopes
The anterior median part is thickened and downwards and backwards. It opens into the
extends from upper border of cricoid cartilage laryngopharynx.
to lower border of thyroid cartilage forming
median cricothyroid ligament. Boundaries
2. Quadrangular membrane
Anterior : Broad upper end of epiglottis.
It is a fibrous sheet extending from epiglottis to
Posterior : Inter-arytenoid fold of mucous
the thyroid cartilage.
membrane.
Upper border is free and forms aryepiglottic fold
Lateral : Ary-epiglottic fold of mucous memb-
on each side. Anterior end is attached to the
rane on each side. It over lies the
lower part of lateral margin of epiglottis and
aryepiglottic muscle and has the
posterior end is illdefined and passes to the
corniculate and cuneiform cartilages at
upper end of arytenoid cartilage.
its posterior end.
Its lower edge is also free. The lower edge is
S E C T I O N-2

Thus, the inlet consists of an anterior (2/3rd)

attached anteriorly to the inner aspect of thyroid
membranous part and a posterior (1/3rd) cartilaginous
angle above the cricothyroid membrane.
part.
Posteriorly, it attaches to the antero-lateral
surface of arytenoid cartilage in front of
Inner Aspect of Laryngeal Cavity (Fig. 30.5)
muscular process. This lower edge is slightly
thickened to form the vestibular ligament. The inner aspect of laryngeal cavity is lined by mucus
Vestibular ligaments: Each is made up of membrane which extends from upper free border of
fibrous tissue and extends anteroposteriorly

Fig. 30.5: Sagittal section of larynx showing interior aspect (cavity of larynx)

aryepiglottic fold to the lower border of cricoid.
Aryepiglottic fold overlies the upper border of
quadrangular membrane and has the cuneiform and
corniculate cartilages at its posterior end. The lining
membrane presents with two folds:
1. Vestibular folds or false vocal cords
These folds are produced by the underlying
vestibular ligaments.
The space between the two vestibular folds is
called as rima vestibuli.
When the vestibular folds come together they
prevent entry of food and liquids into the larynx
and exit of air from the lungs. Hence, they act
as exit valves. They are approximated when a
person holds his breath after deep inspiration
in order to increase the intra-thoracic or
abdominal pressure as occurs during act of
coughing, defecation and micturation.
2. Vocal folds or true vocal cords
These folds are produced by the underlying
vocal ligaments and vocalis muscle and lie
below the false vocal cords.
The space between the right and left vocal folds
is called as rima glottidis
Rima glottidis: It consists of two parts :
a. Intermembranous part: It lies between the
two vocal cords, forms anterior 3/5th of rima
glottidis.
b. Intercartilaginous part: It lies between inner
aspect of the vocal process and medial surface
of arytenoid cartilage on each side, forms
posterior 2/5th of rima glottidis.
Vocal cords act as entry valves. They prevent
entry of all substances through rima glottis
except air.
Speech (phonation) is produced by vibrations
of the vocal cords during expiration. The greater
the amplitude of vibration, the louder is the
sound. Pitch of sound is controlled by the
frequency of the vibrations.
Since the males have longer vocal cords than
females, they have louder but low pitched voices
than females.
Subdivisions of Laryngeal Cavity (Fig. 30.5)
The laryngeal cavity is divided into the following three
parts by vestibular and vocal folds:
1. Vestibule or the supraglottic compartment: It is
present between laryngeal inlet and the vestibular
folds. It is also named as laryngeal introitus.
Larynx 415
2. Sinus of larynx or the glottic compartment: This
lies between the vestibular and the vocal folds. On
each side a deep mucous recess extends laterally
and above towards the lamina of thyroid cartilage
in this region and forms the saccule of larynx. It is
provided with mucus glands which lubricate the
vocal cords by their secretions.
3. Infraglottic compartment: It is the area present
below the vocal folds.
Epithelial Lining of Larynx
The mucus membrane of larynx primarily consists of
ciliated pseudostratified columnar epithelium. The
following areas are however, covered by stratified
squamous non-keratinized epithelium:
1. Upper part of posterior surface of epiglottis
2. Aryepiglottic folds
3. Vocal folds
C H A P T E R-30
CLINICAL AND APPLIED ANATOMY
The vocal cords appear as pearly white avascular
cords on laryngoscopy. This is because the mucosal
lining consists of stratified squamous epithelium
which is adherent to the underlying vocal ligament
without an intervening submucosa.
Laryngeal oedema is the collection of fluid in the
vestibular folds which results in blockage of glottic
area and inability to breath. Laryngeal oedema
usually occurs due to severe allergic reactions As
the vocal cords have no submucosa they are not
involved in oedema.
MUSCLES OF LARYNX
Muscles of larynx can be studied as:
1. Extrinsic muscles of larynx: These muscles attach
from neighbouring structures of the neck to the
cartilages of larynx. They are
a. Infrahyoid muscles of anterior triangle of neck
namely, thyrohyoid, sternothyroid and sterno-
hyoid muscles.
b. Inferior constrictor muscle of pharynx.
c. Stylopharyngeus and palatopharyngeus muscles.
The extrinsic muscles move the larynx up and down
during swallowing and speech.
2. Intrinsic muscles of larynx: These muscles are
present within the larynx it self and act to open or
close various parts of laryngeal cavity.
 416 Human Anatomy For Dental Students

Intrinsic Muscles of the Larynx (Figs 30.6 to 30.8) 2. Lateral cricoarytenoids : Close the glottis
The intrinsic muscles of larynx are arranged in the 3. Transverse arytenoids : Close the glottis
following groups according to their actions. 3. Muscles that increase or decrease the tension of
1. Muscles that open or close the laryngeal inlet vocal cords.
1. Oblique arytenoids : Close the inlet of larynx 1. Cricothyroid : Tense the vocal cords
2. Aryepiglotticus : Close the inlet of larynx 2. Thyroarytenoid : Relax the vocal cords
3. Thyroepiglotticus : Open the inlet of larynx 3. Vocalis : Tense the vocal cords
All the intrinsic muscles of the larynx are supplied
2. Muscles that open or close the glottis by the recurrent laryngeal nerve except cricothyroid
1. Posterior cricoarytenoids : Open the glottis which is supplied by external laryngeal nerve.

Description of intrinsic muscles of the larynx (Figs 30.6 to 30.8)

Muscle Origin Insertion
1. Oblique arytenoid: Is in the form Back of arytenoid cartilage near the Posterior surface of apex of
of an oblique band muscular process opposite arytenoid cartilage
2. Aryepiglottic Anterior surface of apex of Lateral margin of epiglottis
arytenoid cartilage
3. Posterior cricoarytenoid: Posterior surface of cricoid lamina, Back of muscular process of
Triangular in shape lateral to median ridge arytenoid cartilage of same side
4. Lateral cricoarytenoid: Upper border of anterior Front of muscular process of
S E C T I O N-2

Triangular in shape arch of cricoid arch arytenoid cartilage of same side

5. Transverse arytenoid: Lateral border of posterior surface Lateral border of posterior surface
Rectangular muscle of one arythenoid cartilage of other arytenoid angle
6. Cricothyroid: Outer surface of anterolateral part Fibres pass backwards and upwards
A triangular muscle of the arch of the cricoid cartilage to be inserted into
1. Inferior cornu of thyroid cartilage
2. Adjacent part of the lower
border of lamina of thyroid cartilage.
7. Thyro-arytenoid Posterior aspect of thyroid angle, Anterolateral surface of arytenoid
lateral to vocalis cartilage behind vocalis
8. Vocalis: Made up of some fibres Posterior aspect of thyroid angle, Anterolateral surface of arytenoid
of thyroarytenoid that get attached lateral to vocal ligament cartilage lateral to vocal ligament
to vocal ligaments
9. Thyroepiglotticus Posterior aspect of thyroid angle, Lateral margin of epiglottis
Some upper fibres of thyroarytenoid lateral to thyro-arytenoid
curve upwards into the aryepiglottic
fold to reach the margin of epiglottis

Fig. 30.6: Intrinsic muscles of larynx

 Larynx 417

C H A P T E R-30
Fig. 30.7: Intrinsic muscles of larynx

Fig. 30.8: Intrinsic muscles of larynx

S E C T I O N-2 418 Human Anatomy For Dental Students
Fig. 30.9: Various positions of vocal cords and shapes of rima glottidis
Various Position of Rima-glottidis (Fig. 30.9)
1. Position during normal respiration (Fig. 30.9A):
The intermembranous part is triangular in shape
while the intercartilaginous part is rectangular. The
vocal process of arytenoid cartilages are parallel to
each other.
2. Position during forced inspiration (Fig. 30.9B): The
rima-glottidis widens to form a diamond shaped
cavity. The intermembranous and intercartila-
ginous parts appear triangular. The action of
posterior cricoarytenoid muscles abducts and
rotates the arytenoids laterally.
3. Position during phonation or speech (Fig. 30.9C):
The intermembranous and intercartilaginous parts
are adducted to reduced the rima-glottidis to a
linear fissure. Action of lateral cricoarytenoid
muscles and transverse arytenoid muscles bring
about adduction and medial rotation of the
arytenoid cartilages.
4. Position during whispering (Fig. 30.9D): The
intermembranous part is adducted and narrow
while the inter-cartilaginous part is widened.
Action of lateral cricoarytenoid muscles rotates the
arytenoid cartilages that closes the anterior part of
rima-glottidis.
Blood Supply of Larynx
Arterial supply of larynx is derived from the following
arteries:
1. Above the vocal folds: Superior laryngeal artery, a
branch of superior thyroid artery.
2. Below the vocal folds: Inferior laryngeal artery, a
branch of inferior thyroid artery.
The veins run along with the arteries. Superior
laryngeal vein drains into superior thyroid vein and
inferior laryngeal vein drains into inferior thyroid vein.
Lymphatic Drainage of Larynx
The lymphatics from larynx pass to the following lymph
nodes:
1. Above the vocal cords: Lymphatics run along the
superior thyroid vessels and drain into antero-
superior group of deep cervical lymph nodes.
2. Below the vocal cords: It drains into postero-
inferior group of cervical lymph nodes.

Nerve Supply of the Larynx
1. Motor: All the intrinsic muscles of the larynx are
supplied by the recurrent laryngeal nerve except
cricothyroid which is supplied by external laryngeal
nerve.
2. Sensory: The mucus membrane of larynx is
supplied by two nerves:
a. Above the vocal folds: It is supplied by the
internal laryngeal nerve, a branch of superior
laryngeal nerve.
b. Below the vocal folds: It is supplied by recurrent
laryngeal nerve.
Functions of Larynx
Larynx primarily functions as an air passage that
allows only entry of air and prevents entry of food
particles or any foreign body. Closure of laryngeal
inlet is brought about by approximation of
aryepiglottic folds overlapped by epiglottis. Closure
of laryngeal cavity is brought about by approxi-
mation of vocal cords.
Vestibular cords act as exit valves. The approxima-
tion of these cords helps to hold breath after deep
inspiration that result in increase intra abdominal
pressure. This is essential to complete the act of
micturition, defecaction and parturition (child
birth).
Function of phonation is brought about by
vibrations of vocal cords during expiration.
VAGUS NERVE (Fig. 30.10)
The vagus nerve is the 10th cranial nerve. It is a mixed
nerve. Because of its extensive course and distribution
it is named as vagus or wandering nerve. Its field of
supply extends beyond the head and neck to the thorax
and abdomen. It conveys most of the efferent fibres of
the cranial part of the parasympathetic outflow. The
fibres of cranial part of the accessory nerve also distribute
through it.
Functional Components of Vagus Nerve
1. Special visceral efferent (SVE): Motor to the
muscles of palate, pharynx and larynx
2. General visceral efferent (GVE): For para-
sympathetic innervation of the heart, bronchial tree
and most of the GIT
3. Special visceral afferent (SVA): Carries taste
sensations from the posterior most part of the
tongue and epiglottis.
4. General visceral afferent (GVA): For sensory
innervation of the mucus membrane of pharynx,
larynx, trachea, oesophagus and thoracic and
abdominal viscera.
Larynx 419
5. General somatic afferent (GSA): Carries general
sensations from skin of the auricle and external
acoustic meatus.
Nuclear Origin
Fibres of the vagus nerve arise from the following four
nuclei in the medulla oblongata.
1. Nucleus ambiguus: It gives rise to fibres for the
special visceral efferent component or the branchio-
motor fibres of vagus nerve.
2. Dorsal nucleus of vagus: This gives origin to the
parasympathetic motor and secreto-motor fibres for
heart, lungs, tracheobronchial tree and GIT. The
viscero-sensory fibres from these organs also
terminate in the dorsal nucleus.
3. Nucleus of tractus solitarius: This receives fibres
of taste sensations, i.e., the special visceral afferent
component of vagus nerve.
4. Nucleus of spinal tract of trigeminal nerve: It is
the nucleus for general somatic afferent fibres of
vagus nerve. The auricular branch transmits
sensations of pain and temperature from the auricle,
C H A P T E R-30
external acoustic meatus and tympanic membrane.
Fibres from these nuclei pass forwards, through the
substance of medulla and emerge through its lateral
aspect as 10 rootlets.
Intracranial Course
Vagus nerve arises from the lateral aspect of
medulla between the olive and the inferior
cerebellar peduncle in the form of about 10 rootlets
which lie below the glossopharyngeal nerve.
These nerve rootlets unite to form a single nerve
trunk which runs laterally, crosses the jugular
tubercle and then traverses the middle part of the
jugular foramen along with the 9th and 11th cranial
nerves to pass out of the cranial cavity. Here, the
nerve is enclosed within the same dural sheath as
the 11th nerve. The 9th nerve however lies within
a separate dural sheath.
Extracranial Course
After coming out of the cranial cavity the nerve runs
vertically downwards within the carotid sheath
between the internal jugular vein laterally and the
internal carotid artery medially, (common carotid
artery in lower part upto the root of neck).
At the root of the neck
a. The right vagus nerve enters the thorax by
crossing in front of the right subclavian artery
b. Left vagus nerve enters the thorax by passing
between the left common carotid and left
subclavian arteries.
S E C T I O N-2 420 Human Anatomy For Dental Students

Fig. 30.10: Vagus nerve and its distribution


Ganglia Associated with the Vagus Nerve
The upper part of the vagus nerve is associated with
two ganglia.
1. Jugular or superior ganglion: It lies within the
jugular foramen and is small in size.
2. Inferior ganglion: It is larger and lies just below
the jugular foramen.It is also known as ganglion
nodosum. It is 2.5 cm in length.
Both the ganglia contain cell bodies of the sensory
fibres of vagus nerve. The internal branch of the
accessory (XI) nerve unites with the vagus nerve just
above its inferior ganglion and transfers all the fibres of
the cranial root of accessory nerve to the vagus.
Vagus Nerve in the Region of Head and Neck
Course of vagus nerve in head and neck is described
above.
Branches
1. Meningeal branch: It arises from the superior
ganglion and passes back through the jugular
foramen to supply the duramater of posterior
cranial fossa.
2. Auricular branch of the vagus: It arises from the
superior ganglion, enters the mastoid canaliculus
on the lateral wall of the jugular foramen and
emerges through the tympano-mastoid fissure just
behind the external auditory meatus. It supplies the
skin on the back of the meatus and the adjoining
auricle. It then enters the meatus between its bony
and cartilaginous parts to supply the floor of the
meatus and the tympanic membrane.
3. Pharyngeal branch: It arises from the inferior
ganglion and passes forwards between the internal
and external carotid arteries and takes part in the
formation of pharyngeal plexus. It supplies the
following muscles
a. All the muscles of the pharynx except stylo-
pharyngeus which is supplied by the glosso-
pharyngeal nerve.
b. All muscles of the soft palate except tensor palati
which is supplied by the mandibular nerve,
through nerve to medial pterygoid.
4. Branches to carotid body and carotid sinus.
5. Superior laryngeal nerve (nerve of 4th arch): It
arises from the inferior ganglion passes downwards
and forwards deep to the internal carotid artery to
reach the middle constrictor where it divides into
external and internal laryngeal nerves.
a. External laryngeal nerve: It runs downwards
along with the superior thyroid vessels and
supplies the cricothyroid muscle. It also gives
twigs to the inferior constrictor and pharyngeal
plexus.
b. Internal laryngeal nerve: It passes downwards
and forwards, towards the gap between the
Larynx 421
middle and inferior constrictors. It pierces the
thyrohyoid membrane of the larynx and
supplies:
i. Mucus membrane of larynx above the vocal
cords
ii. Mucus membrane of the pharynx, epiglottis,
vallecula and the posterior most part of the
tongue.
6. Recurrent laryngeal nerve (nerve of 6th arch)
On the right side, it arises at root of the neck
from the right vagus nerve as it crosses in front
of the subclavian artery. Then it ascends up (in
a recurrent direction) behind the subclavian and
the common carotid arteries in the tracheo-
oesophageal groove.
On the left side, it arises from the vagus nerve
as it crosses the arch of aorta on its lateral aspect.
Hence, the left recurrent laryngeal nerve
originates in thorax. It hooks below the arch of
aorta on the left side of the ligamentum
arteriosum and passes up behind the arch on
its way to the tracheo-oesophageal groove of left
C H A P T E R-30
side.
In the neck each nerve ascends upwards in the
respective tracheo-eosophageal grooves.
Each nerve passes in close relation to the
respective inferior thyroid artery at the inferior
pole of the thyroid gland and ascends up on the
medial surface of the gland.
Then each passes deep to the inferior constrictor
of pharynx.
Finally, each nerve enters the larynx behind the
cricothyroid joint.
Branches of recurrent laryngeal nerve
a. Sensory supply: To the mucus membrane of the
larynx below the vocal cords.
b. Motor supply: To all the intrinsic muscles of
larynx except, cricothyroid which is supplied by
the external laryngeal nerve.
7. Cardiac branches: They are two in number. The
superior cardiac branch arises in the upper part of
the neck and the inferior in the lower part of the
neck. Out of the 4 cardiac branches (2 from each
vagus), the left inferior cardiac branch forms the
superficial cardiac plexus while the remaining 3 go
to the deep cardiac plexus.
8. Branches to the trachea and oesophagus, supply
the muscus glands and mucus membrane
9. Communicating branch to inferior cervical
ganglion.
10. Articular branches: To cricothyroid and cricoary-
tenoid joints.
11. Twig to inferior constrictor muscle of pharynx.
 422 Human Anatomy For Dental Students

Vagus Nerve in Thorax CLINICAL AND APPLIED ANATOMY

Course The posterior cricoarytenoid muscles are called the
safety muscles of larynx. This is because they are
Right vagus nerve Left vagus nerve the abductors of vocal cord. If they are paralyzed
It passes downward It passes downward the unopposed action of adductors of larynx cut of
posteromedial to between left common air entry and can lead to death.
brachiocephalic vein carotid and left The interior of larynx can be inspected directly by
and superior vena cava subclavian arteries laryngoscope or indirectly through a laryngeal
It passes behind root It is crossed superficially mirror.
of right lung by phrenic nerve just Following structures are viewed
It enters abdomen above aortic arch a. Base of tongue
through esophageal It passes behind root b. Valleculae
opening in diaphragm of left lung c. Epiglottis
It enters abdomen d. Aryepiglottic folds
through esophageal e. Piriform fossae
opening in diaphragm f. False vocal cords (red and widely apart)
g. True vocal cords (pearly white). These are seen
Branches medial to false vocal cords.
h. Sinus of larynx between false and true vocal
1. Left recurrent laryngeal nerve.
cords.
2. Pulmonary branches to form pulmonary plexus
The cricothyroid is the only muscle which lies on
along with sympathetic fibres.
the outer aspect of larynx.
3. Cardiac branches to form deep cardiac plexus.
All the intrinsic muscle of larynx are paired except
4. Esophageal branches.
the transverse arytenoid.
S E C T I O N-2

Posterior cricoarytenoids are the only muscles

Vagus Nerve in Abdomen which abduct the vocal cords. When they contract,
Right and left vagus nerves enter abdomen through the muscular processes of both arytenoid cartilages
esophageal opening of diaphragm. Right and left vagus rotate medially and the vocal processes rotate
nerves form anterior and posterior vagal trunks. laterally. This causes abduction of vocal cords and a
wide diamond-shaped opening of the glottis is seen.
Irritation of the auricular branch of the vagus
Anterior Vagal Trunk
during syringing of external auditory canal to
It is mainly formed by left vagus nerve supplemented remove ear wax may cause reflex vomiting and
by right vagus nerve. It consists of 1 to 3 bundles of fibres coughing because the irritation is referred along
the other branches of the vagus nerve.
Distribution of Anterior Vagal Trunk Pressure on the carotid arteries during palpation
Branch Distribution can lead to stimulation of the carotid sinus. This
1. Hepatic branches : Liver may cause vagal inhibition. If such a pressure is
: Biliary apparatus applied bilaterally it can cause sudden cardiac
: Prepyloric stomach arrest and subsequent death.
: Pyloric sphincter and If internal laryngeal nerve is damaged there is
duodenum anaesthesia of the mucous membrane in the
2. Gastric branches : Anterior superior supraglottic portion, so foreign bodies can readily
surface of stomach enter the larynx.
3. Renal branches If external laryngeal nerve is damaged there is
some weakness of phonation due to loss of the
Posterior Vagal Trunk tightening effect of cricothyroid muscle on the vocal
It is mainly formed by right vagus nerve and supplemen- cords.
ted by left vagus nerve. The following changes occur when recurrent
laryngeal nerve is completely damaged :
Distribution of Posterior Vagal Trunk a. In unilateral involvement, the ipsilateral vocal
Branch Distribution cord comes to lie in the paramedian position
(between abduction and adduction). It does not
1. Gastric branches They supply postero-inferior vibrate. However, the other cord is able to
(Nerve of Latajel) surface of stomach. compensate without any significant loss in
2. Coeliac branches Duodenum, jejunum, ileum phonation.
ascending colon, right 2/3rd b. In bilateral involvement, the vocal cords come
of transverse colon. to lie in the cadaveric position. This leads to loss
3. Renal branches of phonation and difficulty in breathing.
 Chapter

31
Ear

INTRODUCTION It consists of a single crumpled plate of elastic

cartilage with fibrous tissue closely lined by skin.
Ear is the organ of hearing (peripheral apparatus of
The lowest part is however, soft and consists of
hearing). It also houses receptors that help to maintain
fibrofatty tissue only. This is called lobule of the
the balance of the body. It is located in the temporal bone
ear.
and consists of three parts:
The skin of pinna is adherant to the underlying
1. External ear
cartilage. Sebaceous glands are present in the region
2. Middle ear
of concha. Coarse hairs may be present in some
3. Internal ear
elderly males along the tragus, antitragus and

C H A P T E R-31
intertragic notch. (It is a Y-linked genetic expre-
EXTERNAL EAR (Figs 31.1 to 31.3) ssion).
It is the lateral or external part of ear and consists of two
parts namely: Anatomical Features
1. Pinna Pinna presents an external or lateral surface and a cranial
2. External auditory meatus or medial surface.
Lateral or external surface: A number of elevations and
Pinna or Auricle (Fig. 31.1) depressions are seen on this surface.
1. Concha: It is a large central depression that leads
It is a shell like projection present one on each side into the external auditory meatus.
of the head.

Fig. 31.1: Parts of external ear

 424 Human Anatomy For Dental Students

2. Helix: The outer prominent rim of pinna is known

as helix. It passes upwards from the lobule and
curves up at the upper end. It finally descends
down and curves backwards to end as the crus of
helix at the upper part of concha. It divides the
concha into a smaller upper and larger lower part.
It presents an elevation at the postero-superior
aspect known as the Darwins tubercle.
3. Antihelix: The prominent margin lying in front of
and parallel to the helix is the antihelix. It encircles
the concha in a C-shaped manner being deficient
in the anterior part. Its upper end may divide into
two crura that enclose an area known as the
triangular fossa.
4. Scaphoid fossa: It is the area between helix and
antihelix.
Fig. 31.2: Nerve supply of lateral surface of auricle
5. Cymba concha: The smaller part of concha present
above the crus of helix is known as cymba concha.
It corresponds internally to the suprameatal triangle 2. Anterior auricular branches of superficial temporal
on skull. artery.
6. Tragus: It is a triangular flap of cartilage present in 3. Branches of occipital artery.
front of depression of concha. It guards the entry The veins follow arteries and drain into external
into the external auditory meatus. jugular and superficial temporal veins.
S E C T I O N-2

7. Antitragus: It is an elevation on the lower end of Lymphatic Drainage of Pinna

antihelix lying just opposite the tragus. The two are
separated below by a intertragic notch.
8. Lobule of pinna: Skin covered flap of fibro fatty
tissue that hangs below the anti-tragus is the lobule.
Medial surface: It is also known as the cranial surface.
It presents with few elevations that correspond to the
depressions of the lateral surface.
1. Eminentia conchae: This lies opposite the concha.
2. Eminentia triangularis: It lies opposite the tri-
angular fossa.
Muscles of Pinna
They serve minimal or no significant function in human
beings. All are supplied by branches of facial nerve.
1. Extrinsic muscles: Auricularis anterior, auricularis
posterior, auricularis superior.
2. Intrinsic muscles: Helicis major and minor, tragicus
and antitragicus etc.
Lymphatics from pinna drain into the following lymph
nodes:
1. Parotid lymph nodes: These are present in front of
tragus.
2. Mastoid lymph nodes: These lie behind the auricle.
3. Upper group of deep cervical lymph nodes.
Nerve Supply of Pinna (Fig. 31.2)
Following nerve supply the pinna.
1. Great auricular nerve: It supplies the cranial
surface, helix, antihelix and lobule.
2. Lesser occipital nerve: It supplies the upper part
of cranial surface.
3. Auriculotemporal nerve: It supplies the anterior
part of lateral surface, i.e., tragus, crus of helix.
4. Auricular branch of vagus nerve: It supplies the
concha and eminentia concha.
5. Facial nerve: Part of antihelix and crux.

Ligaments of Pinna External Auditory/Acoustic Meatus (Fig. 31.3)

It is a 24 mm long canal which extends from the bottom
1. Extrinsic ligaments: These are present anteriorly
of the concha to the tympanic membrane. It consists of
and posteriorly and connect the auricle to temporal
two parts:
bone.
1. Cartilaginous part: It forms lateral 1/3rd of the
2. Intrinsic ligaments: These connect various parts of
meatus. Its cartilage is continuous with that of the
the cartilage of the auricle with themselves.
auricle. The postero-superior part usually has only
Blood Supply of Pinna fibrous tissue and no cartilage.
Arterial supply is derived from the following: 2. Bony part: Medial 2/3rd of the meatus is bony. It
1. Posterior auricular branch of external carotid artery. is formed by the following parts of temporal bone:

Fig. 31.3: Different parts of the ear (coronal section)
a. Tympanic plate of temporal bone: It forms the
anterior wall, floor and part of posterior wall of
the meatus.
b. Squamous part of temporal bone: It forms the
postero-superior wall of the meatus.
At the medial end of the bony canal a tympanic
sulcus is present that lodges the tympanic membrane.
The floor and anterior wall of meatus are longer than
the roof and posterior wall due to the obliquely placed
tympanic membrane. The meatus presents with two
constrictions. The first is at the junction of bony and
cartilaginous parts. The second is narrower and lies in
the bony part, 5 mm in front of the tympanic membrane.
Direction of meatus: The external auditory meatus has
a peculiar S-shaped course. From lateral to medial side
it curves as follows :
i. Medially, upwards and forwards.
ii. Medially, upwards and backwards.
iii. Medially, forward and downwards.
The meatus is lined by skin which is adherant to the
perichondrium and periosteum of the meatus. Hence,
an infection of meatus is very painful. The skin continues
over the pinna laterally and on external surface of
tympanic membrane medially. The subcutaneous tissue
of cartilaginous part has ceruminous glands which are
thought to be modified sweat glands. These produce ear
wax or cerumen. The wax prevents maceration of the
lining epithelium by water and also aids in opposing
entry of insects into the ear.
Ear 425
C H A P T E R-31
Blood Supply of External Auditory Meatus
Arterial supply is derived from the following:
1. Posterior auricular branch of external carotid artery.
2. Anterior auricular branches of superficial temporal
artery.
3. Deep auricular branch of maxillary artery.
The veins run along with arteries and drain into
external jugular and maxillary veins.
Lymphatic drainage is same as pinna.
Nerve Supply of External Auditory Meatus
1. Auriculotemporal nerve: It supplies the roof and
anterior wall of meatus.
2. Auricular branch of vagus nerve (The only
cutaneous branch of vagus nerve): It supplies the
floor and posterior wall of meatus.
Functions of External Ear
It receives the sound waves and transmits them
inside.
The wax produced by ceruminous glands keeps the
epithelium of external ear moist preventing dryness
and also prevents maceration of epithelium due to
water.
CLINICAL AND APPLIED ANATOMY
We know that external auditory meatus is
S-shaped. Hence, in order to examine the canal and
view the tympanic membrane the auricle is pulled
upwards, backwards and laterally to straighten the
 426 Human Anatomy For Dental Students
external meatus before inserting the ear speculum.
In newborn babies and young children the bony
part of meatus is poorly developed and is in the
form of a bony rim. Hence, the ear speculum should
be inserted minimally and carefully as otherwise
the tympanic membrane can be easily damaged.
Ceruminosis is the excessive collection of wax in
the meatus. The excess wax impedes transmission
of sound waves and patient presents with blocked
ear and decrease in hearing. The wax can be
washed out by syringing with a warm jet of water.
However, this can lead to stimulation of auricular
branch of vagus nerve leading to coughing and
vomiting during the procedure and rarely, can even
cause sudden cardiac inhibition. There is also a
high chance of injury to the tympanic membrane.
Thus, wax now a days is removed by gentle suction
in the meatus. It is not advisable to use earbuds to
clean wax as they push the wax further inside
which gets stuck.
Any infection of skin of external auditory meatus
is very painful because the skin is intimately
adherent to the underlying cartilage and bone.
S E C T I O N-2
TYMPANIC MEMBRANE (SYN. EAR DRUM) (Figs 31.3
and 31.4)
It is a thin, semi-transparent membrane which separates
the external auditory meatus from the middle ear. It is
oval in outline, a little less than inch (12 mm) in its
greatest or vertical diameter.
Anatomical Features
The tympanic membrane is inclined forwards and
downwards. It makes an angle of 55 with the floor
of the external auditory meatus.
It is thickened along its margins and is attached to
the sulcus in the bony ring of tympanic plate of
temporal bone. The posterosuperior part of
tympanic plate does not have any sulcus and is
replaced by a notch. Two folds of membrane extend
from the margin of the membrane downwards from
the two ends of the notch and converge at the level
of lateral process of malleus. They form the anterior
and posterior malleolar folds.
Fig. 31.4: Right tympanic membrane
The tympanic membrane is divided into 2 parts by
these folds:
1. Pars tensa: It is the greater part of membrane
which is taut.
2. Pars flaccida: It is the part of membrane which
is thin and lax. It is present in the small
triangular area above the lateral process of
malleus between the two malleolar folds.
The ear drum has two surfaces:
1. Lateral surface: It is concave and directed
downwards, forwards and laterally.
2. Medial surface: It is convex and is attached to
the handle of malleus. The point of attachment
is maximally convex and is called the umbo.
Structure: The tympanic membrane is composed of
following three layers:
a. Outer cutaneous layer: This is continuous with the
skin of the external auditory meatus.
b. Middle fibrous layer: In the pars flaccida however,
the middle layer consists of loose connective tissue
instead of fibrous tissue.
c. Inner mucous layer: It is continuous with the
mucus lining of middle ear.
Blood Supply of Tympanic Membrane
Arterial supply is derived from the following:
1. Deep auricular branch of maxillary artery.
2. Stylomastoid branch of posterior auricular artery.
3. Anterior tympanic branch of maxillary artery.
The veins runs along with arteries. From the lateral
surface they drain into the external jugular vein while
from the medial surface they drain into the pterygoid
venous plexus.
Nerve Supply of Tympanic Membrane
It is supplied by the following nerves:
1. Auriculotemporal nerve: It supplies the upper and
anterior part of lateral surface.
2. Auricular branch of vagus nerve: It supplies the
lower and posterior part of lateral surface.
3. Glossopharyngeal nerve: It supplies the medial
surface.
Functions of Tympanic Membrane
The tympanic membrane vibrates in response to sound
wavesand transmits them to the middle ear ossicles. It
helps in amplification of sound.
CLINICAL AND APPLIED ANATOMY
Normal appearance of tympanic membrane on
Otoscope (Fig. 31.4): Since the tympanic membrane
 Ear 427

is transluscent, on examination with otoscope, one MIDDLE EAR (SYN.: TYMPANIC CAVITY) (Figs 31.3
can see the underlying handle and lateral process and 31.5)
of malleus and the long process of incus. The The middle ear is a narrow, slit-like, air filled space in
greater part of membrane (pars tensa) is taut. the petrous part of the temporal bone between the
Above the lateral process of malleus, a small external ear and the inner ear.
triangular area of the membrane is seen which is Shape and size: It is like a cube compressed from side
thin and lax (pars flaccida). This triangular area is to side. In coronal section the cavity of middle ear
seen to be bounded by two distinct folds, anterior appears biconcave because the medial and lateral walls
and posterior malleolar folds which reach down are closer to each other in the centre of the cavity.
to the lateral process of the malleus.
The point of greatest concavity on the external Measurements:
surface of the membrane is known as umbo. This Vertical diameter : 15 mm
marks the attachment of the handle of the malleus Anteroposterior : 15 mm
to the membrane. On illumination, the normal
tympanic membrane appears pearly grey in colour Transverse diameter:
and reflects a cone of light in its antero-inferior At roof : 6 mm
quadrant with the apex at umbo. This reflection of In the center : 2mm
light is due to the inclination of tympanic At floor : 4 mm
membrane in the external auditory canal.
Myringotomy means incision in tympanic Boundaries (Fig. 31.5)
membrane. The incision is usually given in the
postero inferior quardant. This is the most 1. Roof: It is wider than the floor and is formed by a

dependent part of the middle ear, where pus
generally collects in acute infection. The risk of
injury to chorda tympani nerve is also minimal in
such an incision since the nerve runs on the inner
aspect of tympanic membrane downwards and
forwards lateral to the long process of incus.
Myringoplasty is the repair of a perforation in the
tympanic membrane by application of a graft. The
graft is usually derived from temporalis fascia or
cartilage of tragus of the patient.
C H A P T E R-31
thin sheet of bone called tegmen tympani. It
separates the tympanic cavity from the middle
cranial fossa and the temporal lobe of brain.
2. Floor: It is formed by a thin bony plate of petrous
temporal which lodges the superior bulb of internal
jugular vein inferiorly.
3. Anterior wall: It is narrow due to approximation
of medial and lateral walls anteriorly. The thin
lamina of bone presents with the following features
(From above downwards):

Fig. 31.5: Middle ear cavity (lateral wall is removed)

 428 Human Anatomy For Dental Students

a. It has an opening for bony part of pharyngo-
tympanic tube which is directed forwards,
downwards and medially.
b. A smaller opening for tensor tympani muscle is
present below.
c. The lowest part is formed by a thin plate of bone
which is the posterior wall of the bony carotid
canal. This separates the cavity from the internal
carotid artery and the sympathetic plexus of
nerves around it.
4. Posterior wall: The bony wall presents with:
a. A large opening in the upper part which
communicates with mastoid antrum. It is called
as aditus and antrum. It lies above the level of
tympanic membrane.
b. Lower part has bone which separates the middle
ear from mastoid air cells. It presents vertical
part of bony canal for facial nerve in lower part,
medially.
c. A pyramidal prominence which contains the
stapedius muscle. It is present in front of the
upper part of facial canal.
5. Medial wall: This bony wall separates the tympanic
S E C T I O N-2
2. Posteriorly, it communicates with mastoid
(tympanic) antrum and mastoid air cells through
aditus to antrum.
Contents of the Middle Ear
1. Three small bones known as ear ossicles: malleus,
incus and stapes.
2. Two muscles: tensor tympani and stapedius.
3. 2 nerves: chorda tympani and tympanic plexus.
4. Vessels supplying and draining the middle ear.
The mucus membrane lining the middle ear forms
folds which project into the cavity, giving it a honey-
combed appearance.
POINT TO REMEMBER
Strictly speaking the middle ear contains only air.
Ear Ossicles
Malleus (Fig. 31.6)
It is the largest ossicle which is situated just medial to

cavity from the internal ear. It presents with the tympanic membrane. Malleus is shaped like a mallet
following features: and consists of the following parts:
a. Promontory: It is a large rounded elevation 1. Head is the larger, rounded upper end of malleus.
formed by the first (basal) turn of the cochlea. It It lies in the epitympanic part and articulates with
is covered by the tympanic plexus. the incus.
b. Fenestra vestibuli (oval window): It is a 2. Neck: It is the constricted part present just below
fenestration present behind the promontory in the head.
upper part that is closed by the base of stapes. 3. Three processes:
c. Fenestra cochleae (round window): It lies below a. Handle of malleus: It is the longest process
and behind the promontory. It is closed by the which is directed downwards and is embedded
mucus membrane of middle ear also called in the medial surface of the tympanic mem-
secondary tympanic membrane. brane.
d. A bony prominence representing the oblique b. Anterior process: It is a small projection.
part of facial nerve canal is seen above the oval
c. Lateral process: It is a conical projection which
window and passes posteriorly.
is attached to the tympanic membrane at the
e. A bony prominence of lateral semicircular canal
convergence of anterior and posterior malleolar
is seen behind the facial canal.
folds.
f. Processus trochleariformis: It is a bony
prominence present above and in front of the
oval window. The tendon of tensor tympani
hooks around it before inserting into the handle
of malleus.
6. Lateral wall: It is mainly formed by the tympanic
membrane. The portion situated above the
tympanic membrane is called as epitympanic
recess. It is formed by the squamous part of
temporal bone and opens posteriorly into aditus ad
antrum.
Communications of Middle Ear
1. Anteriorly, it communicates with nasopharynx,
through pharyngotympanic tube. Fig. 31.6: Ear ossicles

Incus (Fig. 31.6)
It lies between malleus and stapes and presents with a
body and two processes.
1. Body: It is cubical in shape. It articulates with head
of malleus anteriorly. It forms saddle joint.
2. Short process: It is a conical projection towards the
epitympanic recess posteriorly.
3. Long process: It extends downwards from the body
and lies parallel to handle of malleus. The lower
end is curved medially and articulates with head
of stapes and form ball and socket joint.
Stapes (Fig. 31.6)
It is smallest and the medial most ossicle. Its shape
resembles a stirrup and consists of the following parts:
1. Head: It is small and is directed laterally to articulate
with incus.
2. Neck: It is seen as a small constricted part under
the head. It receives insertion of stapedius muscle
on the posterior surface.
3. Anterior and posterior limbs: These arise from
neck and diverge to attach to the base.
4. Base: It is also called foot plate of stapes. It consists
of a plate of bone which is reniform in shape. The
foot plate is connected to the fenestra vestibuli by
an annular ligament.
Muscles of Middle Ear
Tensor Tympani
Origin: Cartilaginous part of auditory tube and
adjoining part of greater wing of sphenoid.
Insertion: Root of handle of malleus
Nerve supply: Mandibular nerve
Stapedius
Origin: Pyramidal eminence in posterior wall of
tympanic cavity.
Insertion: Posterior surface of neck of stapes.
Nerve supply: Facial nerve.
Action of muscles: The tensor tympani makes the
tympanic membrane taut while the stapedius draws the
stapes laterally. This exerts a dampening effect on sound
vibrations. This helps to prevent damage to the internal
ear in the presence of loud noise.
Mucosa of Tympanic Cavity
The mucosal lining of tympanic cavity consists of ciliated
columnar epithelium which continues into the pharynx
along the pharyngo tympanic tube. It is pale and thin.
Non-ciliated low columnar epithelium is present over
Ear 429
tympanic membrane, ossicles, posterior wall and
mastoid antrum.
Blood Supply of Middle Ear
Arterial supply is derived from the following:
1. Stylomastoid branch of occipital artery.
2. Anterior tympanic and deep auricular branch of
maxillary artery.
3. Petrosal branch and superior tympanic branch of
middle meningeal artery.
4. Inferior tympanic branch of ascending pharyngeal
artery.
5. Branch of internal carotid artery.
Veins from middle ear terminate into pterygoid
plexus of veins and superior petrosal sinus.
Lymphatic Supply of Middle Ear
Lymphatics from middle ear pass into the parotid and
upper deep cervical lymph nodes.
Nerve Supply of Middle Ear
C H A P T E R-31
It is derived from the tympanic plexus of nerves which
is situated over the promontory on medial wall of
tympanic cavity. The plexus is made of:
1. Superior and inferior carotico-tympanic nerves -
these consists of post-ganglionic fibers derived from
sympathetic plexus around internal carotid artery.
2. Tympanic branch of glossopharyngeal nerve.
CLINICAL AND APPLIED ANATOMY
Middle ear infections may spread to mastoid
antrum and mastoid air cells through aditus-ad-
antrum. Since the mastoid antrum is intimately
related posteriorly to the sigmoid sinus and
cerebellum, both these structures may also be
involved in severe cases.
In children, upper respiratory tract infections (URI)
are fairly common. The infection spreads easily
from nasopharynx to the middle ear via the
eustachian tube because the tube is short and more
horizontal in position. Hence, examination of ear
is important in all children with URI.
The pharyngotympanic tube connects naso-
pharynx to the middle ear cavity and helps to
equalize the pressure on either side of tympanic
membrane. The tubal opening in nasopharynx is
slit like and normally remains closed except while
yawning or swallowing. When it opens, the air in
middle ear escapes and equalizes with atmosphere
pressure. The pressure of air at higher altitudes is
less. Hence, when ascending up a mountain in a
 430 Human Anatomy For Dental Students
vehicle or travelling by aeroplane, the pressure
changes can lead to ear ache. This is because on
ascent the middle ear pressure (internal) will
exceed the pressure in external ear (external). The
tympanic membrane as a consequence is pushed
outwards leading to pain. This is relieved normally
by constant swallowing. However, in people
suffering from common cold, the tubal opening
may be blocked due to swelling and the pain cannot
be relieved as the escape of air is prevented. During
descent, the pressure changes are reversed and air
is sucked into the middle ear cavity via the tube.
Pain during descent is more because the slit like
tubal opening allows easy escape of air during
ascent while the sucking in of air during descent
via the opening is more difficult.
INTERNAL EAR
It is the inner most part of the ear and is located within
the petrous part of the temporal bone.
Structure: It consists of a complex series of fluid filled
S E C T I O N-2
spaces called the membranous labyrinth. This
membranous labyrinth is loged within similarily
arranged bony cavities forming the bony labyrinth. The
membranous labyrinth is filled with endolymph and
bony labyrinth with perilymph.
Bony Labyrinth (Fig 31.7)
The bony labyrinth consists of a complex series of bony
canals in the petrous part of temporal bone. It is made
up of three parts namely vestibule, cochlea and
semicircular canals which communicate with each other.
Vestibule
The vestibule is the middle part of the bony
labyrinth and is located immediately medial to the
tympanic cavity.
It lodges the utricle and saccule of the membranous
labyrinth.
Fig. 31.7: Bony labyrinth
Relations of vestibule:
a. Its lateral wall opens into the tympanic cavity by
an oval aperture called fenestra vestibuli which is
closed by the foot-plate of the stapes.
b. Its medial wall is related to the internal acoustic
meatus. The interior of the medial wall presents
with a vestibular crest, an oblique ridge which
divides the medial wall into two recess namely:
i. A spherical recess, below and in front. It
presents various foramina for transmission of
lower divisions of the vestibular nerve to the
saccule.
ii. An elliptical recess, above and behind. The floor
of this recess presents a foramen for upper
division of vestibular nerve and lodges the
utricle.
c. Posteriorly, it receives the opening of three
semicircular canals.
d. Anteriorly, it is continuous with the cochlea.
POINT TO REMEMBER
The vestibular crest splits in its lower part to enclose
an recess called cochlear recess.
Cochlea
The cochlea is a helical tube of about 2 to 23/4
turns. It is named cochlea due to its resemblance to
the shell of a snail.
It forms the anterior part of the bony labyrinth.
Its basal coil forms the promontory of the middle
ear and opens into the vestibuli posteriorly.
The cochlea possesses a bony core or central bony
pillar called modiolus which contains the spiral
ganglion and transmits the cochlear nerve.
A spiral ridge of the bone projects from the
modiolus which partly divides the cochlear canal
into two parts:
a. Scala vestibuli, above
b. Scala tympani, below
The partition between scala vestibuli and scala
tympani is completed by the basilar membrane
which extends from the tip of spiral lamina to lateral
wall of cochlea.
The scala vestibuli communicates with the scala
tympani at the apex of the cochlea by a small
opening called helicotrema.
Both scala have perilymph.
The scala tympani is closed by a bony lamina at the
end of the basal turn while the scala vestibuli opens
into the anterior wall of vestibule.
 Ear 431

Semicircular Canals
There are three semicircular canals situated behind
the vestibule. These are superior or anterior,
posterior, and lateral.
Each canal is 15 to 20 mm long and forms 2/3rd of
a circle.
Each canal is dilated at both the ends to form
ampullae.
Both ends of the canals (6 in number) open into the
vestibule by 5 openings.
The three canals are set at a right angle to each other.
Fig. 31.8: Membranous labyrinth
Anterior Semicircular Canal
It lies in a vertical plane at right angle to the long Cochlear Duct (also known as, scala media)
axis of the petrous temporal bone.
Its convexity faces upwards which produces an It is a spiral-shaped duct consisting of 2 and 3/4th
arcuate eminence on the anterior surface of the turns. It lies in the bony cochlear canal between the
scala vestibuli and scala tympani.
petrous temporal bone.
The cochlear duct contains the spiral organ of Corti.
Its ampulla is located anterolaterally and its
Structure: On cross section, the cochlear duct is
posterior end unites with the upper end of the
triangular in shape. Its boundaries are as follows:
posterior semicircular canal to form the crus
Floor is formed by the osseous spiral lamina

C H A P T E R-31
commune which forms a single opening into the
medially and basilar membrane laterally.
vestibule. Medially it is bounded by the vestibular or
Posterior Semicircular Canal Reisseners membrane which passes from upper
It lies in a vertical plane parallel to the long axis of surface of spiral lamina to the lateral wall of
petrous temporal bone. cochlear canal.
Its convexity faces backwards. Laterally, it is bounded by outer wall of the
Ampulla lies at its lower end. cochlear canal.
Its upper end forms the crus commune.
Spiral Organ of Corti (Fig. 31.9)
Lateral Semicircular Canal
It lies in a horizontal plane. It is the peripheral organ of hearing present in the
Its convexity faces posterolaterally. cochlear duct. It rests on the basilar membrane.
Its ampulla lies anteriorly close to the ampulla of
the anterior semicircular canal.

POINT TO REMEMBER
The lateral semicircular canals of both ears lie in the
same plane. The anterior semicircular canal of one side
is parallel to the plane of the posterior semicircular
canal of the other side.

Membranous Labyrinth (Fig. 31.8)

The membranous labyrinth, as mentioned earlier,
consists of closed membranous sacs and ducts
intercommunicating with each other. It lies within the
bony labyrinth. The membranous labyrinth consists of
3 parts:
1. Cochlear duct, within the bony cochlea.
2. Saccule and utricle, within the vestibule.
3. Three semicircular ducts, within the respective
semicircular canals. Fig. 31.9: Spiral organ of Corti
 432 Human Anatomy For Dental Students
Structure: It consists of:
a. Inner and outer rod cells.
b. Inner and outer hair cells: These respond to
vibrations induced in the endolymph by the
sound waves.
c. Supporting cells (Deiters and Hensens cells).
d. Tunnel of Corti, an interval between the inner
and outer rod cells which contains corti-lymph.
e. Membrana tectoria: It is made up of a gelatinous
substance and covers the hair cells. Medially, it
is attached to the vestibular lip of osseous spiral
lamina.
The organ of Corti is innervated by the peripheral
processes of bipolar neurones located in the spiral
ganglion which is located in the spiral canal.
The spiral canal is located within the modiolus at
the base of the spiral lamina.
The central process of these ganglion cells forms
the cochlear nerve.
POINT TO REMEMBER
S E C T I O N-2
Note that the scala tympani containing perilymph lies
below the basilar membrane and scala vestibuli
containing perilymph lies above the vestibular
membrane. Thus cochlear duct containing endo-
lymph is bathed above and below by the perilymph
of the two scalae.
Saccule and Utricle
The saccule is a globular membranous sac which
lies in the anteroinferior part of the vestibule.
It is connected in front to the basal turn of the
cochlear duct by the ductus reuniens and behind
with the utricle by a Y-shaped utriculo-saccular
duct. This duct forms the saccus endolymphaticus.
The utricle an oblong membranous sac that lies
behind and above the saccule in the posterosuperior
part of the vestibule.
It is connected in front to the saccule by a Y-shaped
utriclo saccular duct and behind with the 3
semicircular ducts by 5 openings.
The wall of utricle and saccule consists of an outer
layer of perilymphatic cells and an inner layer of
single row of epithelial cells separated by a tunica
propria.
The inner aspect of medial wall of saccule and
anterior wall of utricle possess the sensory end
organs called maculae. They contain hair cells,
supporting cells and a covering gelatinous mass
impregnated with calcium salts called the otolithic
membrane
The maculae are also called the static balance
receptors and give infromation about the position
of head. They respond to movement of fluid when
there is linear acceleration of head. They are
supplied by the peripheral processes of the neurons
of vestibular nerve.
Semicircular Ducts
Three semicircular ducts are present within the
corresponding bony semicircular canals along their
outer walls.
Each duct is dilated at both its ends forming an
ampulla lodged in the corresponding bony
ampulla.
The three ducts open into the utricle at both their
ends by five openings.
The inner aspect of the medial wall of the ampulla
of each duct possesses sensory end organs called
crista ampullaris or ampullary crests.
Crista ampullaris consists of hair cells, supporting
cells and a gelatinous mass called cupula covering
the sterocilia and kinocilia of hair cells.
The semicircular ducts are responsible for sensing
the rotatory movements of the head and help to
maintain the kinetic balance of the body.
Blood Supply of Internal Ear
Arterial supply is derived from the following:
1. Labyrinthine artery, branch of basilar artery.
2. Stylomastoid branch of occipital artery.
The organ of Corti has no blood vessels but
receives oxygen via the cortilymph.
The veins accompany arteries and form labyrin-
thine vein which end in the superior petrosal sinus.
Nerve Supply of Internal Ear
Internal ear is supplied by the following nerves:
1. The utricle, saccule and semicircular ducts receive
fibres from vestibular nerve.
2. The cochlear duct (organ of Corti) receives fibres
from cochlear nerve.
VESTIBULO-COCHLEAR NERVE (Fig. 31.10)
The vestibulo-cochlear is the 8th cranial nerve. It is a
sensory nerve consisting of two components:
1. The cochlear nerve, the nerve of hearing.
2. The vestibular nerve, the nerve of balance (equili-
brium).
Functional Components
1. Special somatic afferent: Conveys the sensation of
hearing from hair cells organ of Corti
2. Special visceral afferent: For maintaining static and
kinetic equilibrium.
Nuclear Origin
1. Dorsal and ventral cochlear nuclei: They are
present in pons and receive fibres from cochlear
nerve.

Fig. 31.10: Vestibulo-cochlear nerve
2. Vestibular nuclei: They receive fibres from
vestibular nerve and are also present in the pons.
They are four in number namely superior, inferior,
medial and lateral.
Intracranial Course
The vestibular and cochlear components of the 8th
cranial nerve are attached from the brain stem at
the junction of pons and medulla, in the region of
cerebello-pontine angle. They lie lateral and
posterior to the facial nerve at this point.
The two components then pass forwards and
laterally to enter the internal auditory meatus along
with the facial nerve and run in the petrous
temporal bone to the inner ear.
Connections and Distribution
1. The cochlear nerve consists of afferent fibres and is
formed primarily by the central processes of bipolar
neurons which have their cell bodies in the spiral
ganglion located in the petrous temporal bone at
the modiolus. The peripheral processes of these cells
end in relation to the inner and outer hair cells of
the spiral organ of Corti. They are responsible for
perception of sound waves.
2. The vestibular nerve also consists of afferent fibres
which are formed by the central processes of bipolar
neurons of the vestibular ganglion situated at the
bottom of the internal acoustic meatus. The
peripheral processes of these cells end in the macula
of the saccule and utricle which are responsible for
the static balance or equilibrium of the body and
the ampullary cristae of semicircular canals which
are involved in maintaining the kinetic balance of
the body.
CLINICAL AND APPLIED ANATOMY
Vertigo: Is the feeling of giddiness with subjective
sense of rotation either of the surroundings or of
oneself. It is a cardinal sign of labyrinthine
dysfunction. Vertigo may also occurs in a normal
Ear 433
person if there is excessive stimulation of semi-
circular ducts.
Motion sickness: It is characterized by vertigo,
headache, nausea and vomiting. It is primarily due
to excessive stimulation of the utricle and saccule
during motion like travelling in fast moving
vehicle.
Infants do not get motion sickness, since the labyrinth
is not functioning during the first year of life.
Auditory Pathway (Fig. 31.11)
Transmission of Sound Waves
The sound waves are received by the pinna and
passed to tympanic membrane via the external
auditory canal.
This sets up vibrations in tympanic membrane
which are transmitted to the ossicles of middle ear.
The movements are passed successfully from
malleus, incus to the foot of stapes that sets up
vibrations in the cochlea fluid in scala vestibule.
The pressure of sound waves is increased 22 times
as it passes from the tympanic membrane to foot
of stapes.
C H A P T E R-31
The movement of fluid in inner ear sets up pressure
changes on inner hair cells which initiates action
potentials in them and hence in auditory nerves.
Loudness of sound is proportional to amplitude of
sound waves while pitch of sound is proportional
to frequency of sound waves striking the ear.
Intensity of sound is measured on decibel scale. The
human ear can hear sound waves with frequencies
ranging from 20 to 20,000 Hertz (Hz) only.
The primary receptor cells of hearing are inner hair
cells in organ of Corti which initiate action potentials in
the auditory nerve fibers.
Auditory Pathway
The organ of Corti is the peripheral receptor of
auditory pathway. Hair cells of organ of Corti are
the receptor cells which are innervated by the
dedrites of bipolar cells located in spiral ganglion
of modiolus.
Afferents impulses are transmitted via axons of the
bipolar cells which form the cochlear division of
vestibulocochlear nerve (8th cranial nerve).
These relay in the dorsal and ventral cochlear nuclei
located at the upper part of medulla and lower part
of pons.
The fibres from ventral cochlear nuclei decussate
to opposite side forming trapezoid body at basilar
part of pons.
Fibres from ipsilateral dorsal cochlear nucleus and
contra-lateral ventral cochlear nucleus pass through
superior olivary nucleus (some fibres relay here)
and ascend up as lateral lemniscus successively
through inferior colliculus of midbrain, medial
geniculate body, auditory radiation to the auditory
cortex on superior temporal gyrus.
S E C T I O N-2 434 Human Anatomy For Dental Students
Fig. 31.11: Auditory pathway
Masking: Masking is the phenomenon in which
presence of one sound decreases the ability to hear
another sound. Example, we cannot hear clearly human
voice if loud music is playing.
Localization of direction of sound depends upon
the differences in the time of sound waves reaching the
two ears and the variation in the intensity of sound
waves reaching the two ears. This is integrated at level
of auditory cortex and any diseases of the cortex can
affect sound localization.
Vestibular Pathway
Peripheral receptors for vestibular pathway are the
cristae ampularis of the semicircular canals and the
macular located in saccule and utricle of vestibule. They
are innervated by the distal processess of bipolar cells
of vestibular ganglion situated in the lateral part of
internal acoustic meatus.
The afferent impluses are transmitted from the
receptors to the proximal processes of bipolar cells
which form the vestibular division of vestibulo-
cochlear nerve.
The fibres relay in vestibular nuclei located in upper
part of medulla and lower part of pons. Further
transmission is complex and fibres go along various
pathways.
1. Ascend to cerebellum via inferior cerebellar
peduncle.
2. Descend in spinal cord as the vestibulospinal
tract.
3. Cross to vestibular nuclei of opposite side.
4. Have to and from connection with reticular
formation.
5. Ascend to cerebral cortex of temporal lobe.
6. Have connection with nuclei of 3rd 4th and 6th
cranial nerves via medial longitudnal bundle.
Function of vestibular pathway: This pathway
intergrates multiple inputs and helps to co-ordinates
movements of head, neck and body to maintanance of
balance and provides subjective awareness of motion.
 Chapter

32 Cervical Viscera and Deep

Muscles of Neck
The various viscera present in the neck are thyroid gland, Measurements
parathyroid glands, upper part of respiratory and Length : 5 cm
gastrointestinal tracts. Breadth : 3 cm
Thickness : 2 cm
THYROID GLAND (Figs 32.1A, 32.1B and 32.2) Each lobe is pyramidal in shape and presents with
Thyroid gland is a brownish red endocrine gland following features:
situated in lower part of neck, in front and sides of lower 1. Apex: It is directed upwards, towards the oblique
end of larynx and upper part of trachea. It lies opposite line of thyroid cartilage.
the level of C5 to T1 vertebrae.
Relations:

C H A P T E R-32
a. Medially: Inferior constrictor muscle
Anatomical Features
b. Laterally: Sternothyroid
The gland consists of two lobes connected by an isthmus c. Superficial: Superior thyroid artery
(Fig. 32.1). It is enclosed by the pretracheal layer of deep
d. Deep: External laryngeal nerve
cervical fascia.
2. Base: It extends to the 5th or 6th ring of trachea.
Lobes of Thyroid Gland Relations:
There are two lobes, one right and one left. Each extends a. Loop of inferior thyroid artery and inferior
from the middle of thyroid cartilage above to the 6th thyroid vein.
tracheal ring below: b. Recurrent laryngeal nerve.

A B

Fig. 32.1A and B: Thyroid gland, its arterial supply and relations
 436 Human Anatomy For Dental Students
Fig. 32.2: Relations of thyroid gland
3. Three surfaces
a. Lateral surface: It is the largest surface placed
superficially and is covered by
Strap muscles primarily sternothyroid over
S E C T I O N-2
which are present sternohyoid and superior
belly of omohyoid.
Anterior border of sternocleidomastoid
muscle overlaps the inferior part.
b. Posterolateral surface: It is narrow and is
related to the carotid sheath and its contents.
c. Medial surface: This is the deep surface which
is wrapped around the following structures:
In upper part
Larynx, posterior part of thyroid lamina and
lateral surface of cricoid cartilage.
Inferior constrictor and cricothyroid muscles.
External laryngeal nerve.
In lower part
Trachea.
Recurrent laryngeal nerve.
Esophagus.
4. Two borders
a. Anterior border: It is thin lies between
anterolateral and medial surfaces. It is related
to anterior descending branch of superior
thyroid artery.
b. Posterior border: It is rounded and lies between
posterolateral and medial surfaces. It is related
to the following:
Anastomosis between superior and inferior
thyroid arteries.
Parathyroid glands.
Lower part is related to thoracic duct on left
side.
Isthmus
It overlies the 2nd and 3rd tracheal rings and joins the
lower part of the two lateral lobes together. It is 1.25 cm
in both vertical and transverse diameters. It has an
anterior and posterior surface and upper and lower
border.
Relations of Isthmus
1. Anterior surface
a. Strap muscles, sternothyroid and sternohyoid
b. Deep cervical fascia
c. Anterior jugular veins
d. Superficial fascia and skin
2. Posterior surface: 2nd, 3rd and 4th tracheal rings.
3. Upper border
a. Anastomosis between two superior thyroid
arteries
b. Pyramidal lobe if present
4. Lower border: Inferior thyroid veins
Pyramidal lobe: A pyramidal shaped extention may
occasionaly be present. It projects upwards from the
isthmus usually on the left side. Sometimes it is attached
to the body of hyoid bone by a fibromuscular band called
the levator glandulae thyroidae.
Capsules of Thyroid Gland
The gland is enclosed in true and false capsules:
1. True capsule: It is the peripheral condensation of
connective tissue of the gland forms its true capsule.
A dense capillary plexus lies deep to it.
2. False capsule: It is derived from the pretracheal
fascia which splits to enclose the gland. The fascia
extends upwards to be attached on the hyoid bone

and the oblique line on thyroid cartilage. Below it
merges with the apex of fibrous pericardium. This
capsule of thyroid gland is much denser in front
than behind.
From posterior aspect of the medial surface of
thyroid lobe the fascia thickens to form the lateral
thyroid ligament or suspensory ligament of Berry
on each side. This ligament connects each lobe to
the sides of the cricoid cartilage.
In between the two capsules are present para-
thyroid glands and trunks of blood vessels.
POINT TO REMEMBER
Anastomosis between anterior branches of superior
thyroid arteries lies along the upper border of the
isthmus while the inferior thyroid veins leave the
isthmus along the lower border.
Arterial Supply of Thyroid Gland (Fig. 32.1 and 32.3)
The gland is supplied by following arteries on each side:
1. Superior thyroid artery: It is a branch from external
carotid artery. It runs downwards and forwards
along with the external laryngeal nerve. It leaves
the nerve near the upper pole of the thyroid lobe. It
divides into anterior and posterior branches.
The anterior branch descends along the anterior
border of the lobe and continues along the upper
border of isthmus to anastomose with its fellow of
opposite side. The posterior branch descends on the
posterior border to anastomose with the ascending
branch of the inferior thyroid artery.
Superior thyroid artery supplies upper 1/3rd of the
lobe and upper of the isthmus.
2. Inferior thyroid artery: It is a branch of
thyrocervical trunk from the first part of subclavian
artery. It passes behind the carotid sheath to the
back of the lobe, where it is intimately related to
the recurrent laryngeal nerve.
The artery gives 4 or 5 branches. One ascending
branch anastomoses with the posterior branch of
the superior thyroid artery.
The inferior thyroid artery supplies lower 2/3rd of
the lobe and lower of the isthmus.
3. Thyroidea ima artery (present in 30% cases): It is
a branch of brachiocephalic trunk but may
occasionally arise directly from the arch of aorta. It
enters the isthmus from below.
4. Accessory thyroid arteries: These are branches
from tracheal and oesophageal arteries.
Venous Drainage of Thyroid Gland
Thyroid gland is drained by three sets of veins. These
are:
Cervical Viscera and Deep Muscles of Neck 437
1. Superior thyroid vein: It emerges at the upper pole,
and ends in the internal jugular vein or common
facial vein.
2. Middle thyroid vein: This is a short and wide
venous channel that emerges at the middle of the
lobe and soon enters the internal jugular vein.
3. Inferior thyroid vein/veins: They emerge at the
lower border of isthmus, run downward to drain
into the left brachiocephalic vein.
POINT TO REMEMBER
Sometimes a fourth thyroid vein (vein of Kocher)
emerges between the middle and inferior thyroid veins
and drains into the internal jugular vein.
Lymphatic Drainage of Thyroid Gland
1. The upper part drains into prelaryngeal and jugulo-
digastric lymph nodes.
2. The lower part drains into pretracheal lymph nodes.
C H A P T E R-32
Nerve Supply of Thyroid Gland
1. Parasympathetic supply: Vagus nerve, the function
is not very clear.
2. Sympathetic supply: These fibers are derived from
post-ganglionic sympathetic fibres from the
superior, middle and inferior cervical ganglia and
pass along the periarterial plexus of nerve. They
are vasomotor to blood vessels. They may directly
stimulate thyroid hormone synthesis though, to a
much less degree than TSH.
Functions of Thyroid Gland
It produces two thyroid hormones T3 and T4 which
are required for the normal growth and develop-
ment of the body. They also maintain the metabolic
rate of body.
It also produces calcitonin. This hormone has a role
in calcium metabolism.
CLINICAL AND APPLIED ANATOMY
Thyroid gland moves up and down with
deglutition because it is enclosed in the pretracheal
fascia which blends with the laryngeal cartilages
and the hyoid bone.
Enlargement of thyroid gland is known as goitre.
It commonly occurs in India due to iodine
deficiency. Rarely goitre can be due to tumors. If
large, it tends to push backwards pressing the sides
of the trachea and esophagus.
This results in three characteristic symptoms:
 438 Human Anatomy For Dental Students
a. Dyspnoea (difficulty in breathing), due to
pressure on trachea.
b. Dysphagia (difficulty in swallowing), due to
pressure on esophagus.
c. Dysphonea (hoarseness of voice), due to
pressure on recurrent laryngeal nerve which
lies in the tracheo-oesophageal groove.
During thyroidectomy (surgical removal of thyroid
gland) following care must be taken:
a. Superior thyroid artery is ligated as near as
possible to the upper pole to avoid injury to the
external laryngeal nerve. At the upper pole the
nerve lies in a deeper plane but away from the
upper pole it is closely related to the superior
thyroid vessels.
b. Inferior thyroid artery on the other hand should
be ligated well away from the lower pole as the
recurrent laryngeal nerve forms a close
relationship with it near the gland.
c. To avoid haemorrhage during thyroidectomy,
the gland is removed along with the true
capsule. If plane of enucleation is deep to the
true capsule it will damage the dense capillary
plexus present underneath the true capsule
S E C T I O N-2
with consequent haemorrhage. This is opposite
to the surgical removal of prostate gland where
the plane of enucleation is made deep to the
true capsule because the venous plexus lies
between true and false capsules.
The following congenital anomalies can occur in
development of thyroid gland:
a. Ectopic position of gland either at:
Base of tongue
Above or below hyoid bone
b. One of the lobes may be absent.
c. Isthmus may be absent.
d. Persistence of thyroglossal duct. This can lead
to formation of thyroglossal cyst and fistula.
PARATHYROID GLANDS (Fig. 32.3)
These are endocrine glands situated in close relation to
the thyroid gland and hence they are named as
Fig. 32.3: Parathyroid glands
parathyroid glands. They are four in number, two
superior and two inferior.
Size and shape: They are lentiform in shape and
resemble the size of a split pea. Each measures around
6 mm 4 mm 2 mm.
Superior Parathyroids
On each side, one superior parathyroid gland is present
near the middle of the posterior border of thyroid gland.
They develop from the 4th pharyngeal pouch.
Inferior Parathyroids
On each side, one inferior parathyroid gland lies near
the lower pole along the posterior border of thyroid
gland. They develop from the 3rd pharyngeal pouch.
Blood Supply of Parathyroid Gland
Arterial supply is derived from the following:
1. Superior parathyroids are supplied by branches
from the anastamosis between superior and inferior
thyroid arteries.
2. Inferior parathyroids are supplied by branches from
inferior thyroid arteries.
Veins from parathyroid glands drain into the inferior
thyroid veins.
Lymphatic Drainage of Parathyroid Gland
Lymphatics from the gland drain into pre-laryngeal and
pre-tracheal lymph nodes.
Nerve Supply of Parathyroid Gland
It receives sympathetic supply from superior and middle
cervical sympathetic ganglia. It is vasomotor to the
gland.
Function of Parathyroid Gland
The parathyroid glands secrete parathormone which is
responsible to maintain the calcium balance of body.
CLINICAL AND APPLIED ANATOMY
The parathyroids are closely related to the thyroid gland
and during thyroidectomy they can be removed by
mistake as a lymph node or fat lobules. This leads to
hypoparathyroidism which causes hypocalcaemia
leading to tetany.
TRACHEA (Fig. 32.4)
Upper respiratory tract consists of nose, paranasal
sinuses, pharynx, larynx, trachea with two principal
bronchi. Nose, pharynx and larynx have been described
in previous chapters.
Trachea is a wide membrano-cartilaginous tube that
extends downwards from the larynx. It lies mainly in
the neck and partly in the thorax. It is made of 16 to 20
C-shaped rings of hyaline cartilage connected posteriorly
 Cervical Viscera and Deep Muscles of Neck 439

Fig. 32.4: Trachea and its relations

C H A P T E R-32
by fibro elastic tissue. The gap between two rings is Lateral (On each side)
occupied by muscular fibres. 1. Lobes of thyroid gland.
2. Common carotid arteries.
Extent
3. Inferior thyroid arteries.
Upper end : It begins from lower border of cricoid 4. Recurrent laryngeal nerve in the tracheo-eso-
cartilage opposite the C6 vertebra and phageal groove.
enters the superior mediastinum of
thorax. Blood Supply of Trachea
Lower end : It ends by dividing into right and left
It is supplied by following arteries:
bronchi, opposite the sternal angle. (T4
vertebral level). 1. Branches from subclavian artery.
2. Inferior and superior thyroid arteries.
Measurements The tracheal veins pass along inferior thyroid plexus
Length : 10 to 11 cm. into the brachiocephalic veins.
Breadth : 12 mm. It varies in children according
to age. Lymphatic Drainage of Trachea
Lymphatics of trachea drain into the pretracheal and
Relations of Trachea in the Neck (Figs 32.1 and 32.4) paratracheal group of lymph nodes.
Anterior
1. Skin, superficial fascia, deep fascia. Nerve Supply of Trachea
2. Jugular venous arch. 1. Parasympathetic supply: It is via branches of vagus
3. In front of 2nd to 4th tracheal rings, Isthmus of
nerve. It is secretomotor to the mucus membrane.
thyroid gland.
4. Superior thyroid vessels, above isthmus. 2. Sympathetic supply: It is derived from periarterial
5. Inferior thyroid veins, below isthmus. plexus of nerves. It is vasomotor.
6. In lower part: Sternohyoid and sternothyroid of
both sides. Functions of Trachea
Posterior It acts as a passage for air hence it is called the wind
1. Oesophagus. pipe.
2. Bodies of C6 and C7 vertebrae.
 440 Human Anatomy For Dental Students
ESOPHAGUS (Fig. 32.5)
Proximal part of gastrointestinal tract consisting of oral
cavity and pharynx have been described in previous
chapters.
Esophagus is a muscular tube like structure which
originates from the lower end of pharynx.
Extent
Upper end : It begins from the lower border of
cricoid cartilage opposite C6 vertebra.
It passes through the thorax in front of
the vertebral column.
Lower end : It enters into abdomen via an opening
in the diaphragm and ends opposite the
T 11 vertebra by opening into the
stomach.
Measurements
Length : 25 cm, (5 cm lies in neck).
Relations of Esophagus in the Neck
Anterior
1. Trachea
S E C T I O N-2
2. Recurrent laryngeal nerve, anterolaterally on each
side.
Posterior
1. Prevertebral fascia covering the prevertebral
muscles.
2. Bodies of C6 and C7 vertebrae.
Fig. 32.5: Esophagus
Lateral (on each side)
1. Lobe of thyroid gland.
2. Common carotid artery.
3. Thoracic duct, on lower part of left side.
Blood Supply of Esophagus
It is supplied by inferior thyroid artery or occasionally
directly from thyrocervical trunk. Veins drain into
brachiocephalic veins.
Lymphatic Drainage of Esophagus
Lymphatics from esophagus drain into:
1. Retropharyngeal lymph nodes
2. Paratracheal lymph nodes
3. Deep cervical lymph nodes
Nerve Supply of Esophagus
1. Parasympathetic supply: It is derived from
branches of recurrent laryngeal branch of vagus
nerve. It is molar to muscle of esophagus.
2. Sympathetic supply: It is derived from periarterial
plexus of inferior thyroid artery.
DEEP MUSCLES OF NECK
The superficial muscles of front and back of neck have
been described in previous chapters. The deep muscles
of neck comprise of those muscles which lie in front and
on the sides of cervical vertebrae.
Prevertebral Muscles (Fig. 32.6)
They are also called anterior vertebral muscles and
include:
1. Longus colli
2. Longus capitis
3. Rectus capitis anterior
4. Rectus capitis lateralis
General features of prevertebral muscles
1. Lie in front of the vertebral column.
2. Are covered anteriorly by a thick prevertebral fascia.
3. Form the posterior boundary of retropharyngeal
space.
4. Extend from base of the skull to the superior
mediastinum.
5. Are weak flexors of the head and neck. Rectus
capitis anterior causes flexion at atlanto-axial joint.
Longus capitis and colli cause flexion at head and
neck. Rectus capitis lateralis causes lateral flexion
of head and neck.
6. The muscles are supplied by branches from ventral
rami of C1 and C2 spinal nerves except longus colli
which is supplied by C2 to C6 spinal nerves.
 Cervical Viscera and Deep Muscles of Neck 441

Prevertebral Muscles
Muscle
1. Longus colli (cervicis): It covers
the anterior aspect of upper 10
vertebrae. It consists of three parts.
a. Superior oblique part
b. Middle vertical part
c. Inferior oblique part
2. Longus capitis
Strap like muscle which appears
to be continuous with scalenus
anterior
It overlaps the longus colli
3. Rectus capitis anterior
Very short and flat
It lies deep to longus capitis.
4. Rectus capitis lateralis
Origin
Anterior tubercles of tansverse
processes of C3 to C5 vertebrae.
Anterior surfaces of the bodies of
C5 to T3 vertebrae.
Anterior surface of bodies of
T1 to T3 vertebrae.
Anterior tubercles of transverse
processes of C3 to C6 vertebrae.
Anterior surface of the lateral mass
of the atlas and adjoining root of
transverse process.
Upper surface of the transverse
process of atlas.
Insertion
Anterior tubercle of the
anterior arch of atlas.
Anterior surface of bodies of
C2 to C4 vertebrae.
Anterior tubercles of
transverse processes of C5 to
C6 vertebrae.
Inferior surface of the basilar part
of the occipital bone, alongside
the pharyngeal tubercle.
Basilar part of occipital bone in
front of occipital condyle.
Inferior surface of the jugular
process of occipital bone.

Fig. 32.6: Prevertebral and paravertebral muscles C H A P T E R-32

Paravertebral Muscles (Fig. 32.6) posterior is the smallest of the three scalene muscles.
They are also called lateral vertebral muscles and The scalenus anterior is the key muscle of the
include: paravertebral region.
1. Scalenus anterior. 2. The scalenus muscles extend from the transverse
2. Scalenus medius. process of the cervical vertebrae to the first two ribs.
3. Scalenus posterior. They act to bend the cervical part of vertebral
General Features of Paravertebral Muscles column to the same side. Acting from above they
1. The scalenus medius is the largest and the scalenus also elevate the first rib.
 442 Human Anatomy For Dental Students

Paravertebral Muscles
Muscle
1. Scalenus anterior: An elongated
triangular muscle with unequal
sides.
Nerve supply: Ventral rami of
C4 to C6.
2. Scalenus medius: A triangular
muscle with unequal sides.
Nerve supply: Ventral rami of
C3 to C8.
3. Scalenus posterior: Occasionally
blends with the medius or may be
absent.
Nerve supply: ventral rami of
C6 to C8.
Origin
Anterior tubercles of transverse
processes of C3 to C7 vertebrae.
Posterior tubercles of transverse
process of C3 to C7 cervical vertebrae. the groove for subclavian artery
Posterior tubercle of the transverse
processes of C4 to C6 vertebrae.
Insertion
Scalene tubercle on inner border and
adjoining ridge on the superior surface
of first rib between the grooves for
subclavian artery and vein.
Upper surface of first rib between
and the tubercle of the rib.
Outer surface of the second rib
behind the tuberosity for the
attachment for the serratus anterior.

Scaleno-Vertebral Triangle Base : 1st part of subclavian artery

Floor : Neck of 1st rib
It is a triangular space present at root of neck on either
Cupola of the pleura
side.
Contents
S E C T I O N-2

Boundaries
1. 1st part of vertebral artery and accompanying vein.
Medial : Lower oblique part of longus colli
2. Cervical part of sympathetic trunk.
Apex : Scalenus anterior
 Chapter
33 Lymphoid Tissue and Joints
of Head and Neck
The head and neck has about 300 lymph nodes out of a
total of 800 present in the body. They consist of deep
and superficial group of cervical lymph nodes.
DEEP CERVICAL LYMPH NODES (Fig. 33.1)
Lymph from head and neck drains ultimately into the
deep cervical group of lymph nodes either directly or
indirectly. These nodes lie along and around the internal
jugular vein deep to the sternocleidomastoid. They are
divided into two groups by the intermediate tendon of
omohyoid.
1. Superior group
These lie above the omohyoid muscle.
Fig. 33.1: Lymph nodes of head and neck
The nodes are present in a triangle formed by
the internal jugular vein, posterior belly of
digastric and facial vein and are known as
jugulodigastric nodes. These receive lymph
primarily from palatine tonsils (hence, named
node of tonsil).
The superior group drains into the inferior
group
2. Inferior group
C H A P T E R-33
These lie along the internal jugular vein below
the omohyoid.
One lymph node is usually found over the
intermediate tendon of omohyoid as it cross the
vein. It is named the juguloomohyoid node.
 444 Human Anatomy For Dental Students

This node receives lymph primarily from the
tongue (hence, named node of tongue).
Few nodes lie along the brachial plexus and the
subclavian vessels in the supraclavicular
triangle and in front of the scalenus anterior.
Deep cervical nodes receive afferents from
a. Superficial cervical lymph nodes: (discussed
below).
b. Lymph nodes related to the viscera of head and
neck namely:
i. Pretracheal and paratracheal nodes
ii. Prelaryngeal nodes
iii. Retropharyngeal nodes
iv. Lingual nodes
c. Palatine tonsils
d. Tongue
e. Larynx above the vocal folds
Efferents from deep cervical nodes drain into
The lymphatics from deep cervical lymph nodes form
the right and left jugular lymph trunks.
1. On right side: The right jugular lymph trunk (right
lymphatic duct) joins at the junction of subclavian
and internal jugular vein and either directly or via
the right lymphatic duct.
2. On left side: The left jugular lymph trunk joins with
the terminal part of thoracic duct or may directly
enter left subclavian vein.
SUPERFICIAL CERVICAL LYMPH NODES
These nodes are arranged in a circular fashion like a
pericervical collar, at the junction of base of skull with
neck. They form an outer circle of lymphatics. They
consist of the following lymph nodes as discussed in
table below:

Superficial cervical lymph nodes Afferents from Efferents to

1. Submental nodes 1. Tip of tongue 1. Submandibular node.

Four in number. 2. Floor of mouth 2. Jugulo-omohyoid node.
S E C T I O N-2

Present in submental triangle. 3. Central part of lower lip

4. Chin
2. Submandibular nodes 1. Centre of forehead Deep cervical lymph nodes.
Three in number. 2. Medial angle of eye
Lie in the submandibular triangle 3. Side of nose
along the submandibular gland. 4. Cheek
5. Angle of mouth
6. Upper lip and lateral part of lower lip
7. Anterior 2/3rd of tongue
8. Gums
9. Frontal and maxillary sinuses
10. Submental lymph nodes
3. Parotid/Preauricular lymph nodes 1. Forehead Deep cervical lymph nodes.
Superficial group lie over the 2. Temporal region
gland. 3. Auricle, lateral surface
Deep group lie with in the 4. External acoustic meatus,
gland. anterior wall
5. Eyelids, lateral half
4. Retroauricular/Mastoid nodes 1. Auricle, cranial surface Superior group of deep cervical
Lie over upper part of 2. Adjoining scalp lymph nodes.
sternocleidomastoid muscle. 3. External acoustic meatus,
posterior wall
5. Occipital nodes Posterior part of scalp Supraclavicular nodes.
Situated at the apex of occipital
triangle along the occipital artery.
6. Buccal nodes 1. Part of cheek Superior group of deep cervical
Lie on the buccinator muscle, 2. Lower eyelid lymph nodes.
along the facial vein.
Are an upward extension of
submandibular nodes.
 Lymphoid Tissue and Joints of Head and Neck 445

(Contd. ....)

Superficial cervical lymph nodes Afferents from Efferents to

7. Superficial cervical nodes 1. Floor of external acoustic meatus Inferior group of deep cervical
Are present over the 2. Lobule of ear nodes
sternocleido-mastoid muscle, 3. Angle of jaw
along the external jugular vein 4. Lower parotid region
Are off shoots of parotid nodes
8. Anterior cervical nodes Anterior triangle of neck, below Inferior group of deep cervical
Lie along anterior jugular vein hyoid bone nodes
Are a downward extension from
submental nodes

LYMPHATICS ALONG THE VISCERA Atlanto-occipital Joints (Fig. 33.2)

These form the inner circle of lymphatics of head and
neck. They consist of the following groups of lymph
nodes:
1. Infrahyoid: They lie anterior to thyrohyoid
membrane.
2. Prelaryngeal nodes: They are situated in front of
conus elasticus membrane of larynx.
The first cervical vertebra, atlas articulates with the
occipital condyles present on either side of the foramen
magnum to form the atlanto-occipital joints.
Type: Ellipsoid variety of synovial joint.
Articular Surfaces
1. Upper: Condyles of occipital bone of skull. These

3. Pretracheal nodes: They lie in front of trachea,
above the isthmus of thyroid gland.
4. Paratracheal nodes: They are present on either side
of trachea and oesophagus, along the recurrent
laryngeal nerve.
Receive afferents from: These four groups drain lymph
from the larynx (below the vocal folds), trachea,
oesophagus and thyroid gland.
5. Retropharyngeal nodes: They lie in the retro-
pharyngeal space in front of the prevertebral fascia.
Receive afferents from : These drain the pharynx,
palatine tonsils, palate, part of nasal cavity, auditory
tube, tympanic cavity, sphenoidal and ethmoidal
sinuses.
Efferents from visceral cervical nodes drain into deep
cervical group of lymph nodes.
WALDEYERS LYMPHATIC RING
(See page no. 402) (Fig. 29.5)
PALATINE TONSIL
(See page no. 401) (Fig. 29.3)
JOINTS OF HEAD AND NECK
Craniovertebral joints are joints between base of cranial
cavity (basiocciput) and the 1st and 2nd cervical
vertebrae.
C H A P T E R-33
are convex both anteroposteriorly and from side to
side.
2. Lower: Superior articular facets on the lateral mass
of atlas vertebra. They are elongated and directed
medially and forwards. They are reciprocal to the
shape of condyles and are concave.
Ligaments (Fig. 33.2)
The following ligaments are associated with atlanto
occipital joint.
1. Fibrous capsule (capsular ligament)
It surrounds the joint and is attached to the
margins of the articular surfaces.
It is thick posterolaterally and thin postero-
medially.
The synovial membrane lines it internally.
2. Accessory ligaments
a. Anterior atlanto-occipital membrane
It extends from the anterior arch of atlas to
the anterior margin of the foramen magnum.
It is seen as a continuation of anterior
logitudinal ligament.
It fuses with the fibrous capsule laterally.
b. Posterior atlanto-occipital membrane
It extends from the upper border of the
posterior arch of atlas to the posterior margin
of foramen magnum.
Inferolaterally, it arches over a groove on the
upper surface of the posterior arch of atlas
for vertebral artery and first cervical nerve.
S E C T I O N-2 446 Human Anatomy For Dental Students
Fig. 33.2: Different joints and ligaments of vertebral column in cervical region
Arterial Supply of Atlanto-occipital Joints
It is derived from branches of anastamosis between deep
cervical, occipital and vertebral arteries.
Nerve Supply of Atlanto-occipital Joints
Each joint is supplied by a branch from dorsal primary
rami of C1 spinal nerve.
Movements at Atlanto-occipital Joints
The main movements at the atlanto-occipital joints are
of flexion and extension of the head. Slight lateral
movements are also allowed but no rotation is possible.
1. Flexion: Occurs in transverse axis.
Muscles involved: Longus capitis, rectus capitis
anterior.
2. Extension: Occurs in transverse axis.
Muscles involved: Rectus capitis posterior major
and minor, semispinalis capitis, splenius capitis,
upper part of trapezius.
3. Lateral flexion: Occurs in anteroposterior axis.
Muscles involved: Rectus capitis lateralis, semi-
spinalis capitis, splenius capitis, sternocleido-
mastoid, upper part of trapezius.
POINT TO REMEMBER
The line of gravity of weight of the head (about 7 lbs)
passes in front of the atlanto-occipital joints. Hence,
the head tends to fall forwards with gravity. The erect
position of head is maintained by the constant
contraction of the extensor muscles of neck,
particularly semispinalis capitis and the two recti
muscles.
Atlanto-axial Joints (Fig. 33.3)
The atlas (1st cervical vertebra) and axis (2nd cervical
vertebra) form three joints namely:

Fig. 33.3: Medial atlantoaxial jointsuperior view
1. Median atlanto-axial joint: One, central joint.
2. Lateral atlanto-axial joints: Two in number.
Median Atlanto-axial Joint
Type: It is a pivot variety of synovial joint.
3. Ligaments connecting the axis with the occipital
Articular Surfaces
1. Oval articular facet on the anterior surface of the
dens (odontoid process of axis).
2. Oval facet on the posterior surface of anterior arch
of the atlas.
Ligaments: The following ligaments are associated with
atlanto axial joint.
1. Fibrous capsule
A loose capsule is attached arround the margins
of the articular facets.
It is lined by synovial membrane on inside.
2. Transverse ligament of atlas
It is a braod, strong band made up of collagens
that is attached on each side to the medial
surface of the lateral mass of the atlas.
In the median plane its fibres are prolonged in
two directions to form cruciform ligaments:
a. Upwards to the basiocciput.
b. Downwards to the posterior surface of body
of the axis.
The transverse ligament passes behind the
narrow neck of dens and prevents its backward
dislocation.
A synovial bursa is interposed between the
transverse ligament and the dens.
Lymphoid Tissue and Joints of Head and Neck 447
Thus, the dens of axis forms the pivot which
lies in a ring formed by the anterior arch of atlas
C H A P T E R-33
and the transverse ligament.
The dens divides the joint into two parts,
anterior and posterior.
bone
a. Apical ligament of dens
It extends from tip of odontoid process to the
upper surface of the basilar part of occipital
bone near the anterior margin of foramen
magnum.
Morphologically, it represents the remanant
of the notochord (nucleus pulposus)
b. Cruciform ligament
This is a superior longitudinal extension from
middle of the transverse ligament and is
attached above, to basiocciput and below, to
posterior surface body of axis.
It lies behind the apical ligament.
c. Alar ligament
One ligament is present on each side and
extends from the upper part of the dens (from
the sides of its tip) to the tubercle on the
medial aspect of the occipital condyle.
These ligaments are very strong and check
excessive rotation and flexion of head. They
are therefore called as check ligaments.
d. Membrana tectoria
It is an upward continuation of the posterior
longitudinal ligament.
 448 Human Anatomy For Dental Students
It lies posterior to the transverse ligament of
the atlas.
Inferiorly it is attached to the posterior
surface of the body of axis and superiorly to
the upper surface of the basilar part of the
occipital bone above the attachment of upper
band of the cruciform ligament.
Lateral Atlanto-axial Joints
Type: Plane variety of synovial joint.
Articular Surfaces
1. Upper: Inferior articular facet of the lateral mass of
atlas. It is concave in shape.
2. Lower: Superior articular facet of axis. It is convex,
reciprocally curved to the facet on atlas.
S E C T I O N-2
Ligament: Capsule is attached to the margins of the
articular surfaces. It is supported by anterior longitudinal
ligament and ligamentum flavum posteriorly.
Arterial supply and nerve supply of atlanto axial joints
is same as atlanto-occipital joint.
Movements at Atlanto-Axial Joints
The side to side movement of head is produced by
rotation of the atlas along with cranium around the dens
of the axis. The muscles involved in the movement of
head to one side act together and are:
1. On same side: Obliquus capitis inferior, rectus
capitis posterior major, splenius capiti.
2. On opposite side: Sternocleidomastoid.
 Chapter
34 Surface Anatomy of
Head and Neck
BONY LANDMARKS OF HEAD AND NECK (Figs 34.1
to 34.5)
Forehead: It is the area which extends between the
anterior margin of hairline of scalp to the eyebrows. In
bald men upper limit of forehead is upto the frontal
prominences.
Supraciliary arches: These are bony prominences felt
just above the eyebrows, best felt above the medial half
of eye brows. More Prominent in males.
Glabella: It is the median elevation between the two
supraciliary arches.
Nasion: It is the well defined depression seen at the root
of nose, below glabella.
Nasal bones: By placing two finger below the root of
nose, the two nasal bones can be felt.
Fig. 34.1: Surface and bony landmarks of head and neck
Orbital margins: The following orbital margins can be
felt:
1. Superior orbital margin is a well defined bony
margin felt under the eyebrows.
2. Lateral orbital margin can also be felt. A slight
depression can be felt in the middle which is the
site of frontozygomatic suture.
3. Infra-orbital margin
4. Medial orbital margin is indistinct.
C H A P T E R-34
Fronto-zygomatic suture can be recognised as a slight
irregular depression on the lateral orbital margin.
Prominence of cheeks: These are bony prominences felt
below the orbits. They are formed by the anterior surface
of body of zygomatic bone.
Alveolar process of maxilla and mandible with teeth
can be felt above the upper lip and below the lower lips
respectively.
 450 Human Anatomy For Dental Students

Fig. 34.2: Surface and bony landmarks of head and neck

S E C T I O N-2

Fig. 34.3: Surface and bony landmarks of head and neck

Chin: It is the central point of lower border of mandible.
Angle of mandible: It is felt, on each side, at the lateral
end of the base of mandible and is the meeting point of
base of mandible and posterior border of rami of
mandible. It is present below the lobule of pinna.
Condylar process of mandible: It is felt as a bony process
traced upwards from the angle of mandible towards the
ear. It can be felt moving in front of tragus when the
mouth is opened and closed.
Mastoid process: It is a bony prominence felt just behind
the external auditory meatus, posterior to the pinna. Its
anterior border and lateral aspect can be easily palpated
while the posterior border and tip are obscured by the
insertion of sternomastoid and splenius capitus muscles.
External occipital protuberance: It is felt as a bony
prominance on the posterior aspect of head at the upper
end of the nuchal furrow.
 Surface Anatomy of Head and Neck 451

Fig. 34.4: Surface and bony landmarks of head and neck

C H A P T E R-34

Fig. 34.5: Surface and bony landmarks of head and neck

Inion is the highest point on the external occipital Hyoid bone: Anterior surface of body of hyoid bone is
protuberance. felt as a bony prominence in front of neck as finger is
 452 Human Anatomy For Dental Students
passed vertically down from the chin. It is better felt
when the neck is extended.
Thyroid cartilage: The anterior fused margin of laminae
of thyroid cartilage is felt as a bony prominence below
hyoid bone. It is more prominent in males.
Cricoid cartilage: Arch of cricoid cartilage is felt below
thyroid cartilage.
Tracheal rings: These are felt below the lower border of
cricoid cartilage upto suprasternal notch (upper border
of manubrium sterni).
Tip of the transverse process of atlas: It lies midway
between the tip of the mastoid process and the angle of
mandible.
Carotid tubercle: It is the large anterior tubercle of the
transverse process of C6 vertebra. It lies at the level of
arch of cricoid cartilage, about 3 cm. from the median
plane behind the common carotid artery. The artery is
palpated by compressing at this point.
Spine of 7th cervical vertebra: It is also known as
vertebra prominance. It is the first bony prominance felt
at the lower end of back of neck as a finger is run
downwards in the nuchal furrow.
S E C T I O N-2
Suprasternal notch: A depression seen just above the
manubrium sterni.
SURFACE LANDMARKS OF HEAD AND NECK
(Fig. 34.6)
Bregma is marked as the centre of a line drawn across
the vertex from one external auditory meatus to the
other, the head being held in the usual erect position.
Fig. 34.6: Surface and bony landmarks of head and neck
Supraorbital notch: It is marked at the junction of the
rounded, medial 1/3rd and the sharper, lateral 2/3rd
of the supra-orbital margin.
Infraorbital foramen: It is marked on surface by a point
about 0.5 cm below the infraorbital margin, on a line
passing vertically up from the canine fossa.
Mental foramen: It is marked on the surface by a point
1 cm above base of mandible in line with lower 1st
premolar tooth.
The supraorbital notch, infraorbital foramen and
mental foramen lie in the same line.
Pre-auricular point: It is situated immediately in front
of the upper part of the tragus of ear (pinna). The
pulsation of superficial temporal artery can be felt at this
point.
Reids base line: This line runs from the lowest point
on the infra-orbital margin to the upper border of the
external auditory meatus.
The cerebral hemispheres lie above the level of this
line while the cerebellum occupies the area immediately
below the posterior 1/3rd of the line.
Asterion: It lies about 2 cm behind and 1.25 cm above
the superior part of the posterior border of the mastoid
process.
Pterion: Its centre is located approximately 3.5 cm.
behind and 1.5 cm. above the fronto-zygomatic suture.
It can also be located by placing the thumb behind the
 Surface Anatomy of Head and Neck 453

frontal process of the zygomatic bone, two finger breadth
above the zygomatic arch. The angle thus formed lies
on pterion. It also marks the Sylvian point of the brain.
Lambda: It corresponds to an irregular depression above
and in front of the maximal occipital protuberance The
maximum occipital protuberance is the backward
convexity of skull above the external occipital protu-
berance. Lambda lies about 7 cm. above the external
occipital protuberance.
SOFT TISSUE LANDMARKS OF HEAD AND NECK
Palpebral fissure: It is the area enclosed between the
upper and lower eyelids. The anterior most part of sclera
(white area) is visible through the fissure which becomes
continuous as the transparent cornea over the iris and
pupil. Medial end of palpebral fissure, at the point of
meeting of upper and lower eyelids presents with:
Lacrimal caruncle: An elevated mucus membrane
structure.
Lacrimal fold: A fold of mucus membrane which is
2. Point at centre of masseter muscle (felt after
clenching teeth).
3. Point just below and behind angle of mandible,
reaching anterior border of sternocleidomastoid
muscle.
4. Point on anterior border of mastoid process,
corresponds to area behind external meatus of
pinna.
Anterior border of parotid gland is drawn by joining
the first three points by a line curving anteriorly in the
middle. Posterior border of parotid gland is drawn by
joining the 3rd and 4th points along the anterior border
of sternocleidomastoid muscle.
Upper border of parotid gland is drawn by joining
the 1st and 4th points with a line curving along inferior
border of external meatus.
Duct of parotid gland (Fig. 34.8): Two points are marked
on surface of cheek.
1. Point at lower border of tragus of pinna.
2. Point midway between ala of nose and upper
margin of upper lip.

C H A P T E R-34
the lateral limit of the lacrimal caruncle.
Lacrimal papilla and punctum: When the medial
end of lower eyelid is everted, a small elevation is
seen at the margin known as lacrimal papilla. It
presents with pin-point opening known as lacrimal
punctum.
Lacrimal gland: It is marked as an oval structure above
the lateral end of upper eyelid, just below the lateral part
of supraorbital margin.
External nose: It is seen as a pyramidal shaped projection
in about the middle of the face between the eyes and
mouth. Root of nose is attached above to the forehead
and the base presents to openings externally known as
external nares or nostrils separated by a central septum.

Nasolabial fold: It is a groove which extends from either

side of the nose to the angle of mouth of that side.
Fig. 34.7: Surface anatomy of parotid gland
Oral cavity: It is the area enclosed between upper and
lower lips. It can be opened and closed.
External ear: It is seen as a irregular structure known as
pinna on each side of the head which leads to the external
auditory opening. The features are described on page
no. 553 and 554.

Parotid gland (Fig. 34.7): The surface outline of parotid

gland is drawn as inverted triangle by joining the
following points:
1. Point at level of condyle of mandible in front of
tragus of ear.
Fig. 34.8: Surface anatomy of parotid duct
 454 Human Anatomy For Dental Students
A line is drawn joining these two points and parotid
duct is represented as middle 1/3rd part of this line.
Anterior end of duct corresponds to 2nd upper molar
tooth.
Submandibular gland (Fig. 34.9): It is drawn at the base
of mandible anterior to angle of mandible by marking
the following points:
1. Point in front of angle of mandible.
2. Point on inferior border of mandible midway
between angle of mandible and symphysis menti.
3. Point 1.5 cm above inferior border of mandible
midway between 1st and 2nd points.
4. Point at level of greater cornu of hyoid bone.
All points are joined to form an oval figure.
Pituitary fossa and gland (Fig. 34.9): It lies on the straight
line joining the nasion with the inion at a depth of 6 to 7
cm. from the nasion.
Thyroid gland (Fig. 34.9): Isthmus of thyroid gland is
drawn by two horizontally placed lines, 1.5 cm in length
and 2 cm apart. The upper line is drawn across the
trachea,1 cm below the arch of the cricoid cartilage.
S E C T I O N-2
1. Mark a point a little in front of the anterior border
of sternocleidomastoid muscle, at the level of
laryngeal prominence. This represents the site of
upper pole.
2. Mark another point, 2.5 cm below and lateral to the
outer end of the lower border of isthmus.
3. Mark a point 1 cm below the lateral end of the lower
border of isthmus.
Fig. 34.9: Surface anatomy of pituitary, submandibular and isthmus of thyroid glands
Join the first point to the lateral end of upper border of
isthmus medially. Draw a second line from the first point
to the second and continuing to the third point extending
it to the lateral end of lower border of isthmus
Muscles of Head and Neck
1. Masseter (Fig. 34.6): It is palpated when a hand is
placed on the lateral part of mandible and the jaw
is clenched.
2. Temporalis: It is felt by placing a hand over the
side of head just above zygomatic process and
external ear and asking the individual to alternately
clench and unclench his jaw.
3. Sternocleidomastoid (Fig. 34.2): It stands out as a
prominent band passing from mastoid process
down to medial end of clavicle as the head is turned
to opposite side against resistance.
ARTERIES OF HEAD AND NECK
Subclavian Artery (Fig. 34.10)
Two points are marked at the root of neck.
1. First point is marked on sternoclavicular joint.
2. Second point is marked on midpoint of inferior
border of clavicle.
The two points are joined by 2 closely placed parallel
lines that are curved with convexity upwards, the peak
of convexity is 2 cm above clavicle in the middle.

Common Carotid Artery (Fig. 34.10)
Two points are marked in the anterior triangle of neck.
1. First point is marked on sternoclavicular joint.
2. Second point is marked on the anterior border of
sternocleidomastoid muscle, at level of superior
border of thyroid cartilage.
They are joined by two closely placed parallel lines
running upwards and slightly obliquely from 1st to 2nd
point.
Pulsations of common carotid artery can be felt at
the superior border of thyroid cartilage, just in front of
anterior border of sternocleidomastoid muscle.
Internal Carotid Artery (Fig. 34.10)
Two points are marked in the upper part of anterior
triangle of the neck.
1. First point is marked on the anterior border of
sternocleidomastoid muscle at level of superior
border of thyroid cartilage.
2. Second point is marked in front of tragus of external
ear at the level of condyle of mandible.
The two points are joined by two closely placed parallel
lines. This denotes the cervical part of artery as rest is in
the cranial cavity.
Fig. 34.10: Surface anatomy of subclavian, common carotid, external carotid, internal carotid and middle meningeal arteries
Surface Anatomy of Head and Neck 455
External Carotid Artery (Fig. 34.10)
Two points are marked in the upper part of anterior
triangle of neck.
1. First point is marked on the anterior border of
sternocleidomastoid muscle at level of superior
border of thyroid cartilage.
2. Second point is marked on the posterior border of
neck of mandible just below tragus.
The two points are joined by two closely placed parallel
lines.
Pulsations of external carotid artery can be felt as
strong pulse in front of anterior border of
sternocleidomastoid muscle just above the superior
border of thyroid cartilage.
Superficial Temporal Artery (Fig. 34.11)
Pulsations of superficial temporal artery can be felt in
front of the tragus of the ear, where it crosses the root of
zygoma, the preauricular point and also at the temple.
The course of anterior terminal branch of the artery on
C H A P T E R-34
the forehead can clearly be seen in bald men especially
during outbursts of anger. It also becomes noticeably
more tortuous with increasing age.
S E C T I O N-2 456 Human Anatomy For Dental Students
Fig. 34.11: Site of palpation of common carotid, external carotid, facial and superficial temporal arteries
Facial Artery (Fig. 34.11)
Three points are marked on the face.
1. First point is marked on the base or inferior border
of mandible just in front of anterior border of
masseter muscle.
2. Second point is marked 1.2 cm lateral to angle of
mouth.
3. Third point is marked at the medial angle of eye.
The three points are joined by two closely placed parallel
lines running tourtously up from 1st to 3rd points,
passing close to alae of nose.
Pulsations of facial artery can be felt against the base
of mandible at the infero-medial border of masseter
muscle. Ask the patient to clench his teeth and feel for
the masseter muscle, follow it inferiorly and feel for the
pulse at its anterior end.
Middle Meningeal Artery (Fig. 34.10)
1. Put a point a little in front of the pre-auricular point.
2. Mark another point 2 cm above the middle of the
zygomatic arch.
Join the above two points by a line which goes forward
and slightly upwards. This represents the trunk of
middle meningeal artery. Its divisions can be marked
as under
Anterior Division
1. Mark a point on the pterion.
2. Mark another point on the vertex, in the midpoint
of a line joining inion and the nasion.
Draw a line from the end of the trunk of middle
meningeal artery running upwards and slightly
forwards to the first point with slight anterior convexity
and then upwards and backwards in the direction of
the second point.
Posterior Division
1. Mark a point above the auricle.
2. Mark another point on the lambda.
Draw a line from the end of the trunk of middle
meningeal artery upwards and backwards joining the
first and second points.
VEINS OF HEAD AND NECK
Internal Jugular Vein (Fig. 34.12)
Two points are marked on the anterior triangle of neck.
1. First point is marked medial to lobule of ear, behind
neck of mandible.
2. Second point is marked on the medial end of
clavicle.
The two points are joint by two closely placed parallel
lines.
External Jugular Vein (Fig. 34.12)
Two points are marked in the neck.
1. First point is marked just below and behind the
angle of mandible.
 Surface Anatomy of Head and Neck 457

Fig. 34.12: Surface anatomy of internal jugular, external jugular and subclavian veins

Fig. 34.13: Measurement of JVP C H A P T E R-34

2. Second point is marked on upper surface of clavicle
posterior to clavicular head of sternocleidomastoid
muscle.
The two points are joint by two closely placed parallel
lines.
Jugular venous pulse (JVP) (Fig. 34.13) is produced
during systole due to contraction of right atrium. In
patient with mitral valve stenosis this pulse is visible in
the neck due to back pressure from the right atrium.
Subclavian Vein (Fig. 34.12)
1. Mark a point a little medial to the midpoint of lower
border of clavicle.
2. Mark a second point on the medial edge of the
clavicular head of sternocleidomastoid.
Join the two points by a short curved double line with
convexity directed upwards.
 458 Human Anatomy For Dental Students
Fig. 34.14: Surface anatomy of facial nerve
S E C T I O N-2
Fig. 34.16: Surface anatomy of lingual nerve
NERVES OF HEAD AND NECK
Facial Nerve (Fig. 34.14)
The facial nerve exits the skull at stylomastoid foramen
which lies 2 cm deep to midpoint of anterior border of
mastoid process. It can be projected on surface as a short
horizontal line at the point between tragus and
antitragus in intertragus notch.
Mandibular Nerve (Fig. 34.15)
The exit of mandibular nerve is marked on surface as
short stump in front of neck of condylar process of
mandible.
Fig. 34.15: Surface anatomy of mandibular nerve
Fig. 34.17: Surface anatomy of inferior alveolar nerve
Lingual Nerve (Fig. 34.16)
The following points are marked on surface:
1. Point anterior to neck of mandible.
2. Point just below lower 3rd molar tooth.
3. Point at 1st molar tooth.
The nerve is drawn by a line joining the 3 points.
Inferior Alveolar Nerve (Fig. 34.17)
The following points are marked on surface:
1. Point just anterior to neck of mandible.
2. Point on ramus of mandible in centre of masseter,
which is felt when teeth are clenched.
3. Point 1 cm above base of mandible in line with apex
of 1st premolar (site of mental foramen).
 Surface Anatomy of Head and Neck 459

C H A P T E R-34
Fig. 34.18: Surface anatomy of glossopharyngeal nerve

Fig. 34.19: Surface anatomy of vagus nerve

 460 Human Anatomy For Dental Students
The nerve is drawn by a line joining all three points
having a gentle curve with concavity upwards.
Maxillary and Infra-orbital Nerve
1. Mark the angle between the temporal border of the
zygomatic bone and upper border of the zygomatic
arch.
2. Mark the infra-orbital foramen on the maxilla by a
point 1cm. below the infra-orbital margin in line
with the supra-orbital notch.
Join these two points to represent the course of maxillary
nerve and its infra-orbital branch.
Glossopharyngeal Nerve (Fig. 34.18)
The following points are marked on surface:
1. Point at neck of mandible just in front of tragus.
2. Point anterosuperior to angle of mandible.
The nerve is drawn by a line joining the two points with
a gentle curve.
Accessory Nerve
1. Put a point on the lower and anterior part of the
S E C T I O N-2
tragus.
2. Mark the tip of the transverse process of atlas.
3. Put a point at the junction of the upper one third
and lower two-thirds of the posterior border of
sternomastoid.
4. Put a point on the anterior border of the trapezius,
6 cm above the clavicle.
Join these points by a line which goes downwards and
backwards across the elevation produced by the
sternomastoid and the depression of the posterior
triangle of the neck.
Vagus Nerve (Fig. 34.19)
1. Put a point on the lower and anterior part of the
tragus.
2. Mark the medial end of the clavicle.
Join these points to represent the nerve.
Hypoglossal Nerve
The following points are marked on surface:
1. Point at the neck of mandible just in front of tragus.
2. Point at above lateral end of hyoid bone
corresponding to tip of greater cornu of hyoid bone.
3. Midpoint on inferior border of mandible between
angle of mandible and symphyis menti.
The nerve is drawn by a line joining the 1st and 2nd
points which crosses the angle of mandible and then
continues up to the 3rd point.
Sympathetic Trunk
1. Place a point on the posterior border of the condyle
of mandible.
2. Mark a point on the corresponding sternoclavicular
joint.
The line joining the two points represents the trunk.
Superior cervical ganglion is represented on this line
by a spindle extending from the transverse process of
the atlas vertebra to the level of the greater cornu of hyoid
bone.
Middle cervical ganglion is represented as a small
circle opposite the arch of the cricoid cartilage.
Inferior cervical ganglion is represented as a small
circle about 3 cm above the sternoclavicular joint.
Chapter

35 Review of
Head and Neck

HEAD AND NECK Q. What is the clinical significance of pterion?

Ans. Inner aspect of the pterion is related to middle
Q. Enumerate bones forming skull? meningeal vessels. In cases of an extradural
Ans. Skull is made up of 22 + 6 bones namely (Figs 18.1 haematoma due to head injury, where there is
to 18.9) injury to middle meningeal vessels, a burr hole
1. Paired bones is drilled in the region of pterion for evacuation
of blood to release the pressure. This is thinnest
Temporal
part of upper part of skull.
Parietal
Maxilla Q. What is asterion?

C H A P T E R-35
Lacrimal Ans. Asterion is the meeting point of parietomastoid,
Palatine occipitomastoid and lambdoid sutures. In an
Zygomatic infant it is the site of posterolateral (mastoid)
Nasal fontanelle (Fig. 18.7).
Inferior concha Q. What is anterior fontanelle?
2. Unpaired bones Ans. Anterior fontanelle is a rhomboid shaped
Frontal membranous gap present at the meeting point of
Occipital sagittal, coronal and metopic sutures in a new
Sphenoid born. It closes by 18 to 24 months of age due to
Ethmoid growth of surrounding bones (Fig. 18.17).
Vomer
Q. What is posterior fontanelle?
Mandible
Ans. Posterior fontanelle is a triangular shaped
3. Bones of middle ear cavity
membranous gap present at junction of sagittal
Incus and lamboid sutures in a new born. It closes by 4
Malleus months of age due to growth of surrounding
Stapes bones (Fig. 18.17).
Q. What is bregma? Q. Enumerate the structures passing through
Ans. Point at which the coronal and sagittal sutures foramina in the cribriform plate of the ethmoid?
meet is called bregma (Fig. 18.1). Ans.
Q. What is Lambda? 1. Olfactory nerves: Surrounded by lepto-
Ans. Point at which the sagittal and lambdoid sutures meninges (pia and arachnoid maters) from
olfactory epithelium of the nasal cavity to the
meet is named as lambda (Fig. 18.1).
olfactory bulb. They are 15-20 in number on
Q. What is pterion? each side.
Ans. It is the region in the anterior part of temporal 2. Nervi-terminalis
fossa where 4 bones namely, frontal, parietal,
Q. What are structures passing through anterior
squamo-temporal and greater wing of sphenoid ethmoidal foramen?
meet to form an H-shaped suture. It is situated Ans. 1. Anterior ethmoidal nerve, branch of naso-
4 cm above the midpoint of the zygomatic arch ciliary nerve.
(Fig. 18.5).
 462 Human Anatomy For Dental Students
2. Anterior ethmoidal artery, branch of
ophthalmic artery.
3. Anterior ethmoidal vein, tributary of
ophthalmic vein.
Q. What are structures passing through posterior
ethmoidal foramen?
Ans. (Fig. 18.11C)
1. Posterior ethmoidal nerve, branch of
nasociliary nerve.
2. Posterior ethmoidal artery, branch of
ophthalmic artery.
3. Posterior ethmoidal vein, tributary of
ophthalmic vein
Q. What are structures passing through optic
foramen?
Ans. (Fig. 18.11B)
1. Optic nerve: It passes from the optic disc along
with its sheath of meninges, i.e., Duramater,
arachnoid mater and piamater.
2. Ophthalmic artery, branch of cerebral part of
internal carotid artery. It lies inferolateral to
optic nerve.
S E C T I O N-2
3. Sympathetic plexus: This plexus consists of
post ganglionic sympathetic nerve fibres
derived from the superior cervical sympathetic
ganglion and it surrounds the ophthalmic
artery.
Q. What structures pass through superior orbital
fissure?
Ans. This fissure is divided into three parts by means
of the common tendinous ring of Zinn (Figs
18.11C and 20.8).
1. Structures passing through the part within the
common tendinous ring.
a. Superior and inferior divisions of
oculomotor nerve.
b. Nasociliary nerve: It lies between the two
divisions of oculomotor nerve.
c. Abducent nerve: It lies posterior to the naso-
ciliary nerve.
d. Sympathetic root of the ciliary ganglion
2. Structures passing through the part above the
common tendinous ring
a. Trochlear nerve
b. Frontal nerve
c. Lacrimal nerve
d. Lacrimal artery
e. Superior ophthalmic vein
f. Recurrent meningeal branch of lacrimal
artery
3. Structures passing through the part below the
common tendinous ring
a. Inferior ophthalmic vein
Q. What structures pass through foramen
rotundum?
Ans. (Figs 18.11B and C)
1. Maxillary nerve, 2nd division of the trigeminal
nerve
2. Emissary vein
Q. What structures pass through foramen ovale?
Ans. Pnemonic: Male (Figs 180.11B and C
1. Mandibular nerve, 3rd division of trigeminal
nerve.
2. Accessory middle meningeal artery, branch
of 1st part of maxillary artery
3. Lesser petrosal nerve
4. Emissary vein, connecting pterygoid venous
plexus to the cavernous sinus.
Q. Enumerate structures passing through foramen
spinosum?
Ans. (Figs 18.11B anc C)
1. Middle meningeal artery, branch from 1st part
of maxillary artery
2. Nervus spinosus, branch from the undivided
trunk of mandibular nerve.
3. Middle meningeal vein
Q. Enumerate structures passing through foramen
lacerum?
Ans. (Fig. 18.11B)
1. Meningeal branch of ascending pharyngeal
artery
2. Emissary vein, from cavernous sinus to
pharyngeal venous plexus.
3. The anterior part of foramen lacerum lodges
the internal carotid artery along with the
sympathetic plexus around it.
4. Greater petrosal nerve joins the deep pertrosal
nerve to form the nerve of the pterygoid canal
or Vidians nerve.
Q. What structures pass through carotid canal?
Ans. (Fig. 18.8)
1. Internal carotid artery.
2. Sympathetic plexus derived from the superior
cervical sympathetic ganglion surrounding
the artery. This plexus consists of postgang-
lionic fibers.
3. Emissary vein, it connects pharyngeal venous
plexus to the cavernous sinus.
Q. What structures pass through internal auditory
meatus?
Ans. (Fig. 18.11B)
1. Facial nerve
2. Vestibulo-cochlear nerve
3. Nervus intermedius

4. Internal auditory (labyrinthine) vessels
Internal auditory artery is a branch of basilar
artery.
Q. Enumerate structures passing through jugular
foramen.
Ans. Jugular foramen may be divided into 3 compart-
ments, anterior, middle and posterior (Fig. 18.11B)
1. Anterior compartment
a. Inferior petrosal sinus, tributary of internal
jugular vein.
2. Middle compartment, from antero-posterior
direction
a. Glossopharyngeal nerve
b. Vagus nerve
c. Accessory nerve
3. Posterior compartment
a. Sigmoid sinus: It continues as the superior
bulb of internal jugular vein.
Q. What structures pass through hypoglossal
(anterior condylar) canal?
Ans. (Fig. 18.11B)
1. Hypoglossal nerve
2. Meningeal branch of ascending pharyngeal
artery
3. Emissary vein connecting the deep veins of
the neck to the transverse sinus.
Q. What structures pass through posterior condylar
canal?
Ans. Emissary vein, connecting the sub-occipital
venous plexus to the sigmoid sinus.
Q. What structures pass through foramen
magnum?
Ans. It is divided into a small anterior and a large
posterior compartment by means of the alar
ligaments of 2nd cervical vertebra (Fig. 18.11B).
1. Anterior compartment
a. Apical ligament of dens.
b. Upper longitudinal band of cruciform
ligament.
c. Membrana tectoriaA continuation of
posterior longitudinal ligament of the
vertebral bodies.
d. Process of denssometimes.
2. Posterior compartment
a. Medulla oblongata along with its menin-
ges, i.e., duramater, arachnoid mater and
pia mater.
b. Right and left posterior spinal arteries
c. Anterior spinal artery
d. Communicating veins between internal
vertebral venous plexus and basilar veins
e. Right and left vertebral arteries (4th part)
Review of Head and Neck 463
f. Sympathetic plexus around the vertebral
arteries. This plexus consists of post gang-
lionic sympathetic fibres derived from the
inferior cervical sympathetic ganglion.
g. Right and left spinal roots of accessory
nerves
h. Tonsils of cerebellum: These project on each
side of the medulla oblongata.
Q. What structures pass through incisive foramina?
Ans. 1. Lateral incisive foramina: Two in number,
right and left, are present in the lateral wall of
the incisive fossa. Each leads into the floor of
the nasal cavity through the incisive canal
and transmits:
a. Greater palatine vessels
b. Naso-palatine nerve, only when the median
foramina are absent.
2. Median incisive foramina: Two in number,
one present in the anterior and another in the
posterior wall of the incisive fossa.
a. Left naso-palatine nerve
C H A P T E R-35
b. Right naso-palatine nerve
Q. What structures pass through greater palatine
foramen?
Ans. 1. Greater palatine nerves
2. Greater palatine vessels
Q. What structures pass through squamo-tympanic
fissure?
Ans. It is divided into two parts by a down turned part
of tegmen tympani, a part of petrous temporal bone
1. Petro-tympanic fissure
a. Chorda tympani nerve, branch of facial
nerve.
b. Anterior tympanic artery, branch of 1st part
of the maxillary artery
c. Anterior ligament of the malleus
2. Petro-squamous fissure: No structure passes
through it.
Q. What structures pass through palato-vaginal
canal?
Ans. 1. Pharyngeal nerve, branch from pterygo-
palatine ganglion.
2. Pharyngeal artery, branch of 3rd part of
maxillary artery.
Q. What structures pass through vomero-vaginal
canal?
Ans. 1. Pharyngeal nerve
2. Pharyngeal artery
Q. What structures pass through pterygoid canal?
Ans. 1. Nerve of pterygoid canal (Vidians nerve)
2. Vessels of the pterygoid canal
 464 Human Anatomy For Dental Students
Q. What structures pass through tympanic
canaliculus?
Ans. It is located on a bony crest present between the
carotid canal and jugular fossa. It provides
passage to the tympanic branch of glosso-
pharyngeal nerve (Jacobsons nerve).
Q. What structures pass through mastoid
canaliculus (Arnolds canal)?
Ans. It is present in the lateral wall of jugular fossa. It
provides passage to auricular branch of vagus
nerve (Aldermans nerve/Arnolds nerve).
Q. What structures pass through stylomastoid
foramen?
Ans. 1. 7th cranial (facial nerve)
2. Stylomastoid artery: A branch of posterior
auricular artery.
Q. What structures pass through zygomatico-
temporal foramen?
Ans. 1. Zygomatico-temporal nerve
2. Zygomatico-temporal artery
Q. What structures pass through pterygo-maxillary
S E C T I O N-2
fissure?
Ans. 1. 3rd part of the maxillary artery.
2. Maxillary nerve, 2nd division of the
trigeminal nerve.
Q. What structures pass through inferior orbital
fissure?
Ans. 1. Maxillary nerve
2. Infraorbital vessels
3. Zygomatic nerve
4. Vein connecting inferior ophthalmic vein with
pterygoid venous plexus
Q. What structures pass through spheno-palatine
foramen?
Ans. 1. Nasopalatine nerve
2. Sphenopalatine vessels
Q. What structures pass through greater palatine
canal?
Ans. 1. Anterior, middle and posterior palatine nerves
2. Greater palatine vessels
3. Lesser palatine vessels
Q. What structures pass through supraorbital
foramen?
Ans. 1. Supraorbital nerve: A branch of frontal nerve
which in turn is a branch of ophthalmic
division of trigeminal cranial nerve.
2. Frontal diploic vein
Q. What structures pass through infraorbital
foramen?
Ans. 1. Infraorbital nerve: Continuation of maxillary
nerve.
2. Infraorbital artery: Branch of maxillary artery
3. Infraorbital vein
Q. What structures pass through mandibular
foramen?
Ans. 1. Inferior alveolar nerve, branch of the posterior
division the mandibular nerve.
2. Inferior alveolar artery, branch of 1st part of
maxillary artery
3. Inferior alveolar vein
Q. What structures pass through mental foramen?
Ans. 1. Mental nerve, branch of inferior alveolar
nerve.
2. Mental artery, branch of inferior alveolar
artery.
3. Inferior alveolar vein.
Q. Name the nerves related to mandible?
Ans. Nerves related to the mandible are (Fig. 18.23)
1. Lingual nerve: It runs on the inner surface of
the body close to the medial side of the root of
the third molar tooth.
2. Inferior alveolar nerve: Enters the mandibular
foramen and passes through mandibular
canal.
3. Mylohyoid nerve: Runs in the mylohyoid
groove.
4. Mental nerve: It comes out of the mental
foramen.
5. Nerve to masseter: Passes over the
mandibular notch.
6. Auriculo-temporal nerve: It winds around the
medial surface of neck of the condylar process.
Q. What is suprameatal triangle?
Ans. It is also known as triangle of McEven. It is a
triangular depression present posterosuperior to
external auditory meatus. It is bounded by
1. Supramastoid crest, superiorly.
2. Posterosuperior margin of external acoustic
meatus, anteriorly.
3. A vertical tangent to the posterior margin of
the meatus, posteriorly.
The mastoid antrum lies 12 mm deep to this
triangle in adults.
Q. What is the clinical importance of suprameatal
triangle?
Ans. Severe mastoiditis, needing surgical intervention,
is treated by approaching the mastoid antrum
via the supra meatal triangle. Careful anatomical
delineation is important as it is related to the facial
nerve posteriorly and the sigmoid sinus
anteriorly.

Q. What can fracture of anterior cranial fossa
lead to?
Ans. A fracture involving the cribriform plate of
ethmoid can cause bleeding and/or drainage of
cerebrospinal fluid (CSF) from the nose. Leaking
of CSF is known as rhinorrhoea.
Q. What can head injury, causing middle cranial
fossa fracture lead to?
Ans. The usual line of fracture passes downwards
from the parietal tuberosity along the squamous
part of temporal bone and internally into the
petrous temporal bone. It can cause :
1. Bleeding or drainage of CSF from ear
2. Bleeding through nose
3. Vertigo due to involvement of semicircular
canals.
Q. What is the clinical importance of anterior
fontanelle?
Ans. Its clinical importance is due to the fact that it
is easily palpated in newborns.
1. A bulging and tense anterior fontanelle is
suggestive of increased intracranial tension.
2. A depressed fontanelle is a sign of dehydra-
tion in newborn.
3. The superior sagittal sinus lies below this
fontanelle.
4. During labour the position of anterior
fontanelle helps to identify the position of fetal
head in the maternal pelvis.
Q. What is carotid tubercle?
Ans. The anterior tubercle of the transverse process of
sixth cervical vertebra is large and called the
carotid tubercle because common carotid artery
can be compressed and felt against it.
Q. What is hangmans fracture?
Ans. The death in execution by hanging is due to
fracture of odontoid process of axis vertebra with
subsequent posterior dislocation of atlas vertebra
which compresses the medulla resulting in
death.
Q. What is the applied importance of joints of
Luschka?
Ans. Luschkas joints are very common sites of
osteophyte formation. Since cervical nerve roots
lie posterolateral to these joints, the osteophytes
may produce symptoms due to cervical nerve
compression. The osteophytes may also intrude
on the foramen transversaria transmitting
vertebral artery. This may cause distortion of the
artery which produces vertebro-basilar
insufficiency.
Review of Head and Neck 465
Q. What is yes movement?
Ans. Movements between the atlas and the skull at
atlanto occipital joints are flexion and extension
i.e. nodding or yes movements.
Q. What is no movement?
Ans. Movements between atlas and axis at the atlanto-
axial joint are mainly rotation around a vertical
axis, dens of axis, i.e. turning the head from
side to side or No movements.
Q. How does dislocation of TM joint occur?
Ans. Dislocation usually occurs when the mouth is
widely open. In this position the head of
mandible glides forwards and downwards and
comes to lie below the articular tubercle. The joint
is highly unstable and a blow on head in this
position results in forward dislocation of the
head of mandible. The person will not be able to
close his mouth after such an injury.
Q. What are layers of scalp?
Ans. The soft tissues of the scalp are arranged in five
C H A P T E R-35
layers:
S Skin
C Connective tissue
A Aponeurosis
L Loose areolar tissue
P Periosteum
Q. Which is the dangerous layer of scalp?
Ans. Loose areolar tissue layer is the dangerous layer
of scalp.
Q. What is caput?
Ans. Caput is the collection of fluid in the loose aerolar
tissue of scalp due to forces of labour. The
swelling due to caput is generally diffuse and
more on the dependant areas instead of a
particular bone and also crosses the midline as
it is not limited to sutures.
Q. Why do scalp wounds bleed profusely?
Ans. The neurovascular bundle of scalp lies in the
tough connective tissue layer of scalp. In case of
injury to the scalp, this tough connective tissue
prevents the retraction of blood vessels.
Therefore, scalp wounds bleed profusely.
Q. Why does black eye occur in cases of head
injuries?
Ans. Head injury resulting in soft tissue damage can
cause collection of blood in the loose
subaponeurotic layer of scalp which is
continuous with the upper eye lid. The blood
easily tracks down anteriorly over the eyelids
leading to discoloration of the eyelids known as
 466 Human Anatomy For Dental Students
black eye. The spread of this collection is limited
posteriorly and laterally due to attachment of the
aponeurosis to the supranuchal lines and
zygomatic arches at these points.
Q. What is cephalhaematoma? How does it differ
from a fluid collection in the loose areolar tissue
of the scalp?
Ans. Cephalhaematoma is the collection of blood
below the periosteal layer of scalp due to an
injury. The swelling due to the haematoma is
localized over the particular bone involved as
the periosteum is adherent to the underlying bone
at the sutures which limits its spread. In cases of
collection of fluid or blood in the loose aerolar
tissue e.g. caput formation in a newborn (due to
forces of labour), the swelling is generally diffuse
and more on the dependant areas instead of a
particular bone. Caput also crosses the midline
as it is not limited by sutures.
Q. Which is the smiling muscle of face?
Ans. Zygomaticus major and minor.
S E C T I O N-2
Q. Which muscle is involved in expression of
surprise?
Ans. Frontalis and Procerus.
Q. Which muscle is involved in expression of
frowning?
Ans. Corrugator supercilli.
Q. Which muscle is involved in expression of
anger?
Ans. Dilator naris and depressor septi
Q. Which muscle is involved in expression of
laughing and smiling?
Ans. Zygomaticus major
Q. Which muscle is involved in expression of
sadness?
Ans. Depressor anguli oris
Q. Which muscle is involved in expression of
sorrow and grief?
Ans. 1. Levator labii superioris
2. Levator anguli oris
3. Zygomaticus minor
Q. Which muscle is involved in expression of
grinning?
Ans. Risorius.
Q. Which muscle is involved in expression of
disdain or doubt?
Ans. Mentalis.
Q. Which muscle is involved in expression of
whistling?
Ans. Buccinator.
Q. What is dangerous area of face?
Ans. Dangerous area of face comprises of lower part
of nose, upper lip and the adjoining cheek. This
area is drained by facial vein. The facial vein
communicates with the cavernous sinus via
ophthalmic veins and pterygoid plexus of veins.
The facial vein does not contain valves and it
rests directly on the muscles of facial expressions.
Contraction of these muscles aid the retrograde
spread of any infective embolus from an infected
part in the area mentioned above. It can thus
reach the cavernous sinus and cause thrombosis
which can be fatal.
Q. What is the sensory supply of face?
Ans. The face receives its sensory innervation from
following two sources (Fig. 1.25):
1. Trigeminal nerve: The three divisions of
trigeminal nerve supply almost the entire skin
of face except an area over the angle of
mandible. The various branches supplying
face are:
a. From ophthalmic division
Lacrimal nerve
Supraorbital nerve
Supratrochlear nerve
Infratrochlear nerve
External nasal nerve
b. From maxillary division
Infraorbital nerve
Zygomatico-facial nerve
Zygomatico-temporal nerve
c. From mandibular division
Mental branch
Buccal branch
Auriculotemporal nerve
2. Great auricular nerve (C2): This branch of
cervical plexus supplies the area of skin over
the angle of mandible.
Q. What is motor supply of face?
Ans. Nerve supply to the muscles of the face is derived
from the facial nerve and its 5 branches:
1. Temporal
2. Zygomatic
3. Buccal
4. Marginal mandibular
5. Cervical
Q. What is Bells palsy?
Ans. Bells palsy is a lower motor neuron type of palsy
of the facial nerve due to compression of the nerve
in the facial canal near stylomastoid foramen.
The exact etiology is not known but it is probably
due to a viral infection. Facial muscles of the same
side are paralysed.

Q. What are the features of Bells Palsy?
Ans. 1. Facial asymmetry: due to unopposed action
of muscles of the normal side. There is
deviation of angle of mouth to the opposite
side.
2. Loss of wrinkles on forehead: due to paralysis
of fronto-occipitalis muscle.
3. Widening of palpebral fissure and inability
to close the eye: due to paralysis of orbicularis
oculi muscle.
4. Inability of angle of mouth to move upwards
and laterally during laughing: due to paralysis
of zygomaticus major muscle.
5. Loss of naso-labial furrow: It is due to
paralysis of levator labii superioris alaeque
nasi muscle.
6. Accumulation of food into the vestibule of
mouth: due to paralysis of buccinator muscle.
7. Dribbling of saliva from the angle of mouth:
due to paralysis of orbicularis oris muscle.
8. When one presses the cheek with inflated
vestibule the air leaks out between the lips:
paralysis of orbicularis oris muscle.
9. Loss of resistance while blowing out air in
mouth: paralysis of buccinator.
Q. What is lacrimal apparatus?
Ans. The structures concerned with the production
and drainage of lacrimal (tear) fluid constitute
the lacrimal apparatus. The components of the
lacrimal apparatus are (Fig. 20.2):
1. Lacrimal gland and its ducts, accessory
lacrimal glands
2. Conjunctival sac
3. Lacrimal puncta and canaliculi, common
canaliculus
4. Lacrimal sac
5. Nasolacrimal duct
Q. Name the glands present in eye lid?
Ans. Zies glands, Molls glands and Meibomian or
tarsal glands.
Q. Which bones form medial wall of orbit?
Ans. Medial wall of orbit is formed by four bones. They
are, from before backwards:
1. Frontal process of maxilla
2. Lacrimal bone
3. Orbital plate of ethmoid
4. Body of sphenoid
Q. Which bones form lateral wall of orbit?
Ans. Lateral wall of orbit is formed by two bones:
1. Zygomatic bone, in front
2. Orbital surface of greater wing of sphenoid,
behind
Review of Head and Neck 467
Q. Which bones form roof of orbit?
Ans. Roof of orbit is formed by two bones:
1. Orbital plate of frontal bone, in front
2. Lesser wing of sphenoid, behind
Q. Which bones form floor of orbit?
Ans. Floor of orbit is formed by three bones:
1. Orbital surface of the body of maxilla
2. Zygomatic bone, anterolaterally
3. Orbital process of palatine bone, postero-
medially
Q. What are the contents of orbit?
Ans. Contents of orbit are:
1. Eyeball
2. Muscles of orbit
3. Fascia bulbi
4. Nerves:
a. Optic nerve
b. 3rd, 4th and 6th cranial nerves
c. Ophthalmic nerve
5. Ophthalmic artery
6. Superior and inferior ophthalmic veins
C H A P T E R-35
7. Lacrimal gland
8. Orbital fat
Q. What are layers of eye ball?
Ans. The eyeball consists of three concentric coats:
1. An outer fibrous coat, consisting of sclera and
cornea
2. A middle vascular coat, consisting of choroid,
ciliary body and iris
3. An inner nervous coat, consisting of retina
Q. What is macula?
Ans. It is a pale yellowish area seen near the posterior
pole of fundus with opthalmoscope. It is
approximately 5 mm in diameter. A small pit in
its center is called the fovea centralis. This is the
point where light is normally focused. Fovea is
that portion of retina which has the maximum
concentration of cones. Hence, it is the site of
greatest visual acuity i.e. the ability to see fine
images.
Q. What is visual pathway or optic pathway?
Ans. The retina is the photoreceptive layer of the eye
and impulses generated in rods and cones of
retina are finally transmitted along the axons of
ganglion cells of retina which converge to the
optic disc and exit the eyeball as optic nerve.
1. The impulses course through optic nerve,
optic chiasma and optic tract to relay in lateral
geniculate body of corresponding side.
2. The fibers originating from nasal halves of the
retina cross to opposite side at the chiasma.
 468 Human Anatomy For Dental Students
Hence each optic tract consists of fibers from
temporal region of retina of ipsilateral side and
nasal region of retina of contra-lateral side.
3. The fibers from nuclei of lateral geniculate
body extend to the visual cortex in the medial
aspect of occipital lobe via the optic radiation.
Q. What is pupillary light reflex?
Ans. Pupillary light reflex is defined as constriction
of the pupil of the eye when it is exposed to bright
illumination.
Q. What is the pathway of pupillary light reflex?
Ans. The path of nerve impulses causing this reflex is
as follows:
1. On stimulation with bright light the nerve
impulses pass through ganglion cells of retina,
optic, nerve, optic chiasma and optic tract to
pretectal nucleus of mid brain.
2. Fibers of secondary neurons from pretectal
nuclei then convey impulses to the Edinger-
Westphal nuclei bilaterally.
3. Preganglionic fibers from Edinger-Wesphal
nuclei carry impulses to ciliary ganglia via
S E C T I O N-2
oculomotor nerve.
4. Post ganglionic fibers from ciliary ganglion
on each side travel along short ciliary nerves
to supply sphincter pupillae muscle which
contracts in response.
Q. What are direct and indirect light reflexes?
Ans. When one eye exposed to a beam of light the pupil
of both eyes constrict together and equally.
Constriction of pupil which is exposed to beam
of light is called direct light reflex while
simultaneous constriction of pupil of opposite
eye is called consensual or indirect light reflex.
Q. What is near vision reflex?
Ans. In order to view near objects the eyes respond by:
1. Convergence of eyes
2. Contraction of ciliary muscles leading to
change in shape of anterior surface of lens,
accommodation reflex.
3. Constriction of pupils to increase depth of
focus.
Q. What is near vision pathway?
Ans.
1. Afferent path is along optic nerves, optic
chiasma, optic tracts, lateral geniculate bodies,
optic radiation to the visual areas in cerebral
cortex. Then impulses are transmitted to
pretectal region and Edinger-Westphal and
motor nuclei of oculomotor nerve via superior
longitudinal fasciculus, frontal eye field and
internal capsule.
2. Efferent path consisting parasympathetic
fibers arises from Edinger-Westphal nucleus
and travel along oculomotor nerve to relay in
ciliary ganglion. Post ganglionic fibers supply
ciliary muscle and sphincter pupillae via short
ciliary nerves.
3. Efferent fibers from oculomotor nerve supply
medial rectus muscle of eyeball.
Q. What is stye?
Ans. Stye is an acute suppurative inflammation of a
Zies gland. The pus points near the base of the
cilia. Epilation of the concerned eyelash helps to
drain the pus.
Q. What is chalazion?
Ans. Chalazion (internal stye) is the inflammation of
a tarsal (meibomian) gland. The swelling points
on the inner aspect of the eyelid.
Q. What is dacrocystitis?
Ans. Inflammation of lacrimal sac is called
dacryocystitis. It hampers the drainage of
lacrimal fluid into the nose. This causes over flow
of the lacrimal fluid from the conjunctival sac on
to the face, a condition called epiphora.
Q. What happens in case of unilateral ocular
muscle paralysis?
Ans. Unilateral paralysis of an individual extra ocular
muscle, due to involvement of the corresponding
nerve, produces strabismus or squint and may
result in diplopia (double vision). Diplopia
occurs because the light from an object is not
focussed on identical areas of both retinae. The
real image falls on the macula of the unaffected
eye while the false image falls on some peripheral
part of the retina in the paralysed eye leading to
diplopia.
Q. What is the clinical importance of levator
palpebrae superioris?
Ans. Paralysis of levator palpebrae superioris leads
to ptosis i.e. drooping of upper eyelid. This can
be due to either, involvement of oculomotor nerve
or of the cervical sympathetic chain (as in
Horners syndrome).
Q. What is the clinical importance of central artery
of retina?
Ans. The central artery of retina is an end artery and
obstruction of this artery by an embolism or
pressure results in sudden total blindness.
Q. What is arcus senilus?
Ans. Due to ageing there is fatty degeneration along
the periphery of the cornea. This becomes visible
as a white ring in old people and is known as
arcus senilus.

Q. What is retinal detachment?
Ans. In retinal detachment there is separation of the
two layers of retina. Retinal pigment epithelium
separates from the neurosensory layer of retina.
Q. What is papilloedema?
Ans. Normal optic disc appears on ophthalmoscopy
as a cup shaped area, paler than the surrounding
area i.e., the fundus. The edges of the cup are
sharp and well defined. In patients with raised
intracranial pressure the optic disc is congested
and the cup gets obscured and the disc margin is
blurred. This is known as papilloedema. The
intracranial pressure gets transmitted to the disc
via the meningeal coverings which continue over
the optic nerve. The raised pressure also
compresses the central retinal artery which lies
in the subarachnoid space around the optic
nerve.
Q. What is glaucoma?
Ans. An abnormal increase in intraocular pressure
leads to the condition called glaucoma. This
occurs due to a block in the circulation and
drainage of the aqueous humor. In acute
conditions there is severe pain due to pressure
on the highly sensitive cornea. Glaucoma results
in pressure necrosis of the retina and eventually
can cause blindness.
Q. What is accommodation?
Ans. The change in focal length of the lens of the eye
when it focuses on a nearby object is called
accommodation.
This occurs by the contraction of ciliary muscles
and enables us to see both the far and near objects
with the same lens.
Q. What is cataract?
Ans. Opacification of the lens is known as cataract.
The most common cause is senile cataract.
Q. What is presbiopyia?
Ans. It is the gradual loss of power of accommodation
of the lens due to changes secondary to ageing
as mentioned above. The lens plays an important
role in accomodation and as it hardens with age
it looses its flexibility.
Q. What is pachymeninx?
Ans. The dura mater is also called pachymeninx.
Q. What are leptomeninges?
Ans. The arachnoid and piamater are together known
as leptomeninges.
Q. Enumerate the folds of duramater covering
brain?
Review of Head and Neck 469
Ans. Folds of duramater:
1. Falx cerebri
2. Tentorium cerebrai
3. Falx cerebelli
4. Diaphragma sellae
Q. What is extradural haematoma?
Ans. It is the collection of blood between the endosteal
layer of duramater and the bone of the skull. It
generally occurs following head injury. The
commonest vessel involved is the middle
meningeal vein followed by middle meningeal
artery. The blood gradually collects and strips
off the endosteal layer from the skull. The patient
may present initially with loss of consciousness
for a short duration followed by a lucid interval
of normal consciousness. As the intracranial
pressure gradually increases the patient again
presnts with confusion, drowsiness, paralysis
and unconsciousness. Hematoma following
injury to anterior branch of middle meningeal
artery causes pressure on the motor area of the
C H A P T E R-35
brain giving rise to hemiplegia of the opposite
side. Surgical drainage of hematoma is done by
burring a hole through the pterion.
Q. What is subdural haematoma?
Ans. It is the collection of blood between the meningeal
layer of duramater and the arachnoid mater. It
occurs following head injury with damage to
superficial cerebral veins.
Q. What can be the consequences of a fracture of
base of skull?
Ans. If the internal carotid artery is ruptured in a
fracture of base of skull, an arterio-venous comm-
unication may be established between the artery
and cavernous sinus.
The patient presents with following features
1. Pulsating exophthalmos.
2. A loud bruit (loud systolic murmur) that is
easily heard over the eye.
3. Ophthalmoplegia due to an increase in the
venous pressure of the cavernous sinus which
compresses upon the 3rd and 4th cranial
nerves.
4. Marked orbital and conjunctival oedema
because the venous pressure of the cavernous
sinus is raised to the arterial pressure.
Q. Enumerate the dural venous sinuses?
Ans. Dural venous sinusesThey are classified as 7
paired and 7 unpaired sinuses (Figs 21.1 and 21.2).
Unpaired sinuses are:
1. Superior sagittal sinus
2. Inferior sagittal sinus
 470 Human Anatomy For Dental Students

3. Straight sinus Q. What is cavernous sinus thrombosis?

4. Occipital sinus Ans. Thrombosis of cavernous sinus has a varied
5. Anterior intercavernous sinus etiology due to its numerous communications.
6. Posterior intercavernous sinus The commonest cause of thrombosis is due to
7. Basilar venous plexus (sinus) passage of septic emboli from an infection in the
Paired sinuses are: dangerous area of the face through facial plexus
1. Cavernous sinus of veins to the deep facial vein then to the
2. Superior petrosal sinus pterygoid venous plexus and finally via
3. Inferior petrosal sinus emissary vein into the sinus.
4. Transverse sinus
Q. What are featurs of cavernous sirnus thrombosis?
5. Sigmoid sinus
Ans. Features of cavernous sinus thrombosis:
6. Spheno-parietal sinus
1. Severe pain in the eye and forehead, due to
7. Petro-squamous sinus
involvement of ophthalmic nerve.
Q. What are the characteristic features of dural 2. Ophthalmoplegia, paralysis of extra ocular
venous sinuses? muscles due to involvement of 3rd, 4th and
Ans. Characteristic features of the intracranial dural 6th cranial nerves.
venous sinuses are: 3. Marked oedema of eyelids with exoph-
1. The sinuses are present between the two thalmos, due to congestion of orbital veins
layers of duramater. following obstruction of ophthalmic veins.
2. They are lined by endothelium only ,muscular
Q. What is the clinical importance of sigmoid
coat is absent.
sinus?
3. They are valveless.
Ans. The sigmoid sinus is separated from the mastoid
S E C T I O N-2

4. They receive venous blood and CSF.

antrum and mastoid air cells by a thin plate of
5. They receive valveless emissary veins which
bone only. Thrombosis of the sigmoid sinus
regulate the intracranial blood flow and
therefore can occur secondary to an infection of
maintain equilibrium of venous pressure
the middle ear or mastoid process. It is for the
within and outside the skull.
same reason that utmost care should be taken
Q. What structures are passing through lateral wall not to expose the sigmoid sinus during
of cavernous sinus? operations on the mastoid process.
Ans. They are (Fig. 21.3):
Q. What are emissary veins?
1. Oculomotor nerve
Ans. Emissary veins are channels between
2. Trochlear nerve
intracranial venous sinuses and the extracranial
3. Ophthalmic nerve
veins. They pass along the various foramina of
4. Maxillary nerve
the skull.
Q. What structures are passing through cavernous Their clinical significance lies in the fact that they
sinus? can aid the spread of extra cranial infections into
Ans. They are: the cranial cavity.
1. Internal carotid artery
Q. Eumerate important emissary veins?
2. Abducent nerve
Ans. 1. Mastoid emissary veins: It connects sigmoid
Q. Enumerte the tributaries of cavernous sinus? sinus with posterior auricular or occipital vein
Ans. Tributaries of cavernous sinus are: via the mastoid foramen.
1. From orbit 2. Parietal emissary vein: It connects superior
a. Superior ophthalmic vein sagittal sinus with veins of scalp via parietal
b. Inferior ophthalmic vein foramen.
c. Central vein of retina (sometimes) 3. Venous plexus in hypoglossal canal: It
2. From meninges connects sigmoid sinus with internal jugular
a. Sphenoparietal sinus vein.
b. Anterior (frontal) trunk of middle 4. Condylar emissary vein: It connects sigmoid
meningeal vein sinus to the veins in the suboccipital triangle
3. From brain via condylar canal.
a. Superior middle cerebral vein 5. Venous plexus of foramen ovale: It connects
b. Inferior cerebral veins (only few). cavernous sinus to pterygoid plexus of veins.
 Review of Head and Neck 471

6. Venous plexus in carotid canal: It connects Q. What are contents of pterygopalatine fossa?
cavernous sinus to internal jugular vein. Ans. 1. Maxillary nerve: It reaches the fossa through
7. Petrosquamous sinus: It connects transverse the foramen rotundum over the anterior
sinus to external jugular vein. surface of root of pterygoid process.
8. Occipital emissary vein: It connects con- 2. Pterygopalatine ganglion and its connections.
fluence of sinuses with occipital vein. 3. Maxillary artery, 3rd part: It enters the fossa
via the pterygomaxillary fissure and divides
Q. What are cells present in pituitary and their
into its terminal branches.
secretion.
Ans. Q. Name the branches of Ist part of maxillary
artery?
Anterior pituitary Secretion
Ans. (Fig. 23.3)
Gonadotropes FSH, LH
1. Deep auricular artery
Thyrotropes TSH
Corticotropes ACTH
2. Anterior tympanic artery
Mammotropes Prolactin 3. Middle meningeal artery
Somatotropes GH 4. Accessory meningeal artery
5. Inferior alveolar artery
Posterior pituitary Secretion
Posterior pituitary Vasopressin (ADH) Q. Name the branches of 2nd part of maxillary
Oxytocin artery?
Ans. (Fig. 23.3)
Intermediate pituitary Secretion
1. Deep temporal artery
Intermediate pituitary MSH 2. Pterygoid branches

C H A P T E R-35
3. Masseteric artery
Q. What is arterial supply of pituitary gland? 4. Buccal artery
Ans. 1. Superior hypophyseal artery: Branch of
internal carotid artery. Q. Name the branches of 3rd part of maxillary
2. Inferior hypophyseal artery: Branch of artery?
internal carotid artery. Ans. (Fig. 23.3)
3. Portal vessels: The anterior lobe of pituitary 1. Posterior superior alveolar (dental) artery
is supplied by long and short portal vessels. 2. Infraorbital artery
The portal vessels are continuations of the 3. Greater palatine artery
external and internal capillary plexuses 4. Pharyngeal artery
formed by the two superior hypophyseal 5. Artery of pterygoid canal
arteries at the median eminence and upper 6. Sphenopalatine artery
infundibulum. Q. Name the veins forming pterygoid venous
Q. What are contents of temporal fossa? plexus?
Ans. 1. Temporalis muscle Ans. It is the plexus of veins present over the lateral
2. Temporal fascia pterygoid muscle, part of plexus lies between the
3. Deep temporal vessels lateral and medial pterygoid muscles. It is formed
4. Deep temporal nerves by the following veins:
5. Auriculotemporal nerve 1. Sphenopalatine vein
6. Superficial temporal vessels 2. Deep temporal vein
3. Pterygoid vein
Q. What are contents of infratemporal fossa? 4. Masseteric vein
Ans. 1. Muscles 5. Buccal vein
a. Tendon of temporalis muscle 6. Alveolar veins
b. Lateral and medial pterygoid muscles 7. Greater palatine vein
2. Nerves 8. Middle meningeal veins
a. Mandibular nerve and its branches 9. Branches from ophthalmic vein
b. Chorda tympani, branch of facial nerve
c. Otic ganglion Q. Temporomandibular joint is which type of
3. Vessels joint?
a. Maxillary artery Ans. It is condylar variety of synovial joint.
b. Pterygoid venous plexus Anatomically there are two temporomandibular
joints but physiologically they are one.
 472 Human Anatomy For Dental Students
Q. Name the ligaments of temporomandibular
joint?
Ans. They are:
1. Fibrous capsule
2. lateral temporomandibular ligament
3. Sphenomandibular ligament
4. Stylomandibular ligament
Q. What is the nerve supply of temporomandibular
(TM) joint?
Ans. It is supplied by branches of mandibular division
of trigeminal nerve namely:
1. Auriculotemporal nerve
2. Masseteric nerve
Q. Why do you have articular disc in temporoman-
dibular joint?
Ans. Articular disc is an oval fibrocartilaginous plate
with a concavo-convex superior surface and a
concave inferior surface, to accommodate the
head of mandible. It is thickend at the periphery
to form an annulus which is attached to the
fibrous capsule.
Functions of articular disc of joint
S E C T I O N-2
1. It divides the joint cavity into two parts:
a. Upper meniscap-temporal compartment
permits gliding movements.
b. Lower menisco-mandibular compart-
mentpermits rotatory as well as gliding
movements.
2. It reduces the friction between the two articular
surfaces. It allows free sliding movement of
the condyle preventing damage due to
friction. This function is at the cost of slight
instability of the joint.
3. It aids in lubrication of the joint.
Q. What is dislocation of temporomandibular
joint?
Ans. Dislocation of temporomandibular joint usually
occurs when the mouth is widely open. In this
position the head of mandible glides forwards
and downwards and comes to lie below the
articular tubercle. The joint is highly unstable
and a blow on head in this position results in
forward dislocation of the head of mandible. The
person will not be able to close his mouth after
such an injury.
Q. What are the boundaries of parotid bed?
Ans. Boundaries of parotid bed or retromandibular
fossa are:
1. Anterior: Posterior border of ramus of
mandible, laterally, masseter and medial
pterygoid muscles, medially.
2. Posterior: Mastoid process, sternocleido-
mastoid muscle, laterally.
3. Superior: External acoustic meatus, posterior
part of the temporomandibular joint.
4. Inferior: Posterior belly of digastric and
stylohyoid muscles.
5. Medial: Styloid process, styloglossus,
stylopharyngeus and stylohyoid muscles.
Q. What are structures present within parotid
gland?
Ans. Structures present within the parotid gland
(Figs 24.4 and 24.5)
1. Facial nerve and its branches:
2. Retromandibular vein
3. External carotid artery
4. Deep parotid lymph nodes
Q. What is parasympathetic nerve supply of
parotid gland?
Ans. The preganglionic fibres arise from inferior
salivatory nucleus and pass successively
through the glossopharyngeal nerve, tympanic
branch of glossopharyngeal nerve, tympanic
plexus and lesser petrosal nerve to relay in the
otic ganglion. Post ganglionic fibres arise from
the cells of the ganglion and pass through
auriculotemporoal nerve to supply the parotid
gland. It is secretomotor and results in secretion
of watery fluid (Fig. 24.6).
Q. What is sympathetic nerve supply of parotid
glands?
Ans. It is derived from the sympathetic plexus around
the external carotid artery which is formed by
the postganglionic fibres from superior cervical
sympathetic ganglion. It is secretomotor and
results in production of mucus rich sticky
secretion. It is also vasomotor to the gland
(Fig. 24.6).
Q. What is sensory nerve supply of parotid gland?
Ans. It is through following nerves:
1. From auriculotemporal nerve
2. From great auricular nerve
3. C2 is sensory to parotid fascia
Q. What is mumps?
Ans. Mumps is a viral infection which has special
affinity for the parotid glands and results in
swollen and painful glands. Pain is severe as
the gland is surrounded by a tough capsule.
Mastication is also painful due to inflammation
of the glenoid process of gland which is closely
related to the tempromandibular joint. Mumps
is self limiting and requires only supportive care.
Rarely it can lead to complications like
bronchitis, orchitis and pancreatitis.

Q. Describe the treatment of a parotid abscess?
Ans. Infection of parotid gland generally is a
consequence of retrograde bacterial infection
from mouth through the parotid duct. Severe
infection leading to an abscess is drained by
giving a horizontal incision over it. A vertical
incision is avoided as it can lead to injury to
branches of the facial nerve.
Q. What is nerve supply of submandibular gland?
Ans. Nerve supply of submandibular gland (Fig. 24.11):
1. Parasympathetic: Preganglionic fibers arise
from superior salivatory nucleus. They pass
successively through the facial nerve, chorda
tympani nerve, lingual nerve and relay into
the submandibular ganglion. Postganglionic
fibres arise from cells of the ganglion and
directly supply the gland. It is secretomotor
and causes secretion of watery fluid.
2. Sympathetic: Is derived from the sympathetic
plexus around facial artery formed by
postganglionic fibres from superior cervical
sympathetic ganglion. It is secretomotor and
results in secretion of mucus rich fluid. It is
also vasomotor.
3. Sensory: Lingual nerve.
Q. What is nerve supply of sublingual gland?
Ans. It is same as submandibular gland except
postganglionic parasympathetic secretomotor
fibres are carried by lingual nerve.
Q. Name the tributaries of external jugular vein?
Ans. The tributories of external jugular vein are:
1. Posterior division of retromandibular vein
2. Posterior auricular vein
3. Anterior jugular vein
4. Posterior external jugular vein
5. Transverse cervical vein
6. Suprascapular vein
7. It communicates with internal jugular vein by
and oblique jugular vein
Q. What is cutaneous nerve supply of neck?
Ans. Cutaneous nerver supply of neck is derived from
the following branches of cervical plexus:
1. Lesser occipital nerve (C2)
2. Great auricular nerve (C2, 3)
3. Transverse cutaneous nerve of neck (C2, 3)
4. Supraclavicular nerve (C3, 4)
5. Medial branches of dorsal rami of C3, 4, 5 spinal
nerves
Q. What are layers of deep fascia of neck?
Ans. It consists of three layers, from exterior to interior
1. Investing layer
Review of Head and Neck 473
2. Pretracheal layer
3. Prevertebral layer
Q. What is the extent of carotid sheath?
Ans. It extends from the base of skull above to the arch
of aorta below.
Q. What are contents of carotid sheath?
Ans. 1. Common carotid artery in lower part and
internal carotid artery in upper part
2. Internal jugular vein
3. Vagus nerve
Q. Which nerve is embedded in anterior wall of
carotid sheath?
Ans. Ansa cervicalis.
Q. Why does thyroid gland move on swallowing?
Ans. Thyroid gland moves on swallowing because the
pretracheal fascia which splits to enclose it, is
attached to the hyoid bone and the thyroid
cartilage.
Q. Name the triangles of neck?
C H A P T E R-35
Ans. Triangles present in neck are (Figs 25.1 and 25.5):
1. Anterior triangle: It is subdivided into
a. Submental triangle
b. Digastric triangle
c. Carotid triangle
d. Muscular triangle
2. Posterior triangle: It is subdivided into
a. Occipital triangle
b. Subclavian triangle
Q. What are the contents of carotid triangle?
Ans. The contents of carotid triangle are:
1. Common carotid artery with its terminal
branches
a. Internal carotid artery
b. External carotid artery
2. Internal jugular vein
3. Occipital vessels
Q. What are actions of sternocleidomastoid
muscle?
Ans. 1. Acting one at a time, the muscle draws the
head towards ipsilateral shoulder. This results
in turning of face to the opposite side.
2. Flexion of neck is brought about when muscles
of both sides act together. Along with action
of longus colli, they bring about flexion of
cervical part of vertebral column.
3. They aid in elevation of thorax during
inspiration, when the head is fixed.
4. Posterior most fibres of both muscles causes
extension of neck to peeping over the crowd.
 474 Human Anatomy For Dental Students

Q. Name the branches of external carotid artery? Q. Name the branches of cerebral part of internal
Ans. The external carotid artery gives 8 branches, carotid artery?
(Fig. 25.10): Ans. 1. Ophthalmic artery
1. Ascending pharyngeal artery 2. Anterior choroidal artery
2. Superior thyroid artery 3. Posterior communicating artery
3. Lingual artery 4. Anterior cerebral artery
4. Facial artery 5. Middle cerebral artery
5. Occipital artery
Q. Name the tributaries of internal jugular vein?
6. Posterior auricular artery
Ans. 1. Inferior petrosal sinus
7. Maxillary artery
2. Pharyngeal veins
8. Superficial temporal artery
3. Common facial vein
Q. Name the branches of lingual artery? 4. Lingual vein
Ans. Branches of lingual artery are: 5. Superior thyroid vein
1. Suprahyoid branch: It arises from the first part 6. Middle thyroid vein
and anastomoses with its fellow of opposite 7. Occipital vein
side.
Q. What are the contents of occipital triangle (part
2. Dorsal lingual branches: These are usually
of posterior triangle)?
two in number and arise from the 2nd part.
Ans. Contents (from above downwards):
They supply the dorsum of tongue and the
1. Occipital artery at apex
tonsil.
2. Spinal part of accessory nerve
3. Sublingual artery: It is given off from the 3rd
3. Four cutaneous branches of cervical plexus of
part and supplies the sublingual gland.
nerves
S E C T I O N-2

Q. Name the branches of facial artery? a. Lesser occipital

Ans. 1. Branches from cervical part (in the neck) b. Great auricular
a. Ascending palatine artery c. Transverse cutaneous nerve of neck
b. Tonsillar artery (main artery of tonsil) d. Supraclavicular
c. Glandular branches to supply the 4. Muscular branches of C3 and C4 nerves
submandibular gland 5. Upper part of brachial plexus
d. Submental artery 6. Dorsal scapular nerve
2. Branches from the facial part (in the face) 7. Superficial cervical vessels, branches of
a. Inferior labial artery vertebal vessels
b. Superior labial artery 8. Lymph nodes
c. Lateral nasal artery
Q. What are the contents of subclavian or supra-
d. Angular artery
clavicular triangle?
e. Small unnamed branches: These are small
Ans. Contents of supraclavicular triangle are:
and arise from the posterior aspect of the
1. Supraclavicular nerves
artery.
2. Trunks of brachial plexus of nerves with their
Q. Name the branches of occipital artery? branches:
Ans. 1. Sternomastoid branches a. Dorsal scapular nerve
2. Mastoid branches b. Long thoracic nerve
3. Meningeal branches c. Nerve to subclavius
4. Muscular branches 3. 3rd part of subclavian artery
5. Auricular branch 4. Subclavian vein, lies behind the clavicle
6. Descending branches 5. Suprascapular vessels
7. Occipital branches 6. External jugular vein
7. Supraclavicular lymph nodes
Q. Enumerate the parts of internal carotid artery?
Ans. It is divided into four parts: Q. Name the structures that pierce the fascial roof
1. Cervical part of posterior triangle?
2. Petrous part
Ans. Structures that pierces the fascial roof of posterior
3. Cavernous part
triangle are:
4. Cerebral part
1. The cutaneous branches of cervical plexus.

These are:
a. Lesser occipital nerve (C2)
b. Great auricular nerve (C2, C3)
c. Transverse cervical cutaneous nerve (C2,
C3)
d. Supraclavicular nerve (C3, C4)
2. External jugular vein: It pierces the deep fascia
from without to drain into the subclavian vein.
Q. What is the root value of cervical plexus?
Ans. The plexus is formed by the interconnection of
ventral rami of upper four cervical nerves, C1, C2,
C3 and C4.
Q. Name the branches of cervical plexus?
Ans. Branches of cervical plexus are (Fig. 1.35):
Superficial cutaneous branches
1. Lesser occipital nerve, (C2)
2. Great auricular nerve, (C2, 3)
3. Transverse cervical nerve, (C2, 3)
4. Supraclavicular nerve, (C3, 4)
Deep muscular branches: They supply the
muscles directly or indirectly via communicating
branches:
1. Phrenic nerve, (C3, 4, 5): This supplies the
diaphragm.
2. Descendens cervicalis nerve, (C2, 3): This joins
with descendans hypoglossi to form ansa
cervicalis in front of the carotid sheath. It
supplies sternohyoid, sternothyroid and
inferior belly of omohyoid.
3. Branches from C1 communicates with hypo-
glossal nerve to supply thyrohyoid, genio-
hyoid and superior belly of omohyoid
muscles.
4. C2, 3, 4 communicate with the spinal root of
accessory nerve to supply sternocleido-
mastoid (C2).
Q. Name the branches of subclavian artery?
Ans. The subclavian artery gives 5 branches (Fig. 25.20):
1. From first part
a. Vertebral artery
b. Internal thoracic artery
c. Thyrocervical trunk
d. Costocervical trunk (on left side only)
2. From second part
a. Costocervical trunk (on right side only)
3. From third part
a. Dorsal scapular artery
Q. Name the branches of vertebral artery?
Ans. Branches of vertebral artery are:
1. In the neck
a. Spinal branches, which enter the vertebral
canal through intervertebral foramen to
Review of Head and Neck 475
supply the upper 5 or 6 cervical segments
of the spinal cord.
b. Muscular branches, they arise from the 3rd
part of vertebral artery and supply muscles
of suboccipital triangle.
2. In the cranial cavity
a. Meningeal branches, they supply meninges
of posterior cranial fossa.
b. Posterior spinal artery (sometimes it may
arise from posterior inferior cerebellar
artery).
c. Posterior inferior cerebellar artery (largest
branch of the vertebral artery).
d. Anterior spinal artery
e. Medullar branches supply the medulla.
Q. Name the branches of thyrocervical trunk?
Ans. The thyrocervical trunk is very small and divides
almost at once into three branches:
1. Inferior thyroid artery: Branches
2. Superficial cervical artery
3. Suprascapular artery
Q. What are boundaries of suboccipital triangle?
C H A P T E R-35
Ans. These are a pair of muscular triangles situated
deep in the suboccipital region one on either side
of midline and are bounded by four suboccipital
muscles.
Boundaries:
1. Superomedial: Rectus capitis posterior major,
supplemented by rectus capitis posterior
minor.
2. Superolateral: Obliquus capitis superior
3. Inferior: Obliquus capitis inferior
4. Roof: Formed by dense fibrous tissue which
is covered by semispinalis capitis medially
and longissimus capitis laterally.
Q. What are contents of suboccipital triangle?
Ans. 1. 3rd part of vertebral artery.
2. Dorsal ramus of C1 (suboccipital nerve)
3. Suboccipital plexus of veins
Q. What is vestibule of mouth?
Ans. The vestibule of mouth is a narrow space that
lies outside the teeth and gums and inside the
lips and cheeks.
Q. What opens in vestibule of mouth?
Ans. The parotid duct opens into the lateral wall of
vestibule opposite the crown of upper second
molar tooth.
Q. What are the types of mucosa present in oral
cavity?
Ans. Mucosal lining of oral cavity is of three types:
1. Lining mucosa: It lines most of oral cavity and
is made up of non-keratinized stratified
squamous epithelium
 476 Human Anatomy For Dental Students

2. Masticatory mucosa: It is present over alveolar 1. Lingual nerve: Receives general sensation
processes and is made up fo keratinized from anterior 2/3rd of the tongue.
stratified squamous epithelium 2. Chorda tympani: Receives taste sensations
3. Specialized mucosa: It is present over dorsum from anterior 2/3rd except from vallate
of tongue and forms lingual papillae papillae.
3. Glossopharyngeal nerve
Q. What are the parts of tooth? Conveys all general sensations from
Ans. Parts of tooth are (Fig. 27.3): posterior 1/3rd of the tongue.
1. Pulp cavity Carries taste sensation from vallate
2. Dentine papillae.
4. Internal laryngeal branch of superior
3. Enamel
laryngeal nerve conveys taste sensation from
4. Cementum
posterior most part of tongue and vallecula.
5. Periodontal ligament or membrane
Q. What is aglossia?
Q. What are timings of eruption of deciduous Ans. Aglossia is complete absence of the tongue, due
teeth? to total developmental failure.
Ans. The age of eruption is as follows:
Q. What is bifid tongue?
Teeth Time of eruption Ans. Bifid tongue occurs due to non fusion of lingual
Lower central incisors 6 months swellings.
Upper central incisors 7 months
Lateral incisors 89 months Q. What is lingual thyroid?
First molar 12 months (1 year) Ans. The median thyroid rudiment fails to grow
Canines 18 months (1 year) caudally and thyroid tissue persists within the
S E C T I O N-2

substance of the tongue. This is lingual thyroid.

Q. Why is osteomyelitis, i.e., inflammation of bone
more common after extraction of lower teeth? Q. What is tongue tie?
Ans. Sometimes extraction of a tooth leads to Ans. Tongue tie occurs due to shortening of the
osteomyelitis of the jaw. It usually occurs in the frenulum linguae and can interfere in speech. It
lower jaw and not in the upper jaw. This is can be easily excised.
because, the lower jaw is supplied by a single Q. Enumerate muscles of soft palate?
inferior alveolar artery. Therefore, damage to this Ans. 1. Tensor veli palatini
artery during extraction produces bone necrosis. 2. Levator veli palatini
The upper jaw on the other hand receives 3. Musculus uvulae
segmental supply by 3 arteries namely, posterior 4. Palatoglossus
superior, middle superior and anterior superior 5. Palatopharyngeus
alveolar arteries. Therefore ischaemia does not
occur following injury to an individual artery. Q. Which muscle of palate help in opening the
auditory tube?
Q. What is dental caries? Ans. Tensor veli palatini.
Ans. It is the disintegration of one of the calcified
structures covering the pulp cavity. The most Q. What is the result of paralysis of muscles of soft
important cause is inadequate oral hygeine. It palate?
leads to inflammation and pain in the involved Ans. Paralysis of muscles of soft palate due to lesion
tooth due to exposure of the pulp cavity. of vagus nerve produces
1. Nasal regurgitation of liquids
Q. What are functions of tongue? 2. Nasal twang in voice
Ans. 1. Receives bolus of food 3. Flattening of the palatal arch on the side of
2. Mastication (chewing of food). lesion
3. Deglutition (swallowing of food) 4. Deviation of uvula, opposite to the side of
4. Peripheral apparatus of taste lesion
5. Speech
6. Facial expression Q. What is cleft lip?
7. Paste postage stamp Ans. Fusion of the various processes that form the
8. Pattern of papillae has medicolegal importance external part of the face may occasionally be
incomplete and give rise to cleft lip. It can be of
Q. What is the sensory supply of tongue? the following types:
Ans. Sensory supply of tongue is obtained from 1. Cleft upper lip: It can be median cleft lip or
(Fig. 27.10): lateral cleft lip. Median cleft lip is rare and

occurs if the philtrum fails to develop from
the frontonasal process. The upper lip of hare
normally has a median cleft, therefore this
defect is called as hare-lip.
Lateral cleft lip is more common and it may be
on one or both sides of the philtrum. Unilateral
cleft lip occurs if maxillary process of one side
fails to fuse with the corresponding
frontonasal process. Bilateral cleft occurs if
both the maxillary processes fail to fuse with
frontonasal process.
The cleft may be a small defect in the upper lip
or may extend into the nostril splitting the
upper jaw.
2. Cleft lower lip: It is always median and rare.
It occurs when the two mandibular processes
do not fuse with each other. The defect usually
extends into the lower jaw.
Q. What is macrostomia?
Ans. Macrostomia or big mouth occurs due to
inadequate fusion of the mandibular and
maxillary processes with each other. The lack of
fusion may be unilateral. This leads to the
formation of lateral facial cleft.
Q. What is microstomia?
Ans. Too much fusion of mandibular and maxillary
processes may result in the small mouth or
microstomia.
Q. What is the cleft palate?
Ans. The defective fusion of various segments of the
palate gives rise to clefts in the palate. These vary
considerably in degree, leading to varieties of cleft
palate.
Q. Enumerate the openings present in lateral wall
of nose?
Ans. Openings in the lateral wall of the nose (Fig. 28.6):
Site Opening/Openings
Sphenoethmoidal recess Opening of sphenoidal air sinus
Superior meatus Openings of posterior ethmo-
idal air sinuses
Middle meatus
a. On bulla ethmoidalis Openings of middle ethmoidal
air sinus
b. In hiatus semilunaris
Anterior part Opening of frontal air sinus
Middle part Opening of anterior ethmoidal
air sinus
Posterior part Opening of maxillary air sinus
Inferior meatus Opening of nasolacrimal duct
(at the junction of anterior 1/
3rd and posterior
2/3rd)
Review of Head and Neck 477
Q. What is Littles area and what is its clinical
importance?
Ans. The area on the antero-inferior part of the nasal
septum is highly vascular. In this area the septal
branches of anterior ethmoidal, sphenopalatine,
greater palatine and superior labial arteries
anastomose to form a plexus known as
Kesselbachs plexus. This area is named as the
Littles area and is the most common site of
epistaxis or bleeding from nose in children.
Q. What is deviated nasal septum?
Ans. The central septum of the nose may be deviated
in some to the right or to the left side leading to
varying degrees of obstruction of the respective
nasal cavity. The deviation commonly involves
the cartilaginous part and occasionally the bony
part of septum. It can lead to recurrent attacks of
nasal blockage and sinusitis. This condition is
treated surgically by submucous resection of the
deviated part of the septum.
Q. Where do you find olfactory epithelium?
C H A P T E R-35
Ans. Olfactory epithelium is present in relation to the
roof of nasal cavity over the nasal bones and
superior conchae. It is present over an area of 2.5
cm2 and is supplied by olfactory nerves.
Q. Maxillary hiatus is reduced in size by 4 bones,
what are these bones?
Ans. 1. Unicate process of ethmoid, from above.
2. Descending process of lacrimal bone, from
above.
3. Ethmoidal process of inferior nasal concha,
from below.
4. Perpendicular plate of palatine bone from
behind.
Q. What is the clinical importance of maxillary
sinus?
Ans. Maxillary sinus is the commonest site of infection
amongst all sinuses. The infection is called
maxillary sinusitis. This infection can occur from
the following sources
1. Infection in the nose
2. Caries of upper molar teeth
3. Being the most dependant part it acts as a
secondary reservoir of pus from frontal air
sinuses through fronto-nasal duct and hiatus
semilunaris.
The opening of the sinus is unfortunately present
in the upper part of its medial wall. This results
in inefficient drainage and persistence of
infection.
 478 Human Anatomy For Dental Students
Q. What are methods of surgical drainage of
maxillary air sinus?
Ans. Surgical drainage of maxillary sinus may be
performed by following ways:
1. Endoscopic sinus surgery
2. Antral puncture by passing a trocar and
cannula in the inferior meatus in an outward
and backward direction to create a separate
opening in the medial wall of the sinus at a
lower level.
3. Caldwell Luc operation: In this surgery a
fenestra is created in the anterior wall of sinus
above the canine fossa through the gingivo-
labial fold.
Q. What is Waldeyers lymphatic ring?
Ans. It consists of collections of lymphoid tissue in
the submucosal layer of the wall of air and food
passages around their commencement. The
lymph nodules are arranged in a ring like pattern,
from posterior to anterior forming the Walderyers
lymphatic ring. It is made up of the following
(Fig. 29.5):
S E C T I O N-2
1. Pharyngeal (nasopharyngeal) tonsils
2. Tubal tonsils
3. Palatine tonsils
4. Lingual tonsil
Q. Enumerate the structures passing above
superior constrictor of pharynx?
Ans. Between the base of skull and upper concave
border of superior constrictor muscle of pharynx
lies the sinus of Morgagni. It gives passage to
(Fig. 29.8)
1. Auditory tube
2. Levator palati muscle
3. Ascending palatine artery
4. Palatine branch of ascending pharyngeal
artery
Q. Name the structures passing between superior
and middle constrictors of pharynx?
Ans. (Fig. 29.8)
1. Stylopharyngeus muscle
2. Glossopharyngeal nerve
Q. Name the structures passing between middle
and inferior constrictors of pharynx?
Ans. (Fig. 29.8)
1. Internal laryngeal nerve
2. Superior laryngeal vessels
Q. Name the structures passing below inferior
constrictor muscle of pharynx, in the tracheo-
oesophageal groove?
Ans. (Fig. 29.8)
1. Recurrent laryngeal nerve
2. Inferior laryngeal vessels
Q. What are stages of deglutition?
Ans. Deglutition is a process by which the food is
transferred from the mouth to the stomach. It
consists of three successive stages:
1. First stage, in the mouth. It is voluntary
2. Second stage, in the pharynx. It is involuntary
3. Third stage in the oesophagus, it is
involuntary
Q. What are adenoids?
Ans. Nasopharyngeal tonsils are prominent in
children but usually undergo atrophy at and
after puberty. Enlargement of nasopharyngeal
tonsils usually due to upper respiratory tract
infection is known as adenoids. Enlarged
adenoids block the posterior nares and cause
discomfort to the child as he will have to breath
through the mouth. It is a common cause of
snoring in children.
Q. What is the clinical importance of piriform
fossa?
Ans. Piriform fossa is a depressed area where
occasionally the ingested food particles can get
stuck. If adequate care is not taken during the
removal of a foreign body especially any hard
structure like fish bones, it may damage the
internal laryngeal nerve leading to anaesthesia
in the supraglottic part of the larynx.
Q. What is the clinical significance of the
eustachian tube?
Ans. The eustachian tube extends from middle ear to
nasopharynx and helps to equalize pressure
between the middle ear and the external ear.
Infection in nasopharynx can cause swelling and
blockage of the tube. This leads to decrease in
pressure in the middle ear and the tympanic
membrane is pulled towards it. There is a feeling
of fullness in the ear and loss of hearing. Serious
infection can also spread from the pharynx to
middle ear via the eustachian tube. This is more
common in children as the tube is short and
straight.
Q. Enumerate intrinsic muscles of larynx?
Ans. 1. Oblique arytenoid
2. Aryepiglotticus
3. Posterior cricoarytenoid
4. Lateral cricoarytenoid
5. Transverse arytenoid
6. Cricothyroid
7. Thyroarytenoid

8. Vocalis
9. Thyroepiglotticus
Q. Name the adductors of vocal cords?
Ans. 1. Lateral cricoarytenoids
2. Transverse arytenoids
Q. Name the abductor of vocal cords?
Ans. Posterior cricoarytenoids.
Q. Name the tensors of vocal cords?
Ans. 1. Cricothyroids
2. Vocalis
Q. What is sensory supply of larynx above glottis?
Ans. Internal laryngeal nerve.
Q. Enumerate cartilages present in larynx?
Ans. Larynx is made up of three paired and three
unpaired cartilages.
Paired cartilages Unpaired cartilages
They are small and They are large and comprise
comprise of of (from above downwards)
1. Arytenoid 1. Epiglottis
2. Corniculate 2. Thyroid
3. Cuneiform 3. Cricoid
Q. Enumerate the nerves supplying external ear
or pinna?
Ans. 1. Great auricular nerve
2. Lesser occipital nerve
3. Auriculotemporal nerve
4. Auricular branch of vagus nerve
Q. What is sensory nerve supply of tympanic
membrane?
Ans. 1. Auriculotemporal nerve
2. Auricular branch of vagus nerve
3. Glosssopharyngeal nerve
Q. Name ossicles present in ear.
Ans. 1. Malleus
2. Incus
3. Stapes
Q. Sometimes syringing can cause vomiting.
Explain?
Ans. Auricular branch of vagus nerve may get irritated
during the procedure of syringing to remove ear
wax. It may result in reflex vomiting and coughing
because the irritation is referred along the other
branches of the vagus.
Q. What is Aldermans nerve?
Ans. Tickling of the cutaneous distribution of vagus
nerve is said to stimulate a jaded appetite. The
Aldermen in ancient Roman days have been
reported to stimulate their appetite by pouring
Review of Head and Neck 479
cold water behind the ear. Therefore the auricular
branch of the vagus nerve is also called as the
Aldermen nerve. Apparently, this occurs due
to reflex gastric peristalsis caused by stimulation
of the vagus nerve fibers which also supply the
stomach.
Q. Name the arteries supplying thyroid gland?
Ans. 1. Superior thyroid artery
2. Inferior thyroid artery
3. Thyroidea ima artery (present in 30% cases)
4. Accessory thyroid artery
Q. It is not advisable to feel both the carotid
pulsations simultaneously. Why?
Ans. Pressure on the carotid arteries during palpation
can lead to stimulation of the carotid sinus. This
may cause vagal inhibition which leads to
bradycardia. If the pressure is applied bilaterally,
stimulation of both vagi can cause sudden
cardiac arrest and subsequent death.
Q. What is spasmodic torticollis?
C H A P T E R-35
Ans. Spasmodic torticollis may result due to irritation
of the spinal accessory nerve which leads to
clonic spasm of the sternocleidomastoid muscle.
Q. What happens if hypoglossal nerve is cut on
one side?
Ans. If the hypoglossal nerve is cut on one side there
will be a lower motor neuron type of paralysis of
muscles of the tongue on that side. On asking the
patient to protude his tongue, it will deviate to
the paralysed side due to unopposed action of
the muscles of the healthy side. There will be
associated atrophy of paralysed muscles. In
supranuclear lesions involving corticonuclear
fibres, in addition to paralysis of the muscles
initially there will also be fasciculations in
tongue on the affected side and mucous
membrane will show wrinkling.
Q. What is the clinical importance of middle
meningeal artery?
Ans. The middle meningeal artery is sometimes torn
in fracture of side of skull. This results in the
formation of an extradural haematoma that
overlaps the motor area of the cerebral cortex.
Consequently there is compression of the brain
leading to paralysis of the movements of the
opposite half of the body. Pressure due to
haematoma can be relieved by drilling a burr hole
in skull through the pterion.
Q. What is subclavian steal syndrome?
Ans. If there is obstruction of subclavian artery
proximal to the origin of vertebral artery some
 480 Human Anatomy For Dental Students
amount of blood from opposite vertebral artery
can pass in a retrograde fashion to the subclavian
artery of the affected side through the vertebral
artery of that side to provide the collateral circula-
tion to the upper limb on the side of lesion. Thus,
there is stealing of blood meant for the brain by
the subclavian artery of the affected side.
Q. Mention the clinical importance of internal
jugular vein.
Ans. 1. The internal jugular vein acts as a guide for
surgeons during removal of deep cervical
lymph nodes.
2. In patients with mitral valve stenosis, a thrill
may be felt at the root of neck, in the
supraclavicular fossa during systole. This
occurs due to increase pressure in right atria
that is transmitted as a wave to the vein during
its contraction.
3. The vein can safely be cannulated in cases of
cardio vascular collapse. The procedure is
performed by introducing a needle in
backward and upward direction in the
S E C T I O N-2
triangular space between the two heads of
origin of sternocleidomastoid. One should
avoid the puncture of cupola of pleura which
will lead to pneumothorax.
Q. What is the clinical importance of external
jugular vein?
Ans. External jugular vein is adherent to the margins
of the deep fascia of neck. In case of neck wounds,
injury to the vein can results in air embolism.
The air gets sucked in by negative pressure
during inspiration as the fascia prevents the vein
from collapsing.
Q. What is the historical role of phrenic nerve in
treatment of tuberculosis?
Ans. Earlier, before the advent of modern
antitubercular treatment, phrenic nereve crush
used to be performed to produce paralysis of the
half of the diaphragm, corresponding to the site
of lesion. This helped to provide rest to the
diseased lung of that side and was thought to
promote healing.
Q. What is Virchows node?
Ans. Enlargement of a lymph node present on the
scalenus anterior is known as Virchows node.
It is felt enlarged in patients with advanced
cancers mainly involving the stomach and pelvic
structures.
Q. What is clinical significance of tonsils?
Ans. Tonsils are known to increase in size in
childhood due to repeated infections known as
tonsillitis. Tonsillectomy i.e. superficial removal
of tonsils is necessary if they enlarge so much
that they block the passage or they are site of
repeated infections or there is a tonsillar abscess.
Injury to the partonsillar vein during surgery can
lead to significant haemorrhage.
Q. Enumerate the cranial nerves.
Ans. There are twelve cranial nerves in body namely:
1. Olfactory nerve
2. Optic nerve
3. Oculomotor nerve
4. Trochlear nerve
5. Trigeminal nerve
6. Abducent nerve
7. Facial nerve
8. Vestibulocochlear nerve
9. Glossiogaryngeal nerve
10. Vagus nerve
11. Accessory Nerve
12. Hypoglossal nerve
Q. Name the branches of mandibular nerve?
Ans. Branches of mandibular nerve are (Fig. 23.2)
From Main Trunk
1. Nervous spinosus (meningeal branch)
2. Nerve to medial pterygoid
From anterior division
3. Deep temporal nerves
4. Nerve to lateral pterygoid
5. Masseteric nerve
6. Buccal nerve
From posterior division
7. Auriculo-temporal nerve
8. Inferior alveolar nerve
9. Lingual nerve
Q. Name the branches of auriculotemporal nerve?
Ans. Branches of auriculotemporal nerve are (Fig. 23.2)
1. Auricular branches: Supplies the pinna,
external acoustic meatus and adjoining tympa-
nic membrane.
2. Articular branches: To temporomandibular
joint.
3. Superficial temporal branches: These supply
the area of skin over the temple.
4. Communicating branches: It receives
postganglionic secretomotor fibres from otic
ganglion to supply the parotid gland.
Q. Name the branches of inferior alveolar nerve?
Ans. Branches of inferior alveolar nerve are (Fig. 23.2):
1. Inferior dental plexus: It supplies the molar
and premolar teeth and the adjoining gum of
lower jaw.
2. Incisive nerve: Supplies the canine and
incisor teeth with the adjoining gum of lower
jaw.

3. Mental nerve: Supplies skin of chin and lower
lip
4. Nerve to mylohyoid: It supplies mylohyoid
and anterior belly of digastric. It is given before
the inferior alveolar nerve enters the
mandibular foramen
5. Communicating branch to the lingual nerve.
Q. Name the branches of lingual nerve?
Ans. Branches of lingual nerve are:
1. Sensory branches to mucus membrane of
anterior 2/3rd of tongue, floor of mouth and
adjoining area of gum.
2. Communicating branches
a. With chorda tympani
b. With hypoglossal nerve
Q. Name the branches of maxillary nerve?
Ans. Branches of maxillary nerve are:
In the Middle Cranial Fossa
1. Meningeal branch
In the Pterygopalatine Fossa
2. Ganglionic (communicating) branches: Are 2
in number. They suspend the pterygopalatine
ganglion from the lower border of maxillary
nerve in the pterygo-palatine fossa.
3. Zygomatic nerve: Enters the orbit through
inferior orbital fissure and divides on the
lateral wall of the orbit into two
a. Zygomatico-temporal
b. Zygomatico-facial
4. Posterior superior alveolar nerve:
In the Orbit (Infra Orbital Canal)
5. Middle superior alveolar nerve
6. Anterior superior alveolar nerve
On the Face
7. Palpebral branches
8. Nasal branches
9. Superior labial branches
Q. Name the branches of facial nerve?
Ans. Branches of facial nerve:
1. Greater petrosal nerve
2. A twig from geniculate ganglion joins the
lesser petrosal nerve
3. Nerve to stapedius
4. Chorda tympani nerve
5. Posterior auricular nerve
6. Nerve to posterior belly of digastric
7. Terminal branches: They are 5 in number and
arise within the parotid gland. From above
downwards they are
a. Temporal branch
b. Zygomatic branch
c. Buccal branches
Review of Head and Neck 481
d. Marginal mandibular branch
e. Cervical branch
8. Communicating branches
Q. Name the branches of glossopharyngeal nerve?
Ans. Branches of glosso pharyngeal nerve
1. Communicating branches
A twig to the ganglion of vagus nerve.
A twig to auricular branch of vagus nerve.
2. Tympanic branch: It forms the tympanic
plexus over the promontary give rise to
a. Lesser petrosal nerve
b. Twigs to tympanic cavity, auditory tube
and mastoid air cells.
3. Carotid nerve
4. Pharyngeal branch: It joins the pharyngeal
branches of the vagus and the cervical
sympathetic chain to form the pharyngeal
plexus on the middle constrictor of the
pharynx.
5. Branch to stylopharyngeus
6. Tonsillar branches
C H A P T E R-35
7. Lingual branches: Convey taste and common
sensations from the posterior 1/3rd of the
tongue and vallate papillae.
Q. Name the branches of vagus nerve in head and
neck?
Ans. Branches of vagus nerve in head and neck:
1. Meningeal branch
2. Auricular branch of the vagus
3. Pharyngeal branch
4. Branches to carotid body and carotid sinus.
5. Superior laryngeal nerve: It further divides
into
a. External laryngeal nerve
b. Internal laryngeal nerve
6. Recurrent laryngeal nerve (nerve of 6th arch)
Branches of recurrent laryngeal nerve
a. Sensory supply: To the mucus membrane
of the larynx below the vocal cords.
b. Motor supply: To all the intrinsic muscles
of larynx except, cricothyroid which is
supplied by the external laryngeal nerve.
7. Cardiac branches
8. Branches to the trachea and oesophagus,
supply the muscus glands and mucus
membrane
9. Communicating branch to inferior cervical
ganglion.
10. Articular branches: To cricothyroid and crico-
arytenoid joints.
11. Twig to inferior constrictor muscle of pharynx.
 482 Human Anatomy For Dental Students
Q. Name the structures supplied by accessory
branch of 11th cranial nerve?
Ans. Sternocleidomastoid and trapezius muscles.
Q. Name the branches of hypoglossal nerve?
Ans. Branches of hypoglossal nerve:
1. Muscular branches: They supply all the
muscles of the tongue except palatoglossus
which is supplied by the cranial root of
accessory nerve via the pharyngeal plexus.
2. Branches of the hypoglossal nerve containing
C1 fibres
S E C T I O N-2
a. Meningeal branch: It supplies the dura-
mater of posterior cranial fossa.
b. Descendens hypoglossi or upper root of
ansa cervicalis: It arises from the nerve as it
crosses the internal carotid artery. It runs
downwards to join the inferior root of ansa
cervicalis at the level of cricoid cartilage.
c. Nerve to thyrohyoid muscle
d. Nerve to geniohyoid muscle
3. Communicating branches
 Section-3: Histology
36. Histological Techniques ........................................... 485-488
37. Epithelial Tissue and Glands ................................... 489-500
38. Connective Tissue ..................................................... 501-504
39. Cartilage and Bone .................................................... 505-514
40. Muscle ......................................................................... 515-522
41. Nervous System ........................................................ 523-532
42. Cardiovascular System ............................................. 533-538
43. Lymphatic System ..................................................... 539-544
44. Respiratory System ................................................... 545-552
45. Digestive System ....................................................... 553-572
46. Urinary System .......................................................... 573-580
47. Male Reproductive System ...................................... 581-590
48. Female Reproductive System .................................. 591-600
49. Endocrine System ...................................................... 601-610
50. Review of Histology ................................................. 611-614
 Chapter
36
Histological Techniques
HISTOLOGY
Histology is the study of microscopic structure of various
cells, tissues and organs. It helps to understand the
arrangement of cells into tissues and tissues into organs
and to correlate the structure with its function.
HISTOLOGICAL TECHNIQUES
The most common technique to study the microstructure
of an organ or tissue is by preparing a histologic
specimen of the same and studying it under light
microscope. This chapter mainly deals with methods
involved in use of light microscope.
Preparation of Specimen
The organ or tissue pieces that have to be studied need
to be prepared into histological specimens. The common
procedure used for studying specimens under light
microscope involves following steps:
1. Fixation: It is the first step in preparation of a
specimen. Fixation helps to preserve the structure
of tissue preventing autodigestion by intracellular
enzymes or invasion by microorganisms like
bacteria and fungi. It also helps to harden the tissue.
The most common fixative used is formalin,
solution of formaldehyde usually used in dilution
of 10%. Other chemical fixative used is
glutaraldehyde. Physical methods of fixation
involve freezing the specimen.
2. Dehydration and clearing: After fixation, the
specimen is immersed in a series of solutions
containing increasing concentration of ethanol in
water (70% to 100%). This removes excess water.
The specimen is then cleared off ethanol by placing
it in a solvent, usually xylene solution.
3. Embedding: This step involves embedding of
tissues into a solid medium. This allows the tissue
to be sliced into thin sections for viewing under
microscope. The most often used embedding
medium is liquid paraffin. Other media used are
plastic resins for electron microscopy. The tissue is
placed in heated liquid paraffin which is then
allowed to cool. The liquid paraffin impregnates
the tissue and then forms a hard block on cooling.
The block is then sectioned into thin slices by a
special instrument, the microtome. The microtome
can produce slices of 1-10 m thickness. The
specimen slices are then transferred onto glass
slides.
C H A P T E R-36
4. Staining of specimen: The specimen till now is
colorless and not suitable for examination under
light microscope. Staining the specimen allows
visualization of various components of tissues. The
tissue sections are treated with xylene solution to
remove paraffin and then rehydrated before they
are stained with chemical dyes.
Staining of Specimens
The specimens are stained with combination of acidic
and basic compounds. Tissue components stain
differentially according to their chemical composition.
The components that stain with basic dyes are known
as basophilic while the components that stain with acidic
dyes are known as acidophilic.
Basophilic Structures
Examples of basic dyes are
1. Haemotoxylin
2. Toludine blue
3. Methylene blue
They stain nucleic acids (nucleus) and rough
endoplasmic reticulum of cells and glycosaminoglycans
and acid glycoproteins of extracellular matrix.
Acidophilic Structures
Examples of acidic dyes are
1. Eosin
2. Orange G
3. Acid fuchsin
 486 Human Anatomy For Dental Students
They stain cytoplasm, mitochondria, lysosomes and
secretory granules of a cell and collagen fibers of extra
cellular matrix.
The most common combination used for routine light
microscopy is staining with hematoxylin and eosin also
named H and E staining. Haematoxylin stains nucleus,
RNA containing cell components, matrix of hyaline
cartilage blue while eosin stains cytoplasm of cells,
collagen fibers pink. However, H and E staining does
not allow visualization of elastic fibers, reticular fibers,
basement membranes and lipids.
Additional Methods to Improve Visualization
Routine H and E staining gives an overview of structure
but does not help in understanding variations in
chemical structure and functioning of various cell
population in a tissue. The use of additional methods
that help to visualize specific substance or molecules
within tissues can provide information about the
functions of various cell populations and extracellular
matrix. They are:
1. Histochemistry and cytochemistry: This method
S E C T I O N-3
uses specific dyes, heavy metals or fluorescent dye
labeled antibodies to certain cell components or
enzyme that highlights that particular component
in the tissue. For example nucleic acids (Feulgen
reaction), acid phosphates (Gomori stain),
glycoproteins (PAS) and lipids (sudan IV stain).
2. Autoradiography: It is the method of treating
tissues with radioactive molecules and then
studying under light or electron microscope.
Metachromatic Structures
Literal meaning of metachromasia is change in colour.
Structures that stain with these dyes are known as
metachromatic, e.g., cartilage.
Metachromatic dyes: Toludine blue.
Other Stains
1. Periodic acidSchiff (PAS) Reaction: This reaction
is used to identify tissue and cells which contain
carbohydrates by exposing tissue sections to
periodic acid oxidation and then reacting them with
Schiffs reagent. PAS positive cell structures include
a. Glycocalyx
b. Basement membrane
2. Orcein stainfor elastic fibres
3. Weigherts stainfor elastic fibres
4. Silver nitrate stainfor reticular fibres
MICROSCOPE
Microscope is an instrument that magnifies the image
of an object and helps to visualize it in greater detail
than would be possible with naked eye. Microscopes are
primarily of two types namely:
1. Light microscope: It examines the tissue specimens
by passing a beam of light through them.
2. Electron microscope: It is based on the interaction
of a beam of electrons with the tissue specimen to
produce an image.
Other methods of Microscopy
These are mostly used in research labs.
1. Phase contrast microscopy: It is useful to evaluate
living cells without use of any staining method. It
makes use of the differences in refractive indices of
cellular and extracellular structures.
2. Flourescence microscopy: Flourescence is the
property of certain substances that when irradiated
with ultraviolet rays emit light of wavelength in
visible light spectrum. The tissue to be studied is
stained with fluorescent dyes like acridine orange
and studied under fluorescence microscope with
special filters that allow only narrow beam of waves
to pass through specimen.
3. Confocal microscopy: It uses laser to provide the
beam of light which is made to pass through
specimen and then through a pin hole to the
detector. It helps to produce a three dimensional
structure of the tissue by using the image data fed
into computer.
4. Polarizing microscopy: It makes use of polarizer
that polarizes the light beam which is then passed
through the specimen. It is used to evaluate tissues
which have a highly ordered arrangement of the
molecules, e.g. collagen, microtubules, striated
muscle fibers etc.
Light Microscope
The resolving power of an eye is 0.2 mm. Modern day
light microscopes have a resolution limit of 0.2 to 0.4 m.
This is approximately 1/10th of the diameter of the
human erythrocyte. These microscopes utilise day light
for illumination or have an inbuilt electrical illumination
system.
Types of Light Microscope
They are of two types:
1. Simple microscope: This is primarily a magnifying
glass with magnification power of 2 to 200X.
2. Compound microscope: It consists of two or more
lenses set in a specific optical fashion. Compound
microscopes are of the following types depending
on the different modifications of light system in
them.
 Histological Techniques 487

C H A P T E R-36
Fig. 36.1: Monocular compound light microscope (Bright-field type microscope)

Fig. 36.2: Binocular compound light microscope (Bright-field type microscope)

 488 Human Anatomy For Dental Students
i. Bright-field type microscope: This uses
standard lenses and condensers. The limit of
resolution of bright field microscope is
approximately 0.2 to 0.3 m (Figs 36.1 and 36.2).
ii. Phase contrast microscope: It permits direct
examination of living cells without fixation or
staining.
iii. Differential interference contrast microscope:
It uses a special condensor and objective lenses
to transform differences in the refractive indices
between cells of a tissue to give an image with
three dimensional characters.
iv. Fluorescence light microscope: It is used to
localize the inherently fluorescent substances or
substances labeled with fluorescent tags.
MONOCULAR COMPOUND LIGHT MICROSCOPE
This is the most common microscope used in laboratories
(Fig. 36.1). It consists of the following parts:
1. Stand: It is the base of microscope. It is usually horse
shoe shaped.
2. Body: It is attached to the stand below at a joint
S E C T I O N-3
and carries the following parts on it:
a. Limb
b. Body tubes
c. Stage
d. Sub stage
e. Knobs for focus and fine adjustment
Limb: It is attached to the base by means of a swivel
which allows forward and backward inclination of
the microscope. It carries the body tube, stage, sub
stage and mirror. The microscope can be held from
the limb and shifted to a comfortable position.
Body tubes: These consist of an external tube which
has a revolving nose piece attached to a set of three
objective lenses inferiorly and an inner tube
designed to hold a single eye piece superiorly. It is
attached to the limb.
Stage: It is a plate like platform attached to the limb
below the level of lower end of objective lenses. It
bears clips on its superior surface to hold the slide
to be viewed. The slide can be moved from side to
side or anteroposteriorly by knobs attached to slide
holder. The platform has an aperture in the centre
for transmission of light to the slide.
Substage: It is attached to lower end of the limb
below the stage. It consists of a condenser through
which light is focused on the aperture of stage over
which lies the object to be studied.
Knobs for adjustment: Two sets of knobs are
provided on either side of the limb which moves
the external body tube up and down with its lenses.
This helps to achieve coarse and fine adjustments
in focusing the specimen.
Optical System of the Microscope
It consists of the following lenses:
1. Eye piece: It has two planoconvex lenses with
magnification of 10 X usually. Monocular micro-
scope has a single eye piece mounted on the body
tube while binocular microscope has two eyepieces
mounted on body tubes (Fig. 36.2).
2. Objective lenses: These are usually a set of three
lenses fitted into the nosepiece of the outer body
tube of the microscope. Each objective lens consists
of a battery of lenses with prism incorporated into
them and provide a magnification of 10X, 40X, 100X
respectively. The objective lenses enlarge the image
of the specimen and project it to the eye piece. The
differences in the objective lenses provides for
variation in the resolving power of the microscope.
Total magnification is obtained by multiplying the
magnifying power of objective lens and eye piece
lens.
3. Condenser: It is made up of a pair of simple lenses
and it helps to focus light onto the object to be
viewed. It is mounted on the sub stage.
Illumination System of Microscope
Microscopes can have two types of systems to provide
illumination to see the slide.
1. Mirror: A mirror is fitted below the condenser. One
side of the mirror has a plane mirror and other side
has a concave mirror which is used to direct the
daylight on to the condenser.
2. Built in illumination system: This system is
attached to the stand of the microscope, below with
an electrical attachment.
ELECTRON MICROSCOPE
In contrast to light microscopes, electron micro-
scopes illuminate specimens with a stream of
electrons, of short wave lengths, instead of photons.
They form images with help of magnetic lenses
rather than glass lenses.
They have 1000 times the resolving power of light
microscope.
There are two types of electron microscopes namely:
Transmission electron microscope: Thinly
sliced plastic embedded sections are stained
with heavy metals and examined under
transmission electron microscope. It is used to
study fine details of the cell structure and it can
resolve features as small as 0.5 to 1.0 nm
Scanning electron microscope: The entire
specimen is subjected to critical point drying,
coated with a thin layer of gold and palladium
and then examined under scanning electron
microscope. It is used to study the three dimen-
sional features of cell surfaces. It can resolve up
to 2.5 to 5 nm.
 Chapter
37
Epithelial Tissue and Glands
EPITHELIAL TISSUE
It is also known as epithelium. Epithelial tissue lines the
body cavities, glands and tubes and covers the outer
surface of the body (For details see chapter 3).
Characteristics of Epithelium
1. It is made up of one or more layer of cells.
2. The epithelial cells lie on a basement membrane or
basal lamina.
3. There is minimal or no intercellular substance. The
cells are closely opposed to each other by means of
specific cell to cell adhesion molecules. Thus, they
are seen as sheets of cells which act as barriers.
4. Epithelium is avascular. Cells get their nutrition
through diffusion from underlying capillaries.
Basement Membrane (Fig. 37.1)
1. The epithelial cells lie on a narrow layer of extra
cellular matrix known as basement membrane or
basal lamina.
2. It is not clearly seen with routine H and E staining
as it merges with underlying connective tissue. It
is visible with Periodic Acid-Schiff stain (PAS stain).
3. When seen under electron microscope it is 40-60 nm
thick and presents into two layers:
Lamina densa: It is a thin, sheet like layer made
up of collagen fibrils (type IV collagen) with
proteoglycans and glycoproteins, mostly
laminins.
Lamina lucida: This layer is now believed to
be an artifact arising due to fixation of
specimens before staining. It is seen as a clear
zone between the basal plasma membrane of
cell and the lamina densa.
Reticular lamina: It is a dense extracellular
matrix made up of fibrils of type VII collagen
along with proteoglycans. This layer binds the
basal lamina to the underlying connective tissue.
Functions of Basement Membrane
1. It acts as a barrier providing the property of
selective permeability to the epithelium.
C H A P T E R-37
Fig. 37.1: Basement membrane
2. Basal lamina helps anchor the cells to each other at
their bases and to the underlying connective tissue.
This helps to provide stability to the sheets of cells.
3. It plays a role in development and repair of
epithelial cells, also influencing their organization
and cell division.
Functions of Epithelium
1. It covers the body surface and acts as an interface
between the environment and body. It protects
against dehydration, chemical and physical
damage. Example: skin.
2. It acts as a selectively permeable barrier to allow
exchange of selected substances across it. Example:
epithelial lining of alveoli of lung which allows for
exchange of gases.
3. Epithelium lines the tubular structures of body, e.g.,
intestine and proximal convoluted tubes of kidney
where it acts as an absorptive surface.
4. Epithelium gives rise to glands and acts as a
secretory organ.
5. The epithelium lining distal convoluted tubules and
collecting ducts of kidney is excretory in function.
6. Epithelial cells are modified in the body to form
rods and cones of retina of eye, olfactory epithelium
in nose and taste buds on tongue. It functions as a
sensory organ.
7. It can regenerate and can replace the defect due to
any injury.
 490 Human Anatomy For Dental Students

Classification of Epithelium
1. Simple epithelium: It is made up of a single layer
of cells lying on the basement membrane. It is also
known as unilaminar epithelium.
2. Stratified epithelium: It is made up of two or more
layers of cells. The lowest layer of epithelial cells
rests on a basement membrane.

Simple Epithelium
It can be further classified into three types depending
on the shape of cells.
1. Simple squamous epithelium (Figs 37.2 to 37.5):
It consists of a single layer of flat, polygonal cells
lying on the basement membrane. They lie adjacent
to each other and are tightly opposed. They have
minimal cytoplasm with a prominent oval shaped
nucleus. The cells often presents a bulge at the level
of nucleus towards the surface. Exchange of various Fig. 37.3: Simple squamous epithelium (surface view)
substances occurs across simple squamous
epithelium.
It is present at the following sites:
a. Blood vessels
b. Alveoli
S E C T I O N-3

Fig. 37.2: Simple squamous epithelium (transverse section)

Fig. 37.4: Simple squamous epithelium seen in alveoli of lung (stain-hematoxylin-eosin under low magnification)
 Epithelial Tissue and Glands 491

Fig. 37.5: Transverse section of lung showing simple squamous epithelium in alveoli and pseudostratified ciliated columnar
epithelium in intrapulmonary bronchus

C H A P T E R-37
It is found at the following sites:
c. Bowmans capsule a. Thyroid gland
d. Peritoneum b. Small ducts of digestive glands
e. Pleura c. Germinal epithelium of ovary
2. Simple cuboidal epithelium (Figs 37.6 to 37.9): It d. Retinal pigment epithelium
is made up of a single layer of cells lying on e. Respiratory bronchiole
basement membrane. These cells are cubical in
shape, i.e., the width and the height of cells are
similar. The cells have a central rounded nucleus.
Simple cuboidal epithelium is mostly found in the
ducts of various glands.
Fig. 37.6: Simple cuboidal epithelium

Fig. 37.7: Thyroid gland folliclesshowing cuboidal epithelium (stain-hematoxylin-eosin under low magnification)
 492 Human Anatomy For Dental Students

Fig. 37.8: Thyroid gland folliclesshowing cuboidal epithelium (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3

Fig. 37.9: Thyroid gland folliclesshowing cuboidal epithelium (stain-hematoxylin-eosin under high magnification)
3. Simple columnar epithelium (Figs 37.10 to 37.12): staining the mucin is lost as the specimens are
It consists of a single layer of cells which are shaped prepared in parafin sections. Hence, such cells have
like a column, height being more than the width. small amount of basophilic cytoplasm at the base
The nucleus is oval shape, directed longitudinally with flattened nucleus while the upper half of cells
and is present more towards the base of the cell. appears empty. The apical part of some cells may
This type of epithelium is present on the various also appear dilated giving a characteristic flask
secretory and absorptive surfaces of the body. On shaped appearance to the cell. These are known as
the secretory surface the epithelial cells are filled goblet cells.
with protein containing zymogen granules at the
apices. The apices of such cells are eosinophilic
while the basal part of the cells is basophilic due to
presence of the nucleus and endoplasmic reticulum
and ribosomes.
In mucus secreting epithelium the apices of the cells
are filled with mucinogen granules. On H and E Fig. 37.10: Simple columnar epithelium
 Epithelial Tissue and Glands 493

Fig. 37.11: Transverse section of small intestine showing columnar epithelium (stain-hematoxylin-eosin under low magnification)

C H A P T E R-37
Fig. 37.12: Transverse section of stomach showing columnar epithelium (stain-hematoxylin-eosin under low magnification)

The columnar and occasionally cuboidal epithelium Pseudostratified Epithelium (Fig. 37.13 to 37.15)
often presents with surface modifications at their
apices in the form of microvilli and cilia. These surface It consists of a single layer of cells, mostly tall columnar.
modifications are only seen on electron microscopy. The cells are of varying heights and are in contact with
It is present at the following sites: the basal lamina. The location of nuclei of such cells is
a. Uterine tube and uterus
b. Small bronchi and bronchioles
c. Tympanic cavities
d. Eustacian tube
e. Epididymis
f. Ependyma of spinal cord
g. Gall bladder
h. Stomach and intestine Fig. 37.13: Pseudostratified ciliated columnar epithelium
 494 Human Anatomy For Dental Students

Fig. 37.14: Transverse section of trachea showing pseudostratified ciliated columnar epithelium (stain-hematoxylin-eosin
under high magnification)
S E C T I O N-3

Fig. 37.15: Transverse section of trachea showing pseudostratified ciliated columnar epithelium (stain-hematoxylin-eosin
under high magnification)

also at variable heights. This leads to a false (pseudo)

appearance of stratification.
It is present at the following sites:
1. Trachea
2. Bronchi
3. Ductus deferens, epididymis
4. Male urethra
5. Olfactory epithelium
Stratified Epithelium
It is made up of more than one layer of cells. It is of the
following types: Fig. 37.16: Stratified squamous non-keratinized epithelium
 Epithelial Tissue and Glands 495

1. Stratified squamous non-keratinized epithelium It is present at the following sites.

(Figs 37.16 to 37.18): It is made up of 5-6 layers of a. Oral cavity
cells. Basal layer consists of a single layer of b. Tongue
columnar cells. 2-3 layers of polygonal cells lie over c. Tonsils
it. Superficial cells are flat, squamous. It is protective d. Pharynx
in nature. e. Esophagus

C H A P T E R-37
Fig. 37.17: Transverse section of esophagus showing stratified squamous non-keratinized epithelium (stain-hematoxylin-
eosin under low magnification)

Fig. 37.18: Transverse section of cornea showing stratified squamous non-keratinized epithelium (stain-hematoxylin-eosin
under high magnification)
 496 Human Anatomy For Dental Students

f. Vagina
g. External urethral orifice
h. Cornea
i. Conjunctiva
2. Stratified squamous keratinized epithelium (Figs
37.19 to 37.21): It is also made up of 5-6 layers of
cells. It is characterized by the presence of a layer
of keratin over the superficial cells. This epithelium
protects the exposed, dry surfaces of the body. Skin
consists of stratified squamous keratinized
epithelium. Fig. 37.19: Stratified squamous keratinized epithelium
S E C T I O N-3

Fig. 37.20: Transverse section of skin showing stratified squamous keratinized epithelium (stain-hematoxylin-eosin under
high magnification)

Fig. 37.21: Transverse section of tongue shownig stratified squamous thinly keratinized epithelium (stain-hematoxylin-eosin
under high magnification)
 Epithelial Tissue and Glands 497

3. Stratified cuboidal epithelium (Figs 37.22 and

37.23): It consists of two layers of cuboidal cells. It
is present at the following sites
a. Larger ducts of exocrine glands Fig. 37.22: Stratified cuboidal epithelium
b. Ducts of sweat glands and mammary gland
c. Seminiferous tubules
d. Ovarian follicles

C H A P T E R-37
Fig. 37.23: Transverse section of salivary gland showing stratified cuboidal epithelium in large excretory duct (stain-hematoxylin-
eosin under high magnification)

4. Stratified columnar epithelium (Fig. 37.24): It epithelium allows distention of urinary bladder,
consists of two layers of columnar cells. ureters and calyces of kidney. It lines the urinary
It is found at the following sites tract.
a. Fornix of conjunctiva Transitional epithelium is present at following
b. Anal mucous membrance sites:
c. Urethra a. Pelvis of kidney
d. Large ducts of exocrine glands b. Ureter
c. Urinary bladder and upper part of urethra

Fig. 37.24: Stratified columnar epithelium

5. Transitional epithelium (Figs 37.25 to 37.27): In this

epithelium there is transition of cells from basal to
superficial layer. It is made up of 5-6 layers of cells.
Basal cells are columnar lying on basement
membrane and become polygonal above.
Superficial cells are umbrella shape. Transitional Fig. 37.25: Transitional epithelium
S E C T I O N-3 498 Human Anatomy For Dental Students

Fig. 37.26: Transverse section of urinary bladder showing transitional epithelium (stain-hematoxylin-eosin under
low magnification)

Fig. 37.27: Transverse section of urinary bladder showing transitional epithelium (stain-hematoxylin-eosin under
low magnification)
 Epithelial Tissue and Glands 499

GLANDS 1. Simple tubular glands without ducts (Fig. 37.28):

Cells are arranged in a tubular fashion and open
Glands are modified epithelial tissue specialized for
synthesis and secretion of macromolecules. Glands are on the epithelial surface without a duct..
primarily of two types namely, exocrine glands which
secrete their products on to the surface or lumen of an
organ with the help of a duct and endocrine glands
which secrete their products directly into the blood
vascular system.

Classification of Exocrine Glands

Exocrine glands are classified further as given below: Fig. 37.28: Simple tubular without duct
1. Unicellular glands (Fig. 3.13): These are made of
2. Simple tubular glands with ducts (Fig. 37.29):
single cells, which are usually interspersed between
Secreting cells are arranged in tubular shaped
a non secretory epithelial lining, e.g., goblet cells
structures with upper non-secretory parts, which
present in the intestinal and respiratory epithelium.
act as the ducts.
2. Multicellular glands (Fig. 3.14): These are glands
made up of more than one cell. The simplest
arrangement of cells is in form of a sheet of secretory
cells, e.g., mucus lining of stomach. Other multi-
cellular glands are formed by invaginations of the
epithelium into underlying connective tissue. These

C H A P T E R-37
invaginations have two parts namely, a secretory
part which lies deeper and a conducting part which
consists of the duct system that conducts the
Fig. 37.29: Simple tubular with duct
secretions to the surface of epithelium.
The multicellular glands are further classified into 3. Simple branched tubular glands (Fig. 37.30): These
the following types based on the arrangement of glands have a single duct and the secretory cells
secretory part and duct system. are arranged in a tubular fashion with branches.
Classification according to duct system:
a. Simple glands: In which the secretory part is
obtained by a single duct without branches.
b. Compound glands: In these the duct system is
branched:
Classification according to secretory part:
a. Tubular glands: In these the secretory protions
arranged like a tube.
b. Acinar glands: In these the secretory portion is
arranged in the form of dilated sac resembling Fig. 37.30: Simple branched tubular gland
a flask. It is also called alveolar type of gland.
c. Tubulo-alveolar: In this there is a tubular part 4. Simple coiled tubular glands (Fig. 37.31): Secre-
of gland which ends in dilated sac like acini. tory part is coiled and they have a single duct.
The tubular part may be straight, coiled or
branched.
Thus, glands can be of the following types
(Figs 37.28 to 37.34):
1. Simple tubular
2. Simple branched tubular
3. Simple coiled tubular
4. Simple acinar or alveolar
5. Simple branched acinar
6. Compound tubular
7. Compound acinar
8. Compound tubuloacinar Fig. 37.31: Simple coiled tubular gland
 500 Human Anatomy For Dental Students
5. Simple acinar or alveolar glands (Fig. 37.32):
Secretory part is flask shaped with a single
connecting duct.
Fig. 37.32: Simple alveolar gland
6. Compound glands (Figs 37.33 and 37.34): In these
glands the ducts are branched. The secretory part
of such glands may be branched tubuloalveolar or
branched tubular or branched alveolar type.
S E C T I O N-3
Fig. 37.33: Compound alveolar gland
Fig. 37.34: Compound tubular gland
According to Mode of Secretion
1. Exocrine glands: The secretions of exocrine glands
are carried through ducts to the target surface, e.g.,
parotid gland.
2. Endocrine glands: The secretions of endocrine
glands are directly poured into the circulatory
system. These are ductless glands. Secretion is
carried to the distant target cells by circulation, e.g.,
Pituitary gland.
3. Paracrine glands: These glands are similar to
endocrine glands but their secretions diffuse locally
to cellular targets in the immediate surrounding.
According to Mechanism of Secretion
1. Merocrine glands (Fig. 3.10): The cells of merocrine
glands produce secretions that are packaged into
vesicles. The vesicle membranes fuse with the
plasma membrane to release their contents to the
exterior, e.g., simple sweat glands.
2. Apocrine glands (Fig. 3.11): In these glands the
secretions are present as free droplets within the
cytoplasm of the cells and some of the apical
cytoplasm along with cell membrane is also extrud-
ed along with the secretions, e.g., mammary gland.
3. Holocrine glands (Fig. 3.12): Cells are filled with
secretory products and the entire cell disintegrates
to release its secretions, e.g., sebaceous glands.
According to Type of Secretion
Exocrine glands may produce mucus or serous secretions
or can be of mixed variety.
1. Mucus secreting or mucus glands: The cells of
mucus glands are filled with mucus which gives
the cytoplasm a hazy appearance. The nucleus is
flat and located at the base, e.g., sublingual salivary
glands.
2. Serous glands: These glands secrete thin serum like
secretions. The cells have a central nucleus with a
granular eosinophilic cytoplasm, e.g., Parotid
salivary gland.
 Chapter
38
Connective Tissue
INTRODUCTION
Connective tissue is characterised by the presence of
abundant intercellular material known as extracellular
matrix present between the connective tissue cells.
Functions of Connective Tissue
It connects different tissues and facilitates passage
of the neurovascular bundles in different tissues.
It also helps to give shape and form to the various
organs of the body. It protects and supports the
various organs of the body.
Special connective tissue cells are involved in
defence mechanism of the body, e.g., macrophages.
Connective tissue cells play an important role in
producing factor that influence cell growth and
differentiation of the surrounding tissues.
Connective tissue is classified into general connective
tissue which is present all over the body and specialised
connective tissue consisting of bones, cartilages and
blood and lymph.
COMPONENTS OF CONNECTIVE TISSUE
Connective tissue is made up of three components:
1. Cellular components
2. Extracellular matrix
3. Fibres
Cellular Components
There are of two types of cells in a connective tissue.
1. Resident cells: These cells form the stable cell
population of the connective tissue. They are:
a. Fibroblasts
b. Adipocytes
c. Mesenchymal stem cells
d. Cartilage has special resident cells named
chondroblasts and chondrocytes while bone is
made up of osteoblasts, osteocytes and
osteoclasts.
2. Migrant cells: These consist of cells derived from
bone marrow which migrate into the connective
tissue via blood and lymphatic circulation usually
in response to an inflammatory response. These
cells are: macrophages or histocytes, plasma cells,
mast cells, pigment cells, lymphocytes and
monocytes, basophils, neutrophils and eosinophils.
C H A P T E R-38
Fig. 38.1: Fibroblast Fig. 38.2: Fibrocyte
Fibroblast (Fig. 38.1)
They are the most common and most numerous
resident cells of connective tissue.
Fibroblasts produce extracellular matrix i.e. fibers,
collagen and elastic fibres and ground substance.
They also produce growth factors that influence cell
growth differentiation.
The cells lie in close proximity and parallel to
collagen fibers. On routine H & E staining they are
seen as elongated, well stained nuclei present along
the collagen fibers.
Active fibroblasts are large cells with irregular
outline due to cytoplasmic extensions. They have a
ovoid, large, pale staining nucleus with prominent
nucleolus.
Cytoplasm shows basophilia due to high
concentration of rough endoplasmic reticulum
especially in active cells.
Mature fibroblasts known as fibrocytes are spindle
shaped relatively inactive cells with a dark,
flattened nucleus (Fig. 38.2).
Myofibroblast is a type of fibroblast usually seen in
areas of wound repair. On electron microscopy it
is seen to have contractile actin filaments in
cytoplasm and is involved in scar contraction.
Reticular cells are large fibroblasts seen dispersed
between reticular fibers in tissues like liver, spleen
etc. They are abundant in such tissues and form
interconnected links along with reticular fibers
creating a meshwork.
 502 Human Anatomy For Dental Students

Macrophages: They are relatively large, irregular cells with

a large nucleus. The cytoplasm contains numerous gra-
nules. They are responsible for the phagocytosis of foreign
bodies (Fig. 38.5).

Fig. 38.3: Adipocytes

Adipocytes: These cells are oval to spherical in shape
and are filled with large lipid droplets. The cytoplasm
and nucleus are present as a small rim at the periphery.
Thus, the cells look empty on routine haematoxylin and
eosin (H and E) staining. The total number of fat cells in
the body are determined at birth. In obese state, fat cells
get enlarged (Figs 38.3).
Fig. 38.6: Plasma cell
Plasma cells: They are large, round to oval cells with an
eccentric nucleus that has a characteristic cart-wheel
appearance. They are responsible for production of
antibodies in the body. (Fig. 38.6).

Fig. 38.4: Mesenchymal stem cell

S E C T I O N-3

Mesenchymal stem cells: These cells are derived from

the embryonic mesenchyme. They are pluripotent cells
and have the capacity to differentiate into various
mature cells of connective tissue during growth and
development (Fig. 38.4).
Fig. 38.7: Mast cell
Mast cells: They are large round to oval shaped cells
with a central large nucleus. They contain numerous
membrane bound vesicles or granules containing
heparin and histamine. They are mostly located around
blood vessels (Fig. 38.7).

Fig. 38.5: Macrophage

Cell Identifying histological features Functions

Fibroblast Stem cell, with multiple cytoplasmic processes Secretion of fibres and
(Fig. 38.1) Large, rounded vesicular nucleus ground substance
Basophilic cytoplasm
Fibrocyte Spindle shaped cell This is the resting stage
(Fig. 38.2) Homogeneous, basophilic cytoplasm
Lightly stained, large, rounded vesicular nucleus
Adipocytes Spherical or oval in shape Synthesis and storage of fat
(Fig. 38.3) Flattened nucleus present at the
periphery with thin cytoplasm
Rest of the cell is empty because of dissolution of fat
during processing of tissue for histological section
Mesenchymal Similar to fibroblast in appearance They have potential to give
stem cells (Fig. 38.4) but smaller in size rise to all connective tissue cells
Macrophage or Spheroidal, fusiform or stellate in shape Phagocytosis
histiocytes Small, darkly stained indented nucleus
(Fig. 38.5) Cytoplasm contains granules and vacuoles
Plasma cell Ovoid in shape Secretes antibodies
(Fig. 38.6) Eccentric, oval or round nucleus with cart-wheel
appearance
Mast cell Round or ovoid in shape Secretes histamine, heparin
(Fig. 38.7) Small, round nucleus and serotonin
Intensely stained coarse granules are
present in cytoplasm

Matrix (Ground Substance) (Fig. 38.8)
It is made up of ground substance which consists of
soluble complexes of carbohydrate and proteins along
with the systematically arranged insoluble protein fibres.
The ground substance is made up of amorphous
substances of proteoglycans and glycosaminoglycans
namely keratan sulphate and mucopolysaccharides.
Fibres
There are three types of fibres present in the matrix of
connective tissue (Fig. 38.8).
1. Collagen fibres: Collagen fibres are made up of
collagen protein. They are secreted by fibroblasts,
chondroblasts, osteocytes and chondrocytes. They
are present as thick branched bundles of colourless
fibres.
Classification of collagen fibres
Collagen fibres are classified into different types
based on their chemical properties, appearance and
measurement. There are more than 20 types of
collagen fibres. Following four types are the most
common types of collagen fibres found in the body:
a. Type I: These fibres have a large diameter and
prominent cross striations. They are found in
bone, fibro cartilage, dermis of skin, connective
tissue, tendon, ligaments, fasciae, aponeurosis
and meninges.
b. Type II: In this type of collagen fibres, striations
are less prominent than type I. These fibres are
present in hyaline cartilage and vitreous humor.
c. Type III: They are reticular fibres. These fibres
are finer than collagen fibres and uneven in
thickness. They form a network by anasto-
mosing with each other. They are present in
spleen, ligaments, bone marrow, liver, glands
and basement membrane.
Fig. 38.8: Loose areolar connective tissue (Stain-hematoxylin-eosin under low magnification)
Connective Tissue 503
d. Type IV: These fibres are short and form a sheet.
They are present in the basal lamina of basement
membrane and in the capsule of lens of eye.
2. Elastic fibres: They are produced by fibroblasts and
mainly contain elastin protein. These fibres are
thinner than collagen fibres. They are seen as single,
yellow fibres which show extensive branching and
cross linking with each other. The broken ends of
these fibres are seen to recoil.
3. Reticular fibres: They are fine collagen fibres which
form a supporting framework for various tissues
and organs. They are characteristically present in
lymph nodes.
The elastic and reticular fibres are not clearly seen
on routine H and E staining and require special stains
like orcein and silver stain respectively.
Classification of Connective Tissue
General connective tissue is further classified into the
following types based on relative proportion of cells,
fibres and ground substance in the connective tissue.
1. Irregular connective tissue: It is further classified as
C H A P T E R-38
a. Loose areolar connective tissue: It is the most
generalized form of connective tissue and is
widely distributed in the body. It consists of a
meshwork of thin collagen and elastic fibres.
Loose areolar connective tissue is present
around and within the blood vessels and the
submucosa of various organs (Fig. 38.8).
b. Dense irregular connective tissue: It is found
in those regions which are subjected to consi-
derable mechanical stress. Matrix is relatively
acellular and consists of thick collagen bundles.
Dense irregular connective tissue is present as
sheaths around blood vessels and nerves,
dermis of skin, periosteum and perichondrium
and in the capsules of organs like liver.
 504 Human Anatomy For Dental Students
Fig. 38.9: Adipose tissue (Stain-hematoxylin-eosin under low magnification)
S E C T I O N-3
Fig. 38.10: Longitudinal section of tendon: (Stain-hematoxylin-eosin under low magnification)
c. Adipose tissue (Fig. 38.9): It contains abundant
fat cells in a vascular loose connective tissue
network. Adipose tissue is present in certain
regions like subcutaneous tissue, bone marrow,
mammary gland, omenta and mesenteries,
surrounding kidneys and behind the eye balls.
2. Regular connective tissue (Fig. 38.10): This type
of connective tissue is characterised by presence of
abundant fibrous tissue, mostly made up of
collagen fibres with few elastic fibres. The fibres
are regularly oriented forming sheets and bundles
and they run in one direction. This is also known
as white fibrous tissue and it is seen in tendons,
ligaments and aponeurosis.
Mucoid tissue: It is fetal or embryonic type of connective
tissue which consists of mesenchymal fibroblasts and
loose areolar connective tissue with mucoid matrix. It
is present in Whartons jelly, vitreous body of the eye,
nucleus pulposus of intervertebral disc and pulp of
developing tooth.
Functions of General Connective Tissue
1. Binds together various structures.
2. Facilitates passage of neurovascular bundle.
3. In the form of deep fascia, connective tissue keeps
the muscles and tendons in position, gives origin
to muscles and forms different functional
compartment of muscles.
4. In the form of ligaments, binds the bones.
5. Attaches muscle to the bone with the help of
tendons and facilitates a concentrated pull.
6. Facilitates venous return in lower limb with the help
of deep fascia.
7. Helps in wound repair due to the presence of
fibroblasts.
8. Aponeurosis is a regular dense connective tissue
associated with the attachment of muscles. It is
made up of densely arranged collagen fibres.
 Chapter
39
Cartilage and Bone
CARTILAGE
Cartilage is a specialized connective tissue which
provides strength and elasticity. It is composed of cells
and fibres embedded in firm gel like matrix which is
rich in mucopolysaccharides.
Structure of Cartilage
Cartilage is avascular and is covered by a dense fibrous
covering named perichondrium. It consists of the
following components:
1. Cells: Cartilage has two types of specialised cells:
a. Chondroblasts: These are young cells which
have the ability to divide. On microscopy, the
cells appear small, rounded in shape with a
central euchromatic nucleus. They are arranged
singly or in groups of 2 to 3 surrounded by a
thin cavity in the matrix known as lacuna.
b. Chondrocytes: These are mature cells derived
from chondroblasts. They cannot divide but are
very active in producing and secreting proteins.
They are seen as larger, round to oval cells with
a heterochromatic nucleus.
Fig. 39.1: Transverse section of hyaline cartilage (stain-hematoxylin-eosin under low magnification)
2. Extracellular matrix: It is abundant and is made
up of ground substance consisting of proteoglycans
and glycosaminoglycans. It also contains collagen
and elastic fibers.
3. Fibres: Cartilage is made up of collagen fibres and
elastic fibres in the matrix. The collagen fibres are
primarily collagen type-II. The perichondrium and
fibrocartilage are composed of collagen type I fibers.
C H A P T E R-39
Histology of Various Types of Cartilage
Cartilages are of three types based on the variations in
the composition of extracellular matrix and fibers.
Hyaline Cartilage (Figs 39.1 to 39.3)
On routine H and E staining hyaline cartilage presents
with the following features:
It appears as a bluish, opalescent, tissue. It is made
up of abundant extracellular matrix which appears
homogenous and basophilic. Fibres are not seen in
the matrix on routine staining because the refractive
index of fibres and ground substance is similar.
 506 Human Anatomy For Dental Students
Fig. 39.2: Transverse section of hyaline cartilage (stain-hematoxylin-eosin under high magnification)
S E C T I O N-3
Fig. 39.3: Transverse section of hyaline cartilage (stain-hematoxylin-eosin under high magnification)
Chondrocytes are seen scattered within the matrix.
The cells are large, appear round to elliptical in
shape and are arranged characteristically in groups
of two to six. The cell outline may appear slightly
irregular due to preparation of specimen but the
opposing surfaces of a pair of cells is flattened.
Active cells have abundant basophilic cytoplasm
while mature inactive cells have clear cytoplasm
due to loss of organelles. The cells have a prominent
heterochromatic nucleus.
A pair of cells are surrounded by a faint matrix
cavity known as lacuna. Each cell nest is further
surrounded by a dense layer of matrix which
appears as a dark basophilic ring surrounding the
lacuna and is known as the pericellular or capsular
matrix. It contains the highest concentration of
glycosaminoglycans and proteoglycans, secreted by
the active chondrocytes.
Hyaline cartilage is surrounded by a thin, dense
connective tissue layer called perichondrium. It is
seen as a peripheral thin eosinophilic layer with
scattered, flattened nuclei of fibrous cells.
In actively growing cartilage, perichondrium may
be divided into an outer fibrous layer and an inner
cellular layer. The outer layer is made up of collagen
fibres and fibrocytes. Inner layer is made up of
chondroblasts which appear as rows of small
elliptical cells lying parallel to the surface. This layer
is responsible for growth of cartilage.
 Cartilage and Bone 507

Hyaline cartilage which covers the articular
surfaces of synovial joints is also named as articular
cartilage. Perichondrium is absent on the articular
surfaces of this articular cartilage and at the
opposite site where it is in contact with the bone.
Distribution: It is widely distributed in the body and is
present at the epiphyseal ends of the bone in children. It
is also present in articular cartilage, thyroid cartilage,
cricoid cartilage, lower part of arytenoid cartilage,
tracheal rings, costal cartilages, bronchial cartilages,
nasal cartilage.
Elastic Cartilage (Figs 39.4 and 39.5)
On routine H and E staining elastic cartilage presents
with the following features:
Extracellular matrix is metachromatic due to high
concentration of glycosaminoglycans. It is
characterised by the presence of numerous elastic
fibres. These fibers anastomose and branch in all
directions and appear as dense network of
basophilic fibres interconnecting with each other
around groups of cells.

C H A P T E R-39
Fig. 39.4: Transverse section of elastic cartilage (stain-hematoxylin-eosin under high magnification)

Fig. 39.5: Transverse section of elastic cartilage (stain-hematoxylin-eosin under high magnification)
 508 Human Anatomy For Dental Students

Chondrocytes are seen scattered within the ground
substance. They are large, round to irregular shaped
cells arragned in groups of 2 to 3 surrounded by
matrix lacuna.
Outer most covering of elastic cartilage is the
perichondrium which is seen as a thin dense fibrous
layer.
Alternate stain to demonstrate elastic fibres is
Orcein stain.
Distribution: Pinna of external ear, epiglottis,
corniculate cartilage, cuneiform cartilage, apex of
arytenoid cartilage, auditory tube, external auditory
meatus.
S E C T I O N-3
White Fibro-cartilage (Figs 39.6 and 39.7)
Fibrocartilage is a dense, opaque fibrous tissue and
presents with the following features on routine H and E:
It consists of regularly arranged collagen fibres in
the form of fascicles within the matrix. The fibers
are made up of mainly collagen type-I and they
appear as eosinophilic bundles.
It is less cellular than hyaline cartilage and
chondrocytes are scattered in the matrix. The
chondrocytes appear as a single row of cells or are
seen in groups of two or three surrounded by
basophilic matrix. It also consists of fibroblasts
which are seen as scattered single spindle shaped

Fig. 39.6: Transverse section of fibrocartilage (stain-hematoxylin-eosin under high magnification)

Fig. 39.7: Transverse section of fibrocartilage (stain-hematoxylin-eosin under high magnification)


nuclei (cell outline and cytoplasm is not seen
separately).
Fibrocartilage does not have any perichondrium.
Special stain for fibrocartilage is Mallory trichrome
method of stain.
Distribution: Intervertebral disc, interpubic disc,
menisci of knee joint, articular discs of tempora-
omandibular, sternoclavicular and inferior radioulnar
joints, labra of glenoid and acetabular cavities.
BONES
Bones are specialized, highly vascular, constantly
changing, mineralized connective tissue. They are hard,
resilient and have enormous regenerative capacity. They
are made up of cells and intercellular matrix. Cellular
component is 2% of bone mass. Matrix is made up of
40% organic substance consisting mainly of collagen and
60% inorganic substance made up of, inorganic salts of
calcium and phosphate.
Structure of Bone
1. Cellular Components: These consist of the
following cells:
a. Osteoblasts: These are large, basophilic cells
with a round and slightly eccentrically placed
nucleus. They originate from osteogenic stem
cells of bone marrow.
Functions:
i. They are responsible for the synthesis of
organic matrix, i.e., collagen and other
glycoprotein molecules, which is called
osteoid.
ii. Osteoblasts also play a significant role in
mineralization of the osteoid.
iii. They have a role in bone remodeling.
b. Osteocytes: They form the majority of the
cellular component. They are mature bone cells
derived from osteoblasts which do not produce
matrix and have lost their ability to divide. They
form the cellular architecture of bone. The cells
lie singly. Each osteocyte is a large, round to
ellipsoid cell which is embedded in the matrix
and is surrounded by a faint matrix cavity
known as lacuna. These cells have numerous
dendritic processes that branch out and are
interconnected to the processes of adjacent cells.
The dendrites are surrounded by extensions of
lacunae forming canaculi which serve the
function of providing channels for diffusion of
nutrients, gases and waste products.
Functions: Osteocytes play significant role in
maintainance of bone.
c. Osteoclasts: These are large multinucleated cells
with eosinophilic cytoplasm. They arise from
monocytes in bone marrow.
Cartilage and Bone 509
Functions: They help in resorption and remodel-
ing of bones.
d. Other cells: Osteoprogenitor cells are mesen-
chymal stem cells present in the bone marrow
which give rise to osteoblasts. Bone lining cells
are the cells derived from osteoblasts which
form the periosteal and endosteal lining of the
bone.
2. Matrix: It is the extracellular component of bone
which is made up of
a. Organic component: This is mostly made up of
collagen (collagen type-I) with small amount of
proteoglycans and glycoproteins. Collagen
fibres are arranged in bundles. In woven,
immature bones they form an interwoven
meshwork. In mature bones they have lamellar
arrangement which is in the form of regular and
parallel lamellae.
b. Inorganic component: The mineral component
of bone gives it the hardness and rigidity. It
consists of hydroxyapatite crystals of calcium
and phosphate. These crystals are closely
packed and arranged along the collagen fibers.
C H A P T E R-39
Histology of Bone
Histologically bones are of two types namely:
1. Compact bone
2. Trabecular or spongy bone
Histology of Compact Bone (Figs 39.8 to 39.10)
The histological specimen of a compact bone is a thin
section of dry ground bone section without any staining.
The microscopic appearance of compact bone is
characterised by presence of Haversian systems or
osteons. The osteons are actually cylindrical structures
that are arranged parallel to the axis of the shaft of bone
and on sections they appear as cross section of these
cylinders.
Each Haversian system consists of concentrically
arranged layers of mineralised ground substance
and collagen fibres known as lamellae around a
central Haversian canal.
Haversian canals appear as black round to oval
structures surrounded by lamellae. Each canal
contains capillaries and axons of nerves, i.e., the
neurovascular channel of bone.
In between lamellae are present concentrically
arranged osteocytes with their canaliculi. During
dry fixation the cells dry up and on microscopy they
appear as concentrically arranged lacunae with
flattened nuclei. On high magnification canalicular
process can be seen extending between adjacent
lamellae.
A number of Haversian systems are arranged
adjacent and parallel to each other.
 510 Human Anatomy For Dental Students

Fig. 39.8: Transverse section of compact bone (dried-section under high magnification)
S E C T I O N-3

Fig. 39.9: Transverse section of compact bone (dried-section under high magnification)

Vascular channels known as Volkmanns channels
are present obliquely or horizontally. They are seen
to be perpendicular to the Haversian systems and
connect adjacent Haversian systems to each other
and the Haversian systems to marrow cavity.
Hence, Volkmanns channels are seen as canals
passing through the lamellae while Haversian
canals are seen as dark rounded structures
surrounded by lamellae.
Outer most covering of the bone is the fibrous layer
of dense collagen tissue called periosteum.
Periosteum in an actively growing bone can be
divided into an inner cellular layer of osteoblasts,
osteoprogenitor cells and osteoclasts and an outer
 Cartilage and Bone 511

Fig. 39.10: Longitudinal section of compact bone (dried-section under high magnification)

fibrous layer. Periosteum is absent on articular 3. Helps in formation of subperiosteal deposits,

surfaces of bone where is replaced by hyaline increasing the width of the bone.
cartilage and at sites of insertion of muscles or 4. Protects the bone.

tendons.
Inner layer covering the marrow cavity is known
as endosteum. It consists of a single layer of cells
with flattened nuclei and a thin layer of connective
tissue. It can not be identified separately on routine
microscopy.
Functions of Periosteum
1. Receives attachment of muscles and maintains the
shape of the bone.
2. Provides nutrition to outer 1/3rd of cortex of
compact bone by periosteal blood vessels.
C H A P T E R-39
5. Periosteum is sensitive to pain.
6. It is important in the healing of bone injuries or
fractures.
Histology of Trabecular Bone (Figs 39.11 to 39.13)
Trabecular bone consists of plates of bones of varying
width and length known as trabeculae. These trabeculae
are curved and branched and enclose a number of
marrow cavities in between. Each trabecula is lined by
endosteum. H and E staining of section of cancellous
bone presents with following features:

Fig. 39.11: Transverse section of cancellous bone (stain-hematoxylin-eosin under low magnification)
 512 Human Anatomy For Dental Students

Fig. 39.12: Transverse section of cancellous bone (stain-hematoxylin-eosin under high magnification)
S E C T I O N-3

Fig. 39.13: Transverse section of cancellous bone (stain-hematoxylin-eosin under high magnification)

Trabeculae of bone of variable thickness enclosing
blood filled bone marrow spaces.
The arrangement of ground substance of matrix and
collagen fibres of trabeculae is lamellar, i.e., in
regular parallel fashion. No definite Haversian
system is seen.
The lamellae present with rows of osteocytes seen
as small rounded cells with rounded nuclei in
matrix lacunae. On high magnification canaliculi
can be seen interconnecting the lamellae.
Outermost covering is made up of a thin dense layer
of connective tissue known as periosteum.
 Cartilage and Bone 513

Ossification of Bone (Figs 39.14 to 39.16) multiply in hyaline cartilage and form zone of
proliferation. These cells become mature and form
Ossification literally means deposition of the proteo-
zone of maturation. These mature cells secrete
osseous substance or the process of bone formation. It
matrix. These mature cells become hypertrophic
involves the differentiation of osteoblasts which secrete
and form zone of hypertrophy. Hypertrophic cells
organic intercellular substance or matrix and deposition
of Ca2+ crystals and salts. Ossification is of two types:
1. Intramembranous or membranous ossification: It
is the formation of bone from primitive mesench-
yme. The mesenchymal cells differentiate to
osteogenic progenitor cells and then osteoblasts
around a branch of the capillary network of
mesenchyme. The osteoblasts proliferate and lay
down lamellae of collagen and ground substance
molecules. Calcification of matrix occurs and
continuous deposition of matrix and calcification
with proliferation of osteoblasts results in formation
of trabecular bone. This gradually thickens to form
compact bone.
Example: Bones of the vault of skull.
2. Endochondral or cartilaginous ossification (Figs 39.14
to 39.16): The basic principle of endochondral

C H A P T E R-39
ossification is that bone formation occurs over
templates of hyaline cartilage. It means that
cartilage dies and bone forms. Most bones ossify in
cartilage. At the site of future bone formation
mesenchymal cells get collected. These mesen-
chymal cells becomes chondroblasts and form
hyaline cartilage. Mesenchymal cells on the surface Fig. 39.14: Endochondral ossification
of cartilage forms perichondrium. Chondroblasts

Fig. 39.15: Endochondral ossification

S E C T I O N-3 514 Human Anatomy For Dental Students
Fig. 39.16: Endochondral ossification
secrete alkaline phosphatase. Alkaline phosphatase
helps in deposition of calcium salts. This zone is
known as calcifiction zone. Due to calcium salt
deposition there is no diffusion of nutrition in
cartilage, leading to death of cells. This leaves spaces
around them known as primary areola. Inner layer
of perichondrium (now periosteum) give rise to
osteoprogenitor cells. These cells enter along with
nutrient artery inside the cartilaginous matrix and
proliferate to form the periosteal bud. These
osteoprogenitor cells eat away the wall of primary
areola and these cavities become larger and now
called as secondary areola. Osteoprogenitor cells
get converted into osteoblasts and lines the walls
of these cavities. Osteoblasts lay down the ground
substance and collagen fibres to form osteoids.
These osteoids become calcified and called as
lamellae of new bone.
On histological section all above zones of
ossification are visible on H and E stain. In zone of
proliferation chondroblasts are seen in lacunae. In
zone of maturation chondrocytes are seen as seen
in hyaline cartilage. In zone of hypertrophy
chondrocytes are seen in as large cells. A white area
is seen in calcified zone. New bone seen as seen in
trabecular bone in new bone formation.
 Chapter

40
Muscle
INTRODUCTION
Muscular tissue consists of specialised cells known as
myocytes. The cells have a cytoskeleton made up of
contractile proteins namely actin and myosin filaments
that help in lengthening and shortening of muscle cells.
This is responsible for altering the length of a muscle as
a whole which provides the primary function of muscle,
i.e., movement.
The arrangement of actin and myosin filaments

within myocytes is responsible for classification of
muscle tissue into:
Fig. 40.1: Diagrammatic representation of cut section of
1. Striated muscle: It further consists of skeletal
skeletal muscle
muscle and cardiac muscle.
2. Smooth muscle
SKELETAL MUSCLE (Figs 40.1 to 40.7)
It is also called voluntary muscle as it is mostly under
the conscious control of CNS. The muscle fibres are
attached to the skeletal framework of the body and help
in movement of joints and bones.
Structure of Skeletal Muscle
A skeletal muscle cell is also known as fibre. It is a
multinucleated, elongated, cylindrical shaped cell
surrounded by cell membrane named sarcolemma.
The sarcolemma is surrounded by a basal lamina,
the endomysium. The muscle fibers are arranged
in bundles. Each bundle is covered by a layer of
connective tissue, known as perimysium. The
bundles together form a muscle which is invested
by connective tissue named as epimysium
(Fig. 40.1).
The cytoplasm of muscle cell is known as
sarcoplasm. It contains myofibrils, well developed
mitochondria and specialized sarcoplasmic
reticulum. It contains a special protein complex,
dystrophinglycoprotein complex that provides
strength and support to myofibrils. It also contains
myoglobin, a protein that stores oxygen in muscles.
C H A P T E R-40
Each fiber is made of myofibrils formed by
filaments of contractile proteins. The filaments are
of two types:
Thick filaments made up of protein, myosin
Thin filaments made up of proteins, actin,
troponin and tropomyosin.
The main contractile protein of the thin filaments
is actin. It is arranged as a double helix and forms
cross links with myosin. Tropomyosin are long
filaments which have troponin units located along
their length. The troponintropomyosin complex
prevents interaction of actin and myosin.
The arrangement of thick and thin filaments in the
muscle fiber is shown in figure (Figs 40.2 and 40.3).
The above arrangement of fibrils results in
variations in the refractive index in various parts
of muscle fiber. Thus, on microscopic examination
of cut section of a skeletal muscle, alternate light
and dark bands are seen. This gives it a character-
istic appearance of cross-striations (Figs 40.2
to 40.7). The various bands have been labeled as
(Figs 40.2 and 40.3)
1. A-band: It is a relatively darker band which is
formed by the thick filaments made up of
myosin.
2. I-band: It is a relatively lighter band, formed by
arrangement of thin filaments, that is actin and
tropomyosin.
 516 Human Anatomy For Dental Students
Fig. 40.2: Diagrammatic representation of striations seen on electron micrograph picture of a skeletal muscle fiber
S E C T I O N-3
Fig. 40.3: Diagrammatic representation of striations seen on electron micrograph picture of a skeletal muscle fiber-showing
changes during contraction of muscle
3. H-band: It is a slightly lighter band seen in the
middle of A band. This is the area of relaxed
muscle consisting of thick filaments only, where
there is no overlapping of thick and thin
filaments. The width of H-band decreases
during contraction of muscle.
4. M-line: It is the line seen in centre of H-band.
Myosin filaments extend on either side from this
line.
5. Z-line: It is a dark line seen in the centre of I-
band. It appears dark due to a high refractive
index. The actin filaments extend from each side
of Z-line towards the myosin filaments till edge
of H-zone. When muscle contracts the two
adjacent Z-lines move closer.
Sarcomere: Functional unit of a muscle fiber or cell is
called sarcomere. It extends between the two Z-lines.
Histology of Skeletal Muscle
Longitudinal section through a muscle presents with the
following features on H and E staining (Figs 40.4 to 40.7):
Regularly arranged elongated, cylindrical muscle
fibers (cells) with multiple nuclei. The nuclei are
flattened and are located in the periphery just below
the sarcolemma (plasma membrane). Each muscle
cell is surrounded by a thin connective tissue layer
known as endomysium.
The cytoplasm of muscle fibre stains pink
(eosinophilic) due to presents of contractile
filaments. It presents with cross striations due to
characteristic arrangement of these filaments. The
cross striations are clearly seen on high
magnification. These are seen as alternating light
and dark pink bands.
Capillaries can be identified between the muscle
fibres as skeletal muscle is richly supplied by blood
vessels.
Cross section of a striated muscle presents with
following features:
Muscle fibres are seen as round to oval bundles of
myocytes. Each muscle cell appears polygonal in
shape with peripherally placed nuclei and is
surrounded by a thin connective tissue layer known
as endomysium.
A number of muscle cells form a muscle bundle or
fascicle. Each fascicle is surrounded by a layer of
connective tissue known as perimysium.
Capillaries are identified in the connective tissue
layers.
 Muscle 517

Fig. 40.4: Longitudinal section of skeletal muscle (stain-hematoxylin-eosin under low magnification)

C H A P T E R-40
Fig. 40.5: Longitudinal section of skeletal muscle (stain-hematoxylin-eosin under medium magnification)

Fig. 40.6: Longitudinal section of skeletal muscle (stain-hematoxylin-eosin under high magnification)
 518 Human Anatomy For Dental Students
Fig. 40.7: Longitudinal section of skeletal muscle (stain-hematoxylin-eosin under high magnification)
S E C T I O N-3
SMOOTH OR NON-STRIATED MUSCLE
Non striated or smooth muscles are widely distributed
in the wall of hollow viscera, tubular and saccular
viscera, ducts of exocrine glands, blood vessels, stroma
of solid organs and the tracheo-bronchial tree.
In blood vessels smooth muscles are predominantly
arranged in a circular fashion. In the gastrointestinal tract
smooth muscles are arranged in inner circular and outer
longitudinal layers. In urinary bladder, uterus and
stomach smooth muscles are arranged in three layers,
namely circular, longitudinal and oblique. Smooth
muscles are supplied by parasympathetic and
sympathetic nervous system. Parasympathetic
stimulation usually causes contraction while sympa-
thetic stimulation causes relaxation of the smooth
muscle.
Structure of Smooth Muscle (Figs 40.8 to 40.11)
A smooth muscle fiber is a unicellular, spindle
(fusiform) shaped cell. Each cell is surounded by
cell membrane called sarcolemma.
The contractile units primarily, actin and myosin
are scattered irregularly within the cytoplasm and
do not form a definitive pattern as in skeletal muscle
fibre. Hence, it does not presents any cross
striations.
Histology of Smooth Muscle
Longitudinal section through a muscle presents with the
following features on H and E staining (Figs 40.8 to 40.11):
The muscle fibres are seen as bundles of spindle
shaped cells arranged parallel to each other, in close
proximity. The tapering ends of each muscle fibre
is closely applied to the adjacent muscle fibre and
the cells are also interconnected by gap junctions.
Each muscle fibres has a centrally placed elongated,
spindle shaped nucleus. On high magnification the
nucleus of a smooth muscle fibre is typically
described as cockscrew in shape.
Individual cells are surrounded by a fine connective
tissue layer known as endomysium.
The cytoplasm stains evenly and is strongly
eosinophilic due to presents of contractile filaments.
Cross section of a smooth muscle presents with following
features (Fig.40.9):
A number of round to polygonal shaped bundles
of muscle fibres are seen surrounded by fine
connective tissue layer known as perimysium.
Each muscle fibre appears as a round to oval cell
with central nucleus.
Depending on the variations in obtaining the cut
section of the organ containing smooth muscle
fibres, individual muscle bundles as well as cells
within the bundles appear of varying sizes.
 Muscle 519

C H A P T E R-40
Fig. 40.8: Longitudinal section of smooth muscle (stain-hematoxylin-eosin under high magnification)

Fig. 40.9: Longitudinal section of smooth muscle (stain-hematoxylin-eosin under high magnification)
 520 Human Anatomy For Dental Students

Fig. 40.10: Longitudinal section of smooth muscle (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3

Fig. 40.11: Longitudinal section of smooth muscle (stain-hematoxylin-eosin under high magnification)

CARDIAC MUSCLE (Figs 40.12 and 40.13)
Cardiac muscles are present in the heart and at the
beginning of great vessels.
Structure of Cardiac Muscle
Cardiac muscle fibers are uninucleated, long
cylindrical fibers with similar striations as seen in
skeletal muscle fibers. However, since the fibers
branch and interdigitate the arrangement is not
linear. Each fiber is surrounded by the cell
membrane or sarcolemma and has a centrally
placed nucleus (Fig. 40.13).
Most distinctive feature of cardiac muscle fibres is
the presence of interconnections between the
muscle fibres in the form of side branches.
At the site where one muscle fiber meets the other,
it shows extensive folds of sarcolemma that
provides a strong union between adjacent fibers.
These form intercalated disks. This gives the fibers
an appearance of syncytium with dark lines
representing the intercalated disks. Also this allows
for the rapid transmission of impulses. Thus, the
cardiac muscle functions as a syncytium. This is the
anatomical basis for the spread of contraction over
entire heart from a single point.
 Muscle 521

The T-system of cardiac muscle fiber is located at
Z line and not at junction of A and I bands.
The cells are rich in mitochondria, glycogen and
have a well developed capillary network.
Histology of Cardiac Muscle (Figs 41.12 and 40.13)
Cut section of heart presents with the following features
on routine H and E stain.
Cardiac muscle fibres are seen as bundles of
longitudinally arranged cells. The fibres are parallel
to each other and show occasional areas of
branching (branching may be seen under high
magnification)
The cytoplasm of cardiac muscle fibres is strongly
eosinophilic and presents similar striations as in
skeletal muscle fibres.
Intercalated disks are seen as densely staining
eosinophilic bands perpendicular to the fibres at
regular intervals. These are the site of attachment
between adjacent cardiac cells.
Each fibre has a single centrally placed, rounded
nucleus which is seen between two intercalated
disks.

C H A P T E R-40
Fig. 40.12: Transverse section of cardiac muscle (stain-hematoxylin-eosin under high magnification)

Fig. 40.13: Longitudinal section of cardiac muscle (stain-hematoxylin-eosin under high magnification)
 522 Human Anatomy For Dental Students

As the cut section passes through various layers Blood vessels (small arteries) may be seen in
cross section of cardiac muscle fibres are also seen between the muscle fibres.
in between. Connective tissue bands with nerve fibres can be
identified in some sections.

Differences in the microscopic structure of the three types of muscle fibers.

Features Skeletal muscle
(Fig. 40.4 to 40.7)
1. Cell type Cells are long, thick and
cylindrical. Longest cell
may be upto 30 cm in length.
They are unbranched.
2. Length of cell 4 to 30 cm
3. Number of nuclei Multinucleated. The
and their position elongated nuclei are
placed peripherally.
4. Cell arrangement Cells lie parallel to each
other and form bundles.
5. Striations Transverse striations are
the characteristic feature
and are seen as light and
dark bands.
6. Electron microscopic T tubules are present. They
S E C T I O N-3
Smooth muscle Cardiac muscle
(Fig. 40.8 to 40.11) (Fig. 40.12 to 40.13)
Cells are small Cells are cylindrical in shape.
and spindle shaped. Fibres are branched.
They are unbranched.
15 to 500 microns 80 to 100 microns
Single nucleus which is Centrally placed, single
centrally placed. nucleus.
Cells overlap each other Intercalated discs are present
with distinct outlines. at the cell to cell junction.
No transverse striations Transverse striations
present but indistinct are present but not so
longitudinal striations clear as seen in the
may be present. skeletal muscle.
T tubules are not present. T tubules are present

structure form a triad and lie at the at Z lines and form dyads.
junction of A-I band.

Functional Correlation movements. Contraction of smooth muscle is not

Skeletal muscle fibres are responsible for strong,
quick, discontinuous voluntary contractions.
Smooth muscle fibres are responsible for slow,
prolonged contractions leading two wave like
peristaltic movements or stronger expulsive
only initiated by neuronal stimulus but also by
mechanical (stretch reflex) and chemical
(angiotensin, vasopressin) stimuli.
Cardiac muscle fibres are responsible for autonomic,
strong, quick contraction in a rhythmic fashion.
 Chapter

41
Nervous System

INTRODUCTION Structure of Neuron

Nervous system is made up of two parts namely, central
nervous system and peripheral nervous system. Central
nervous system consists of brain and spinal cord. It is
derived from neural tube. Brain and spinal cord are
made up of neurons their processes the dendrites and
axons and neuroglia arranged in specific pattern within
vascular connective tissue. The brain and spinal cord
Each neuron consists of
a. Soma or cell body
b. Neurites or processes: They are, axons and dendrites
Soma or Cell Body (Perikaryon)
Cell body is surrounded by a plasma membrane. The
shape of cell body can vary from stellate, fusiform, basket
shape, flask or pyramidal shape. Soma is made up of

C H A P T E R-41
are covered by three layers of connective tissue
the following two components:
membranes known as meninges. Arachnoid mater and 1. Cytoplasm: It contains numerous organelles and
diamater can be peeled of from surface during inclusion bodies. Cytoplasm is surrounded by the
preparation of specimen. Piamater is the innermost layer plasma membrane.
of meninges and is intimately adhered to the outer 2. Nucleus: It is large, vesicular and contains a
surface of brain and spinal cord and follows the contour prominent nucleolus.
of their surfaces. Few connective tissue bands with blood
vessels extend between arachnoid matter and piamater.
The structure of brain and spinal cord is divided into
grey matter and white matter. Grey matter is made up
of mostly neuronal cell bodies with their dendrites and
axons and the neuroglial cells. Synaptic meshwork is
seen in grey matter. The neuronal cells may be grouped
together to form nuclei or may be present in layers. The
proximal part of axon in this region is mostly non
myelinated.
White matter consists primarily of axons of neuronal
cells i.e. nerve fibers. The nerve fibers are arranged as
bundles and are grouped to form tracts within a vascular
connective tissue. Neuroglial cells are scattered in
between. The axons are mostly myelinated. On cut
section of any part of CNS, the grey and white matter
are named because they present with relative differences
in the colour. Myelinated axons of white matter give a
whitish appearance to it relative to the grey matter.

NEURON
Neuron is the structural and functional unit of the
nervous system (Fig. 41.1).
Fig. 41.1: Diagrammatic representation of myelinated neuron
 524 Human Anatomy For Dental Students
Cytoplasmic Organelles and Inclusions
a. Nissl bodies: These are made up of rough endoplas-
mic reticulum with ribosomes. They are basophilic
in nature. Nissl bodies are present in cell body and
dendrites. They are absent in axons. These bodies
disappear, when the neuron is injured and this
phenomenon is known as chromatolysis.
Functions: Synthesis of new proteins and enzymes.
b. Smooth endoplasmic reticulum
Functions: It helps in transmission of neuro-
chemical substances by forming synaptic vesicles.
c. Golgi apparatus: It is present close to the nucleus
and is absent in axon and dendrites.
Functions: Is responsible for the packaging of
neurosecretions.
d. Mitochondria: These are rod like structure with
double membrane, present in soma, dendrites and
axons.
Functions: Mitochondria are the site of production
of energy molecules for the cell.
e. Lysosomes: They are thick walled membranous
vesicles containing hydrolytic enzymes.
Functions: Phagocytosis, hydrolysis of Nissl bodies.
f. Neurofilaments and Microtubules: These are agg-
S E C T I O N-3
regated at the axon hillock. They form the cyto-
skeleton of the neuron.
Functions: Are responsible for the shape and
mobility of the neuron. Microtubules provide
contractility to the neuron.
g. Centrioles: These are present in soma.
Functions: They help in regeneration of the cyto-
plasmic microtubules.
h. Pigments and mineral containing granules: These
are present at specific sites
Neuromelanin: Present in substantia nigra.
Functions: Synthesis of dopamine.
Zn (zinc): Present in hippocampus.
Fe (Iron): Present in oculomotor nucleus.
Cu (copper): Present in locus ceruleus.
Lipofuscin, Lipochrome: These are old age
pigments.
Dendrites
These are 5 to 7 small processes which arise from
cell body and branch repeatedly and end in
terminal arborization.
The ends form dendritic spines. They contain Nissl
bodies, mitochondria and neuro filaments.
Dendrites receive and transmit impulses towards
the cell body.
Axons
These are generally single and they terminate away
from the cell body. Collateral branches may
occasionally be present at right angles.
Nissl bodies are absent.
Spines are absent.
They carry impulses away from the cell body.
The terminal portion of axons usually branch and
end in dilated ends called as synaptic knobs.
Axons are surrounded by myelin sheath (Fig. 41.2).
Myelin sheath consists of a proteinlipid complex
which is produced by Schwann cells. Schwann cells
surround the axons and are present along the length
of the axons. The myelin sheath is deficient at
regular intervals of around 1 mm. These points are
known as nodes of Ranvier (Fig. 41.1).
NEUROGLIAL CELLS
There are primarily three types of glial cells in CNS
known as neuroglia. These are:
1. Astrocytes
2. Oligodendrocytes
3. Microglia
Other cells are ependymal cells lining the central
canal of spinal cord and ventricles of brain. Schwann
cells are the glial cells in peripheral nervous system.
Structure of Neuroglial cells
Astrocytes
These are small, star shaped cells due to presence of
multiple processes radiating out of soma (cell body).
They are the largest of glial cells and are most abundant
in CNS. They are of two types namely:
a. Protoplasmic astrocytes: They are cells with smaller
branches and are located in grey matter. They are
mostly associated with blood vessels and piamater.
b. Fibrocytic astrocytes: These are cells with long
fibrous processes and are mostly present in the
white matter.
Functional correlation: The astrocytes form an
interconnected network. They are believed to:
Support the neuronal tissue
Regulate the movement of metabolites and ions
there by maintaining the intercellular communica-
tion and activity of neurons.
Help maintain the tight junction of capillaries that
form blood brain barrier.
They proliferate at site of injury and form glial scar.
Oligodendrocytes
These are rounded cells with a centrally placed, round
euchromatic or heterochromatic nucleus and dense
cytoplasm. They are usually arranged along the nerve
fibers as they myelinate the axons.

Functional correlation: One oligodendrocyte can
provide myelin sheath to number of nerve fibers. Myelin
is a lipid rich lipoprotein structure that surrounds the
axons and helps in insulation of the electrical conduction
through it.
Microglia
These are smallest of glial cells. They are elongated cells
with a characteristic elongated nucleus with scanty
cytoplasm and few small processes. They are believed
to be derivatives of monocytes from blood and are parts
of mononuclear phagocytic system.
Functional correlation: Their exact function is unclear
but they are seen to proliferate at sites of injury or
damage to CNS.
Ependymal Cells
These are low columnar cells forming a single layer of
epithelium lining the ventricles of brain and central canal
of spinal cord. The apical surfaces of the cells bear
microvilli and cilia and help in flow of cerebrospinal
fluid.
Schwann Cells (Fig. 41.2)
These are small rounded cells present along the axons
in the peripheral nervous system (PNS). They lay down
Fig. 41.2: Myelin sheath and neurilemma formation by
Schwann cell
Nervous System 525
the myelin sheath in PNS. One Schwann cell myelinates
part of only one axon while one oligodendroglia can
myelinate many axons. Schwann cell proliferate at site
of nerve injury and provide a path for regeneration of
nerve while oligodendroglia are not involved at site of
injury.
NERVE FIBER (Figs 41.1 to 41.3)
Each nerve fiber is surrounded by a thin membrane
called neurilemma. It is made by the Schwann cells.
Inner to neurilemma is present myelin sheath which
is laid down by Schwann cells.
Myelin sheath is made up of phospholipids and
hence can be stained with osmic acid stain. It is not
seen on routine H and E staining. On osmic acid
staining, it appears as a thick, black band surround-
ing a lighter, central axon.
The myelin sheath is interrupted between adjacent
Schwann cells. These points are called nodes of
Ranvier and at these points the neurilemma is in
contact with the axon.
C H A P T E R-41
In the centre of a nerve fiber is present a light
staining cylinder which is the axon, with axoplasm
and neurofibrils.
A thin connective tissue layer of endoneurium is
present between two nerve fibers.
PERIPHERAL NERVE TRUNK
Peripheral nerves are made up of afferent and efferent
nerve fibers. Afferent fibers are axons of neuronal cells
located in the dorsal root ganglia or sensory root ganglia
of cranial nerves and special sensory organs eg. olfactory
epithelium, organ of Corti in ear etc. and carry impulses
Fig. 41.3: Transverse section of peripheral nerve (stain-
hematoxylin-eosin under low magnification)
 526 Human Anatomy For Dental Students
from periphery to CNS. Efferent fibers are made up of
axons of neuronal cells in grey matter of CNS that
connect CNS to effector organs and tissues.
Structure of Peripheral Nerve Trunk
(Figs 41.3 to 41.5)
Peripheral nerve trunk is made up of several
bundles of nerve fibers (afferent and efferent fibers).
The nerve trunk is surrounded by a dense, irregular
connective tissue layer known as epineurium. It is
made up of collagen fibers, blood and lymphatic
vessels supplying the nerve and adipose tissue. The
fat provides a cushion to the nerve and prevents
against compression of nerve.
On cut section, the nerve trunk presents with
bundles of nerve fibers known as fascicles. Each
fascicle is surrounded by a specialized connective
tissue layer known as perineurium. The
perineurium is made up of fine connective tissue
with blood vessels extending inwards from the
S E C T I O N-3
Fig. 41.4: Longitudinal section of a peripheral nerve (stain-holmess stain under high magnification)
Fig. 41.5: Transverse section of optic nerve (stain-hematoxylin-eosin under low magnification)
epineurium and passing between the fascicles. It
also consists of layers of flat, polygonal cells which
contain contractile actin microfilaments and have
numerous tight junctions. This layer forms a part
of the blood nerve barrier.
Each fascicle presents aggregations of cut sections
of nerve fibers. Each nerve fiber has a central axon
surrounded by myelin sheath and a thin layer of
cytoplasm covered with cell membrane the
neurilemma. Unmyelinated fibers do not have
myelin sheath. Nuclei of Schwann cells can be seen
scattered between nerve fibers. They are
characteristically present close to neurilemma of
axons. Occasional nuclei of fibroblasts may also be
seen in between nerve fibers.
A thin connective tissue layer known as
endoneurium surrounds individual nerve fibers.
It is made up of collagen fibrils produced by
Schwann cells, occasional nuclei of fibroblast cells

along with poorly defined blood vessels.
Endoneurium is not seen on routine H and E
staining and requires special stains like Holmes
stain.
Histology of Peripheral Nerve Trunk (Figs 41.3 to 41.5)
On routine H and E staining cut section of nerve fiber
presents with following features:
Round to polygonal shaped aggregations of nerve
fibers are seen. These are known as nerve fascicles.
Each fascicle is surrounded by fine connective tissue
layer known as perineurium. Perineurium is seen
as eosinophilic bands of connective tissue fibers
with blood vessels and fat cells.
Each fascicle presents with aggregations of cut
sections of axons. These are seen as small round to
Fig. 41.6: Transverse section of dorsal root (spinal root) ganglion (stain-hematoxylin-eosin under low magnification)
Fig. 41.7: Transverse section of dorsal root (spinal root) ganglion (stain-hematoxylin-eosin under high magnification)
Nervous System 527
oval eosinophilic dots surrounded by a very fine
clear space (myelin).
Nuclei of Schwann cells and fibroblast are seen
scattered in between the nerve fiber.
GANGLION
A ganglion is a collection of nerve cell bodies with their
processes namely, axons and dendrites, along with
supporting cells surrounded by connective tissue
capsule. It is present outside the CNS e.g. dorsal root
ganglion, sympathetic ganglion.
Sensory Ganglia
They are ganglia associated with spinal nerves and the
sensory root of five cranial nerves namely, trigeminal,
facial, vestibulo-cochlear, glossopharyngeal and vagus
nerves.
C H A P T E R-41
 528 Human Anatomy For Dental Students
Fig. 41.8: Transverse section of dorsal root (spinal root) ganglion (stain-hematoxylin-eosin under high magnification)
Dorsal root ganglia: Dorsal root ganglia are the ganglia
present just outside spinal cord (CNS). They contain cell
bodies of sensory neurons that bring afferent impulses
from periphery to CNS.
Autonomic ganglia: Sympathetic ganglia are located in
S E C T I O N-3
the paravertebral sympathetic chain. They are made up
of cell bodies of postsynaptic neurons that receive inputs
from CNS via presynaptic neurons and send along
postsynaptic axons to the smooth muscles and glands
of viscera and heart muscle.
Parasympathetic ganglia are small ganglia present
close to organs which they supply. They are collections
of cell bodies of postsynaptic neurons of parasympa-
thetic outflow.
Histology of Dorsal Root Ganglion (Figs 41.6 to 41.8)
The ganglion is covered by a thin connective tissue
layer which may be seen on one side if the section
includes the outer edge of ganglion.
Fig. 41.9: Transverse section of sympathetic ganglion (stain-hematoxylin-eosin under low magnification)
It is seen to be made up of clusters of neuronal cells,
separated by bundles of nerve fibers.
The neuronal cells are pseudounipolar and give rise
to a single axodendritic process. The process
bifurcates to form a peripheral process that reaches
the sensory nerve endings and a central process that
continues into CNS. Cell bodies are large, round to
oval with pale staining cytoplasm and a centrally
placed vesicular nucleus with prominent nucleolus
(seen on high magnification).
Each cell body is surrounded by satellite cells or
capsular cells which are seen as rounded nuclei
surrounding each cell body.
Nerve fibers are seen as bundles of thin strands.
Nuclei of Schwann cells are seen along length of
nerve fibers at regular intervals.
Thin connective tissue with fine blood capillaries
is seen in between the neuronal cluster.

Histology of Sympathetic Ganglion
(Figs 41.9 to 41.11)
The outer connective tissue capsule is not well
defined.
The ganglion cells and nerve fibers are scattered in
substance of the ganglion.
The ganglion cells are multipolar neurons which
are smaller and more uniform in size than the dorsal
root ganglion cells.
The nuclei of the ganglion cells are eccentrically
placed and often binucleated with a dark staining
nucleolus.
Cytoplasm of ganglion cells consists of Nissl bodies.
Most of the cells contain lipofuscin pigment in their
cytoplasm.
In between the ganglion cells lie fibroblasts,
connective tissue, blood vessels, myelinated and
unmyelinated axons.
Fig. 41.10: Transverse section of sympathetic ganglion (stain-hematoxylin-eosin under high magnification)
Fig. 41.11: Transverse section of sympathetic ganglion (stain-hematoxylin-eosin under high magnification)
Nervous System 529
Satellite cells are less numerous than in dorsal root
ganglion.
SPINAL CORD
Structure of Spinal Cord
The cross section of spinal cord reveals two parts,
an outer white matter and inner grey matter.
The centre of spinal cord presents with a small,
round to oval opening known as central canal.
The grey matter is arranged around the central
canal in an H-shaped manner. The posterior limbs
of H-shaped grey matter are called dorsal horns.
Each dorsal horn is made up of neurons which
receive synaptic inputs from sensory neurons of
dorsal root ganglia, axons, dendrites and neuroglial
cells. The anterior limbs or ventral horns are made
up of large neuronal cell bodies of motor neurons.
C H A P T E R-41
 530 Human Anatomy For Dental Students
The grey matter appears darker due to high cellular
content.
White matter consists of bundles of nerve fibers
(axons) with scattered neuroglia.
The surface presents a thin loose connective tissue
layer with blood vessels which is the piamater.
Histology of Spinal Cord (Fig. 41.12)
Cut section of spinal cord on routine H and E staining
shows the following features:
Outermost covering or piamater may be seen in
some sections. It is seen as a thin, eosinophilic layer
of loose connective tissue with blood capillaries.
White matter presents with bundles of axons
separated by loose connective tissue. Axons are seen
as round to oval bodies surrounded by a clear zone
which represents the myelin. Myelin is not seen on
H and E staining as it dissolves during preparation
of specimen. Outer to each axon is a fine connective
tissue known as endoneurium.
The grey matter stains darker than white matter
due to presence of numerous neuronal cell bodies
S E C T I O N-3
and neuroglial cells. Neuronal cells are seen as
clusters of round, oval or pyramidal shaped cells
Fig. 41.12: Transverse section of spinal cord at thoracic region (stain-hematoxylin-eosin under medium magnification)
with prominent nucleus and basophilic granules in
cytoplasm (Nissls granules) alongwith numerous
cell processes (dendrites).
Neuroglial cells are seen scattered in the grey
matter. Branches of blood vessels are also seen in
between.
CEREBRUM (Fig. 41.13)
Cerebrum is made up of two cerebral hemisphere which
are the highest level of control of all motor and sensory
activities of the body. On cut section each cerebrum
presents an outer layer of grey matter named cortex and
an inner core of white matter. The white matter in the
inferior part of cerebral hemisphere present with
collection of nuclear masses known as basal ganglia.
On histology of the cerebrum presents with following
features:
The cerebral cortex presents six laminae or layers
arranged parallel to the surface. The cortex is
primarily made up of various types of neuronal cells
and neuroglia. Each layer is identified according to
types of cell predominant in the layer with its
characteristic arrangement of dendrites and axons.
The layers are:
 Nervous System 531

C H A P T E R-41
Fig. 41.13: Transverse section of cerebral hemisphere showing all layers of cerebral cortex
(stain-Cajals under medium magnification)
1. Layer I: It is known as plexiform layer. It is made size of pyramidal cell increases from superficial
up of numerous neuroglial cells seen as nuclei to deep side. Intervening vertical bundles of
with intervening meshwork of dendrites and myelinated axons are seen.
axons. Few horizontal cells (of Cajal) are present. 4. Layer IV: Internal granular lamina. It is made
2. Layer II: External granular layer. It is made up up of densely packed small rounded non
of small pyramidal and granule cells with pyramidal granular or stellate cells. Numerous
intervening bundles of vertically arranged neuroglia are present. Vertical bundles of
axons. myelinated axons are present in between. A
3. Layer III: External pyramidal lamina. It is made prominent band of horizontal nerve fibers is
up of mostly small to medium size pyramidal seen in this layer.
cells with few non pyramidal (granule) cells. It 5. Layer V: Internal pyramidal lamina: It is mostly
is not clearly separated from layer II except that made up of large pyramidal cells with few
 532 Human Anatomy For Dental Students
granule cells. Intervening vertical bundles of
axons are seen. Another prominent band of
horizontally arranged axons are seen in this
layer.
6. Layer VI: It is the multiformic or pleiomorphic
lamina. It is made up of neurons of variable
shapes namely, pyramidal cells, spindle cells,
fusiform cells and granular cells. It has more
number of axon fibers which blend with inner
mass of white matter.
Inner most is the white matter which has dense
aggregation of nerve fibers with neuroglial cells
seen as small rounded nuclei scattered in between
the fiber. Blood capillaries can be identified in each
layer.
CEREBELLUM (Fig. 41.14)
Cerebellum is made up of two cerebellar hemispheres
joined by central vermis. On cut section cerebellum
presents with an outer layer of grey matter called
cerebellar cortex and an inner dense core of white matter.
The cortex is highly convoluted and the central white
S E C T I O N-3
matter is seen arranged as medullary laminae with a
highly branching pattern.
On histology the cerebellum presents with following
features:
The cerebellar cortex is made up of densely packed
neuronal cells which are arranged in three layers
or laminae, parallel to the surface.
Fig. 41.14: Transverse section of cerebellum showing layers of cerebellar cortex with white matter
(stain-Cajals under medium magnification)
The three laminae are:
1. Molecular layer is made up of few neuronal
cells primarily basket cells and stellate cells with
their dendrites and axons. It contains the
dendritic tree like fibers of purkinje cells. Axons
of golgi cell and scattered neuroglial cells.
Hence, it appers as a lightly stained layer.
2. Purkinje cells layer: It is made up of primarily
purkinje cells. There are large, pear shaped cells
with dendrites passing into molecular layer.
Axons of purkinje cells are not seen clearly on
routine microscopy but they pass inwards and
form the fibers of white matter.
3. Granule cell layer: It is made up of densely
packed neuronal cells with numerous granular
cells their dendrites and origin of axons. They
are seen as numerous rounded nuclei and hence
this layer appears darker than molecular layer
on H and E stain. It also contains golgi cells with
dendrites and its axons with ramification,
passing fibers, branching terminals of climbing
fibers with neuroglial cells.
Inner most mass is the white matter which is made
up of nerve fibers, blood vessels and neuroglia.
The surface presents a thin loose connective tissue
layer with blood vessels which is the pia mater.
 Chapter

42
Cardiovascular System
INTRODUCTION
Cardiovascular system is responsible for circulation of
blood throughout the body. It helps to carry oxygen,
various nutrients, hormones and other factors to various
parts of body for nourishment and regulation of activity
of body. It also helps in carrying of waste products like
CO2 (to lungs for expulsion), metabolites for removal
via kidneys and liver. Cardiovascular system comprises
of heart which pumps the blood and blood vessels which

C H A P T E R-42
conduct the blood to and fro from the heart to peripheral
organs and tissues of the body.

HEART
Heart is primarily a muscular organ. On microscopic
examination, it can be divided into three layers namely:
1. Endocardium: It is made up of single layer of
squamous cells, endothelial cells overlying the
basement membrane and a subendocardial layer.
The subendocardial layer is a thin layer of loose
connective tissue with few smooth muscle fibers
along with a network of veins, nerves and fibers of
conducting system.
2. Myocardium: It forms the major bulk of heart and
is mostly the only identifying structure seen on
microscopy. The microscopic structure of cardiac
muscle has been described in chapter no. 40 (see
page no. 520).
3. Pericardium (Epicardium): It is a thin, external
layer consisting of single layer of simple squamous
epithelium known as mesothelium resting on a thin
layer of connective tissue.
GENERAL HISTOLOGY OF BLOOD VESSELS
Blood vessels are tubular structures with a central lumen
surrounded by three concentric layers of vessel wall. The
three layers are (from within outwards) (Fig. 42.1):
1. Tunica intima: It is made up of the following parts:
a. Endothelium: It consists of a single layer of flat,
polygonal, squamous cells known as endothelial
Fig. 42.1: Layers of a blood vessel
cells with their basal lamina or basement
membrane.
b. Subendothelial layer: It is a thin layer of loose
connective tissue made up of elastic fibers, type
I collagen fibers, fibroblasts and few smooth
muscle type flattened cells known as
myointimal cells.
c. Internal elastic lamina: It is a thin layer of elastic
fibers separating the tunica intima and tunica
media.
2. Tunica media: It is the middle layer and is made
up of concentrically arranged layers of smooth
muscle cells with variable amounts of elastic fibers
and reticular fibers.
3. Tunica adventitia: It is the outermost connective
tissue layer made up of primarily collagen fibers
(type I) and few elastic fibers and large vessels. It
presents with fibroblasts, macrophages, nerve fibers
and blood and lymphatics supplying it.
Histology of Arteries
The arteries carry oxygenated (except pulmonary
arteries) blood from heart to various organs and tissues.
 534 Human Anatomy For Dental Students
The microscopic structure varies according to the size
of the artery due to variations in the muscular content
(tunica media) and the amount of elastic tissue.
Large Elastic Arteries (Figs 42.2 to 42.4)
These are aorta and its major branches. The microscopic
structure of the large elastic arteries presents a lumen
surrounded by three tunics of the wall.
1. Tunica intima: It is made up of a single layer of
endothelial cells resting on their basal lamina and
a subendothelial loose connective tissue layer. The
subendothelial tissue has collagen and elastic fibers
along with smooth muscle cells known as
myointimal cells. The internal elastic lamina is
made up of fenestrated layer of elastic fibers.
2. Tunica media: It is a thick layer made up of
concentric layers of smooth muscle fibers (cells),
S E C T I O N-3
Fig. 42.2: Transverse section of elastic artery (stain-hematoxylin-eosin under low magnification)
Fig. 42.3: Transverse section of elastic artery (stain-hematoxylin-eosin under high magnification)
with collagen fibers and extracellular matrix of
proteoglycans with interspersed layers of elastic
fibers. It is limited outside by a concentric layer of
elastic fibers known as external elastic lamina.
3. Tunica adventitia: It is a relatively thin connective
tissue layer with collagen fibers, elastic fibers,
macrophages, fibroblasts, blood vessels (vasa
vasorum) and nerve fibers.
Note: The internal and external elastic laminae are not
clearly demarcated under microscopy with routine H
and E staining due to a relatively high elastic fiber
content of tunica media.
Points to remember: It is the myointimal cells of arteries
that accummulate lipid with age and cause athero-
scelerosis that is thickening of tunica intima inwards
which may cause narrowing of the lumen.
 Cardiovascular System 535

Fig. 42.4: Transvere section of elastic artery (stain-hematoxylin-eosin under high magnification)

Functional correlation: The distinctive elastic content
of these arteries allows them to expand and conduct the
blood pumped by the heart during systole. They recoil
during diastole of heart and this helps them to continue
to conduct blood even during diastole.
Muscular Arteries (Fig. 42.5)
These are branches of large arteries which further divide
and distribute blood to various organs and tissues. They
C H A P T E R-42
are characterized by a definitive smooth muscle layer
in tunica media. They help to regulate blood flow to a
particular region depending on its physiological activity.
1. Tunica intima: It is thinner than elastic artery. It is
made up of a single layer of endothelial cells resting
on basement membrane with a thin layer of
subendothelial connective tissue. The distinctive
feature is the presence of a well defined internal
elastic lamina identified between tunica intima and
tunica media.

Fig. 42.5: Transvere section of Muscular artery (stain-hematoxylin-eosin under high magnification)
 536 Human Anatomy For Dental Students

2. Tunica media: It is characterized by concentrically

arranged layers of smooth muscle fibers with few
lamella of elastic fibers. Extracellular matrix is also
limited. The external elastic lamina is made up of
fenestrated sheets of elastic fibers and separates the
tunica media from tunica adventitia. The thickness
of the layer of tunica media varies with the size of
an artery.
3. Tunica adventitia: It is the connective tissue layer Fig. 42.7: Capillary
made up of collagen fibers, elastic fibers, fibroblasts
and few vasa vasorum. Tunica adventitia is well
developed in muscular arteries as compared to
elastic arteries. As the size of vessel diminishes the
tunica adventitia and tunica media are almost
similar in thickness.

Arterioles (Fig. 42.6)

These are smallest arteries with a diameter of 100 . On
microscopy arterioles have a narrow lumen surrounded Fig. 42.8: Diagrammatic representation of capillary seen
under electron microscope
by:
1. Tunica intima: It consists of a single layer of flat,
polygonal cells with scanty cytoplasm and On microscopic examination, capillaries are seen as:
S E C T I O N-3

relatively larger nuclei that project into the lumen. They have a very narrow lumen surrounded by a
The cells rest on a basal lamina. Subendothelial single layer of flat, polygonal cells lying on a basal
tissue is minimal. Internal elastic lamina is usually lamina.
absent. Basal lamina is surrounded by a thin layer of
2. Tunica media: It is made up of two compact layers subendothelial connective tissue.
of concentrically arranged smooth muscle fibers On electron microscopy few flat cells known as
with minimal extra cellular tissue. pericytes may be seen inserting between endothelial
3. Tunica adventitia: It is thin and ill defined. cells and basal lamina.
Capillaries are of three types: The following features
are primarily identified on electron microscopy:
1. Continuous capillaries (Figs 42.7 and 42.8): These
are the most common type of capillaries found in
various tissues.
2. Fenestrated capillaries (Fig. 42.9): These present
with wide fenestrations, upto 80 to 100 nm, in walls
of endothelial cells. These act as channels across
capillary walls. The basal lamina is intact all over.
They are typically seen in endocrine glands and
gastrointestinal tract where active secretion or
Fig. 42.6: Arteriole absorption of metabolites is happening.
Functional correlation: They are densely supplied by
sympathetic fibers and act as resistance vessels or
precapillary sphincters regulating the blood flow
according to local vasoactive and metabolic factors.

Capillaries (Figs 42.7 and 42.8)

These are blood vessels with smallest diameter, usually
with a lumen of 4 to 8 . They act as exchange vessels as
their walls allow movement of fluids, metabolites and
gases across, to and from the tissues. Fig. 42.9: Fenestrated capillary

Fig. 42.10: Discontinuous capillary or sinusoids
3. Discontinuous capillaries (Fig. 42.10): They are
also known as sinusoids and are found in liver,
spleen and bone marrow. These have a relatively
large lumen, 30-40 , surrounded by discontinous
arrangement of endothelial cells.
Endothelial cells are made up of single layer of
relatively larger, spindle shaped cells with
intercellular gaps. The basal lamina is also deficient
at such gaps.
Functional correlation: The density of capillary network
is highest in organs with high metabolic activity like
liver, kidney, cardiac muscle and skeletal muscle to
provide adequate surface area for exchange. The blood
flow in the capillaries is regulated by neurological
(sympathetic control) and local stimuli.
Histology of Veins (Figs 42.11 and 42.12)
Veins carry deoxygenated blood (except pulmonary
veins) from periphery to the heart. They are divided into
three types:
1. Small veins and venules
Fig. 42.11: Transverse section of vein (stain-hematoxylin-eosin under low magnification)
Cardiovascular System 537
2. Medium veins
3. Large veins
Venules
They usually have a lumen of 10-30 m with thin walls
made up of one layer of flat, oval to polygonal cells lying
on basal lamina and a thin layer of adventitia with
connective tissue consisting of collagen fibers and
fibroblasts.
Muscular layer consisting of smooth muscle fibers
is present in larger venules above 50 m in diameter.
Veins
Veins are medium (with a diameter of 8-10 mm) or large
veins (>10 mm). The veins have a larger lumen with
relatively thin wall as compared to the arteries. On
microscopy the walls of veins consist of three layers:
1. Tunica intima: It is the innermost layer made up
of a single layer of flat, polygonal cells resting on
the basal lamina. Subendothelial layer of connective
tissue is thin.
C H A P T E R-42
Larger veins present with semilunar shaped folds
of tunica intima into the lumen at two sites. These
are the valves. The valves have a central core of
densely arranged elastic fibers lined by endo-
thelium on each side. Internal elastic lamina may
be seen and is indistinct.
2. Tunica media: It is a thin layer of concentrically
arranged smooth muscle fibers with collagens fibers
and elastic fibers. Larger veins have thicker tunica
media (it is still thinner than arteries). External
elastic lamina is absent.
 538 Human Anatomy For Dental Students

Fig. 42.12: Transverse section of vein (stain-hematoxylin-eosin under low magnification)

S E C T I O N-3

3. Tunica adventitia: It is the outermost connective
tissue layer made up of collagen fibers and
fibroblasts. It is thicker than tunica media.
Functional Correlation
The veins are known as capacitance vessels because
less muscular tissue allows easy expansion with
blood. Thus, they are easily compressible.
The valves in large veins allow flow of blood only
in one direction. This is useful in carrying blood
from lower limbs, as it is mostly against
gravity.
 Chapter

43
Lymphatic System
INTRODUCTION c. Spleen
d. Thymus
Lymphatic system is a closed system of vessels which
e. Bone marrow
collects the extra tissue fluid and delivers it into the blood
f. Mucosa associated lymphoid tissue
vascular system. It also provides a pathway for
circulation of leukocytes. The lymphatic tissue and
LYMPH NODES (Figs 43.1 to 43.3)
lymphoid organs associated with the vessels are
responsible for the immune system of the body. These are small oval to bean shaped bodies that are
present along the path of lymphatic vessels.
Components of Lymphatic System

C H A P T E R-43
1. Lymph and lymph vessels Structure of Lymph Nodes
a. Lymph Grossly, they appear bean shaped with an indentation
b. Lymph capillaries on one side, that is the hilum. Hilum is the site of entry
c. Lymph vessels proper and exit of blood vessels and nerves. Efferent lymphatic
d. Terminal lymph ducts (trunks) vessels also leave the node from the hilum. A number
2. Lymphoid tissue and lymphoid organs of afferent vessels enter the node through the convex
a. Primary lymphatic follicles periphery of lymph node. Each lymph node consists of
b. Lymph nodes a capsule and the gland substance.

Fig. 43.1: Transverse section through a lymph node

 540 Human Anatomy For Dental Students
A fibrous capsule invests the entire node and is
separated from the gland substance by a sub-capsular
space known as subcapsular sinus. A number of
connective tissue trabeculae extend radially into the
substance of the node from the capsule dividing it into
lobules.
Gland substance is made up of an outer cortex and
an inner medulla. Cortex is cellular and consists of
densely packed B lymphocytes with plasma cells,
macrophages and dendritic cells arranged on a
background of reticular fibres. The cells are arranged in
the form of lymphatic follicles. Primary follicles consist
of densely packed lymphocytes while secondary follicles
have a lighter staining germinal center consisting of
stimulated B lymphocytes and large plasma cells
surrounded by a zone of densely packed lymphocytes.
An inner part of cortex is madeup of a zone of T-
lymphocytes and dendritic cells. Medulla is madeup of
irregular cords of lymphocytes known as medullary
cords with intervening network of lymphatic channels
S E C T I O N-3
Fig. 43.2: Transverse section of lymph node (stain-hematoxylin-eosin under high magnification)
Fig. 43.3: Transverse section of lymph node (stain-hematoxylin-eosin under high magnification)
or sinuses. Macrophages and plasma cells are present
in medulla.
Histology of Lymph Node (Figs 43.2 and 43.3)
The outermost covering of lymph node which is
the capsule maybe seen in some sections. It is made
up of dense connective tissue consisting of collagen
fibres and few elastic fibres. It is seen as a thin
eosinophilic layers of fibres with scattered nuclei
of fibroblasts.
A number of connective tissue trabeculae are seen
to extent radially inwards from the capsule into the
substance of the node.
The parenchyma of each node can be divided into
a dark staining outer cortex and a lighter inner
medulla.
Cortex is highly cellular and is made up of
aggregates of lymphocytes on a background
meshwork of reticular fibres (reticular fibres are not

seen on routine H and E staining). The aggregates
of lymphocytes form round to oval structures
known as lymhoid follicles. Primary follicles consist
of densely packed lymphocytes while secondary
follicles have a lighter staining germinal center
consisting of stimulated B lymphocytes and large
plasma cells surrounded by a zone of densely
packed lymphocytes. Narrow clear spaces are seen
scattered between the follicle which are the
lymphatic sinuses and capillaries.
The innermost cortical area is made up of a dense
collection of lymphocytes (primarily small T
lymhocytes). These are arranged as layers of cells
without any follicular arrangement.
Medulla is made up of cords of lymphoid cells
mostly lymphocytes along with plasma cells,
Fig. 43.4: Transverse section of spleen (stain-hematoxylin-eosin under high magnification)
Fig. 43.5: Microscopic appearance of transverse section of spleen (stain-hematoxylin-eosin under high magnification)
Lymphatic System 541
macrophages and dendritic cells. The cords enclose
wide spaces known as medullary sinuses which
contain lymph.
Functional correlation: Filtration of lymph occurs in the
lymphatic sinuses of lymph nodes. They are responsible
for phagocytosis of foreign bodies and also initiate the
immune response of the body.
SPLEEN (Figs 43.4 and 43.5)
It is the largest lymphoid organ of the body.
Structure of Spleen
Spleen is an oblong shaped organ and is covered by the
serous layer of peritoneum. Below the serous layer the
spleen is enclosed by a fibrous capsule. The capsule gives
rise to a number of connective tissue trabeculae into the
substance of the spleen.
C H A P T E R-43
 542 Human Anatomy For Dental Students

Parenchyma of spleen contains two components
namely, red pulp and white pulp. The red pulp provides
for 75% of splenic volume and gives it the spongy texture
while the white pulp is seen as aggregates of lympho-
cytes scattered within the red pulp.
Histology of Spleen (Figs 43.4 and 43.5)
Following features are seen on microscopy.
A dense connective tissue capsule made up of
collagen fibres and few elastic fibres may be seen
on one end of the slide. Numerous connective tissue
trabeculae extend inwards from the capsule into
the substance of spleen.
The trabeculae are seen as dense eosinophilic
connective tissue bands with blood vessels.
The parenchyma of spleen is made up of two distinct
components namely white pulp and red pulp.
White pulp is made up of aggregates of lympho-
cytes and plasma cells in the form of follicles which
surround a small splenic arteriole. The follicles have
a characteristic light staining germinal centre made
up of larger plasma cells surrounded by dense
S E C T I O N-3
alongwith irregular cords of cells containing
lymphocytes, macrophages, dendritic cells, plasma
cells and few red blood cells and granulocytes.
These cellular cords are known as Bilroths cords.
The venous sinusoids present within the red pulp
drain into tributaries of splenic veins within the
connective tissue trabeculae.
Functional correlation: The spleen is responsible for
filtering blood via the red pulp. It also provides immune
response to various antigens via the white pulp.
THYMUS (Figs 43.6 and 43.7)
It is a symmetrical bilobed structure present in the
superior and anterior mediastinum. At birth, it is
prominent and weighs about 10 to 15gm, it is about 20
gm at puberty. It rapidly diminishes after puberty.
Histology of Thymus
Thymus is covered by a fibrous capsule. Fibrous
septae extend inwards from the capsule into the
substance of the gland and divide it into lobules.
Each lobule has an outer dark staining cortex and

staining nuclei of lymphocytes. The cut section of

an inner light staining medulla.
the arteriole is seen to be located eccentrically in
The framework of thymus is formed by epithelio-
the follicle.
cytes instead of reticular fibres and is packed with
Between the white pulp and red pulp is presents a
lymphocytes.
zone of loosely arranged lymphoid tissue with
Cortex consists of numerous closely packed small
capillaries and venus sinuses.
thymocytes or thymic (T) lymphocytes and few
Red pulp is made up of numerous venous sinosoids
macrophages, dendritic cells and epithelioid cells.
which are seen as clear spaces surrounded by a layer
Typical lymphatic follicles are not present in the
of discontinuous, elongated endothelial cells. The
thymus.
sinuses contain blood derived from terminal pencil
Medulla contains loosely arranged lymphocytes
branches of splenic arterioles. A network of reticular
and epithelioid cells. The epithelioid cells are larger
cells with reticular fibres enclose these spaces

Fig. 43.6: Transverse section of thymus (stain-hematoxylin-eosin under medium magnification)


Fig. 43.7: Transverse section of thymus (stain-hematoxylin-eosin under medium magnification)
than lymphocytes and contain vesicular nucleus.
Characteristic feature of medulla is the presence of
Hassalls corpuscles. Each corpuscle has a central
core formed by the epithelioid cells that have
undergone degeneration. This cellular debris is seen
as a pink stained hyaline mass. This mass is
surrounded by concentrically arranged epithelioid
cells.
Thymus does not receive any lymph vessels but
gives off efferent lymph vessels which lie along the
blood vessels supplying it.
After puberty the gland undergoes atrophy and the
thymic tissue is replaced by adipose and aerolar
tissue.
Mucosa Associated Lymphoid Tissue (MALT)
These are aggregates of B and T-lymphocytes
present under various mucosal surfaces. They are
seen in the mucosal walls of intestine (Payers
patches, Fig. 45.18), respiratory, reproductive and
urinary tracts.
These aggregates are seen in the lamina propria.
They are supported within a fine network of
reticular fibres. However, they are not covered by
capsule. They do not have any afferent vessels but
are drained by efferent lymphatic channels. Hence,
Lymphatic System 543
C H A P T E R-43
they do not filter lymph but are the first site of local
immune response.
Larger collections form the various tonsils in the
body namely: Palatine tonsil, lingual tonsil, etc.
Tonsils (Figs 43.8 and 43.9)
There are various collections of lymphoid tissue around
the naso-oral orifices forming the tonsils. They are
palatine, nasopharyngeal, tubal and lingual tonsils.
Tonsils are made up of lymphoid follicles and are
surrounded by a connective tissue capsule (except
lingual tonsil).
Histology of Palatine Tonsil
Palatine tonsil is lined by stratified squamous
epithelium. The epithelium forms invaginations
into the parenchyma of the tonsil which are known
as tonsillar crypts.
The parenchyma of tonsil is made up of lymphatic
follicles. Lymphatic nodules are aggregation of
lymphocytes in a meshwork of reticular fibres. Each
lymphatic nodule is made up of a central lighter
staining germinal centre consisting of lymphocytes
and plasma cells surrounded by few layers of
circularly arranged densely staining small
lymphocytes.
 544 Human Anatomy For Dental Students

Fig. 43.8: Transverse section of palatine tonsil (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3

Fig. 43.9: Transverse section of palatine tonsil (stain-hematoxylin-eosin under low magnification)

Characteristic features of tonsils

Tonsil Location Epithelial covering Capsule Number of crypts
Palatine tonsil In the tonsillar Stratified squamous non Thick dense
fossa of oropharynx keratinized epithelium connective tissue 10-120
Nasopharyngeal Roof of nasopharynx Ciliated pseudostratified Thin connective No crypts
and Tubal tonsil Lateral wall of columnar epithelium tissue
nasopharynx
Lingual tonsil Root of the tongue Stratified squamous Has no capsule One crypt
or posterior 1/3rd of epithelium which is is seen
tongue thinly keratinized

Characteristic identifying features of spleen, lymph node, thymus and tonsil

Features Spleen Lymph node Thymus Tonsil
1. Subcapsular sinus Absent Present Absent Absent
2. Eccentric arteriole in the lymphocytic follicle Present Absent Absent Absent
3. Hassalls corpuscles Absent Absent Present Absent
4. Epithelial covering of stratified squamous epithelium Absent Absent Absent Present
5. Cortex and medulla Absent Present Present Absent
6. Lymphoid follicles Present Present Absent Present
7. Cords and sinuses Present Present Absent Absent
 Chapter
44
Respiratory System
INTRODUCTION
Respiratory system is made up of a pair of lungs and a
system of tubes which serve as conduits for air to and
from the lungs to external environment. The primary
function of respiratory system is uptake of oxygen into
the body and elimination of carbon-di-oxide from the
body. The respiratory passage is divided into two parts:
1. Conducting airways, comprising of nasal cavity,
nasopharynx, oropharynx, larynx, trachea, bronchi,
bronchioles upto terminal bronchioles. These help
conduct air to and from the lungs and maintain the
air conditioning of inspired air.
2. Respiratory airways comprising of respiratory
bronchioles, alveolar ducts and alveoli. These are
involved in the actual exchange of gases (O2 and
CO2) to and from circulation.
NASAL CAVITY
It consists of a pair of cavities separated by a median
nasal septum. For anatomical details see chapter no. 28
(page no. 390).
Fig. 44.1: Respiratory mucosa of nose showing respiratory epithelium
The inner aspect of nasal cavity can be structurally
divided into three parts namely:
1. Vestibule of nasal cavity: It is the anterior most
part which communicates with external
environment. It is lined by stratified squamous
keratinized epithelium (continuation of skin of
external nose). The epithelium has variable
amounts of hair follicles known as vibrissae and
sebaceous glands. Traced posteriorly, the
C H A P T E R-44
epithelium changes to pseudostratified epithelium
without hair follicles and sebaceous glands.
2. Respiratory part (Fig. 44.1): It is lined by the
respiratory epithelium found in majority of airways.
It is made up of ciliated pseudostratified columnar
epithelium with goblet cells. A thin layer of lamina
propria made up of connective tissue fibers, blood
vessels, lymphatic plexuses, lymphocytes and
nerves lies below the epithelium. It directly attaches
to the periosteum of the underlying bone.
 546 Human Anatomy For Dental Students
Fig. 44.2: Olfactory mucosa of nose showing olfactory epithelium
S E C T I O N-3
3. Olfactory mucosa (Fig. 44.2): It is made up of
specialized epithelium, present on the roof of nasal
cavity extending to the superior concha on each
side. On high magnification and on electron
microscopy the epithelium presents with olfactory
cells (bipolar neurons), supporting cells (tall
columnar cells), basal cells (small columnar cells)
and brush cells (columnar cells with villi). Lamina
propria is a thin layer of connective tissue made up
of blood vessels, lymphatics, nerve fibers and
olfactory glands. Olfactory glands are also known
as Bowmans glands. They are branched tubulo-
alveolar serous type of glands.
Functional correlation: The epithelium of vestibule with
hair follicles and sebaceous secretions serves to entrap
and prevent the entry of large foreign particles in
inspired air. The respiratory epithelium along with its
highly vascular supply maintains air conditioning of
inspired air. The olfactory mucosa is responsible for
sense of smell.
NASOPHARYNX AND OROPHARYNX
Pharynx is a fibromuscular tubular structure.
Histology of Pharynx
On microscopy, cut section of pharynx presents with
the following four layers:
1. Epithelium: It is the innermost lining of pharynx.
The lumen is lined by respiratory epithelium in
proximal part i.e., nasopharynx and by stratified
squamous epithelium in oropharynx.
2. Submucosa: The epithelium lies over a fibrous layer
of submucosa.
3. Muscular coat: It encloses the submucosa. It consists
of an inner longitudinal layer and an outer circular
layer of striated muscle fibers.
4. Adventitia: It is the outer most layer which is made
up of loose areolar tissue with blood vessels,
lymphatics, nerves and is known as the bucco-
pharyngeal fascia.
LARYNX
It serves as a passage for air from orpharynx to trachea.
It has a tube like structure internally but externally has
a complex arrangement of plates of hyaline cartilages
(thyroid and cricoid cartilages).
Histology of Larynx
The inner lining of larynx or mucosa of larynx
consists of epithelium and lamina propria. The
epithelium lining larynx is primarily respiratory
epithelium i.e. ciliated, pseudostratified columnar
epithelium with goblet cells except over vocal cords
and oral surface of epiglottis which are lined by
stratified squamous epithelium.
Lamina propria is a thin layer of connective tissue
with blood vessels, lymphatics and nerve fibers. In
region of vestibular cords lamina propria has
 Respiratory System 547

Fig. 44.3: Transverse section of epiglottis through anterior surface

C H A P T E R-44
Fig. 44.4: Transverse section of epiglottis through anterior surface

numerous serous glands. In region of vocal cords
lamina propria has elastic fibers and striated muscle
fibers (vocalis muscle) arranged longitudinally in
anteroposterior manner.
External aspect of lamina propria presents plates
of hyaline cartilage in the region of thyroid and
cricoid cartilages.
Epiglottis (Figs 44.3 and 44.4)
Epiglottis is made up of a plate of elastic cartilage
as the core which is lined by mucosa. The mucosa
lining oral or lingual surface and part of laryngeal
surface is made up of stratified squamous
epithelium with a thin lamina propria. The mucosa
lining most of laryngeal surface of epitlottis is made
up of ciliated pseudostratified columnar
epithelium. The underlying lamina propria in this
region has mucus and serous glands in it.
TRACHEA, BRONCHI AND BRONCHIOLES
(Figs 44.5 to 44.7)
The conducting airways form a tubular passage. The
tubular structures on cut section have a lumen
surrounded by the wall which is made up of mucosa
and submucosa.
 548 Human Anatomy For Dental Students

Mucosa consists of lining epithelium and a thin layer Histology of Trachea and Extrapulmonary Bronchi
of lamina propria. Submucosa is made up connective
The lumen is surrounded by following layers:
tissue containing plates of hyaline cartilage with smooth
1. Epithelium: It consists of ciliated, pseudostratified,
muscle fibers and submucosal glands. It also contains
columnar epithelium with goblet cells.
connective tissue fibers with blood vessels, lymphatic
2. Lamina propria: It is the loose connective tissue
vessels, lymphoid tissue and nerves.
layer outer to epithelium. It is very cellular
S E C T I O N-3

Fig. 44.5: Transverse section of trachea (stain-hematoxylin-eosin under low magnification)

Fig. 44.6: Transverse section of trachea (stain-hematoxylin-eosin under low magnification)


Fig. 44.7: Transverse section of trachea (stain-hematoxylin-eosin under high magnification)
containing numerous small lymphocytes and mast
cells which extend into the basal parts of epithelium.
It also has plasma cells, eosinophils and fibroblasts.
3. Submucosa: A dense framework of elastic fibers
is present within the collagenous framework at
junction of lamina propria and submucosa. It is the
mechanical element which is responsible for elastic
recoil during expiration. The submucosa is made
up of a loose connective tissue with lymphatic
nodules (mucosa associated lymphatic tissue
MALT). It also has tubulo-acinar sero-mucinous
glands with small ducts lined by simple cuboidal
epithelium that traverse lamina propria to open
on surface of epithelium. These glands secrete
mucins, lysozymes, lactoferrin and secretory
antibodies (IgA) that provide for innate immunity
for the passage.
4. Tracheal cartilage and muscle: A C-shaped ring
of hyaline cartilage is present external to
submucosa. It covers about 2/3rd of circumference.
It is joined at its posterior ends by smooth muscle
fibers and fibroelastic tissue. The cartilage plates
decrease in width distally and also become
discontinuous in distal parts of extrapulmonary
bronchi.
5. Adventitia: It is the external most connective tissue
layer that blends with and binds the trachea and
Respiratory System 549
C H A P T E R-44
bronchi to surrounding mediastinum. It has blood
vessels, nerve fibers and lymphatic vessels
traversing through it.
Functional correlation: The cartilaginous framework
help keep the lumen of the passages open at all times.
The musculature helps regulate the flow of air during
inspiration and expiration and in cough reflex.
Histology of Bronchi and Bronchioles
(Figs 44.8 and 44.9)
The intrapulmonary bronchi are tubular structures
which branch to form smaller bronchi and finally
bronchioles. Bronchioles have an inner diameter of
5 mm.
The epithelium changes from ciliated pseudo-
stratified columnar epithelium with goblet cells in
large bronchi to simple columnar epithelium with
goblet cells. Height of cells further decreases in
smaller bronchi and becomes cuboidal in
bronchioles.
Lamina propria is seen in large bronchi and
diminishes towards smaller bronchi.
A muscular layer with smooth muscle fibers
arranged in continuous, circular fashion seen in
bronchi inner to submucosa. The quantity of muscle
fiber decrease and they become loosely arranged
in smaller bronchi and bronchioles.
 550 Human Anatomy For Dental Students

Fig. 44.8: Transverse section of Lung (stain-hematoxylin-eosin under low magnification)

S E C T I O N-3

Fig. 44.9: Transverse section of Lung (stain-hematoxylin-eosin under low magnification)

Submucosa: It is a loose connective tissue layer with
lymphoid follicles and seromucinous glands. It
diminishes as size of bronchi decreases and
submucosal glands disappear at level of
bronchioles.
As the size of bronchi decreases the cartilage layer
is made up of discontinuous cartilage plates which
decrease in size.
 Respiratory System 551

Fig. 44.10: Diagrammatic representation of respiratory tract showing alveoli and its cells

C H A P T E R-44
ALVEOLI (Figs 44.8 to 44.10)
They are the terminal air spaces that are the actual
surface of exchange of gases. They are roughly polygonal
chambers lined by flattened cells and are surrounded
by capillaries. The alveolar epithelium is made up of
two types of cells. Alveolar ducts are elongated
epithelium lined pathways ending in alveoli and
alveolar sacs. Alveolar sac are large spaces surrounded
by a group of alveoli.
Structure of alveoli (Fig. 44.10): Alveoli are lined by two
types of cells:
1. Pneumocyte-I: These are the most common cells
making the basic structure of alveoli. They are
flattened squamous cells. Fig. 44.11: Various type of cells present in respiratory tract
2. Pneumocyte-II: These are rounded cells present in
between the squamous cell. They bear microvilli
and secrete surfactant. LUNG (Figs 44.8 to 44.10)
The connective tissue between alveoli has lympho-
The lung parenchyma is made up of the broncho-
cytes, macrophages, mast cells, plasma cells and
fibroblasts. pulmonary tree accompanied by branches of pulmonary
artery and tributaries of pulmonary veins with associa-
ted lymphatics and nerves enclosed in a connective
Different Types of Cells Present in Respiratory Tract tissue framework.
(Fig. 44.11) Each lung is enclosed within a serous membrane, the
Ciliated columnar cells, brush cells, goblet cells, serous visceral peritoneum. Underlying the serosal membrane
cells, Clara cells, argyrophilic cells, pneumocyte-I and II, is a layer of connective tissue. A number of trabeculae
macrophages. extend from the connective tissue layer into the
 552 Human Anatomy For Dental Students

substance of lung dividing it into lobules. These
trabeculae carry the bronchioles and their vessels.
Histology of Lung (Figs 44.8 to 44.10)
On microscopy lung parenchyma is made up of
clusters of alveolar sac and ducts. Interspersed
between the alveoli are present respiratory
bronchioles, terminal bronchioles, bronchioles and
intrapulmonary bronchi. Branches of pulmonary
arteries and veins are seen along the bronchi and
bronchioles.
Alveolar sacs are surrounded by pulmonary
capillaries. Exchange of gases occurs across the
alveolocapillary membrane made up of:
a. Epithelium of alveoli: It consists of flat,
squamous, epithelium.
b. Basement membrane of epithelium.
c. Basement membrane of endothelium.
d. Endothelial cells of pulmonary capillary.
The table below gives an overview of the histological
structure of bronchi and bronchioles.

Characteristic histological features of different parts of airway present in the lung (Fig. 44.9)
Feature Intrapulmonary Bronchiole Terminal Respiratory Alveoli
bronchus bronchiole bronchiole
1. Epithelium Ciliated Simple columnar Simple cuboidal, Low cuboidal. Simple squamous
columnar with goblet cells goblet cells No goblet cells type with
pseudostratified are rare pneumocyte type I
with goblet cells and type II cells
2. Subepithelial Present as a Present but there Decreased in Very thin Predominantly made
connective thick layer. Has are no glands thickness. No glands of elastic fibres and
S E C T I O N-3

tissue mucus glands No glands capillaries

3. Cartilage A complete ring No cartilage No cartilage No cartilage No cartilage
of cartilage is
present
4. Smooth Several layers of Smooth muscle Gradual decrease Not present or No smooth
muscle smooth muscle content is in smooth muscle only few fibres muscle fibres
fibres are present relatively high fibres are seen present
 Chapter
45
Digestive System
INTRODUCTION
The digestive system consists of gastrointestinal tract
(alimentary tract) and associated organs like tongue,
salivary glands, liver, gall bladder and pancreas.
The proximal end of digestive system includes oral
cavity. The primary organ of oral cavity studied in
histology is tongue which is describe below.
TONGUE (Figs 45.1 to 45.2)
Tongue is made up of interlacing bundles of striated
muscle fibers covered by mucus membrane.
Histology of Tongue
The following features are seen on microscopic section:
Mucus membrane (mucosa): It is made up of:
a. Epithelium: It is predominantly stratified
squamous nonkeratinized epithelium with few
areas presenting with a thin layer of
keratinization.
Fig. 45.1: Transverse section of tongue (stan-hematoxylin-eosin under high magnification)
b. Lamina propria: It is a dense layer of connective
tissue under the epithelium, it consists of elastic
fibers, blood vessels, lymphocytes and
lymphatic plexus, nerves and lingual glands.
Note: Submucosa is absent in dorsum of tongue.
The lamina propria itself continues into the
interlacing muscle fibers. A thin submucosal
layer is however present on ventral aspect of
tongue.
Lingual papillae: These are surface projections of
C H A P T E R-45
epithelium of mucus membrane with a core of
lamina propria. They are of four types:
a. Filiform papillae: These are seen as minute,
conical projections. The epithelium is
keratinized over the filiform papillae.
b. Fungiform papillae: They appear as larger,
mushroom shaped surface projections with a
vascular core. Few taste buds are present on
their epithelial surface.
c. Foliate papillae: They are leaf like projections.
They are usually not seen in routine microscopic
 554 Human Anatomy For Dental Students
Fig. 45.2: Transverse section of tongue (stain-hematoxylin-eosin under high magnification)
slides as they are located only along the lateral
zones of the tongue. They have numerous taste
buds.
S E C T I O N-3
d. Circumvallate papillae: These are large,
cylindrical papillae, seen as dome shaped mucus
membrane projections presenting with a sulcus
on each side due to their characteristic shape.
They have numerous taste buds. They are also
only seen if cut section of tongue is taken
through an area just in front of sulcus terminalis.
Taste buds (Fig. 45.3): They are barrel shaped
structures within the epithelium. They appear as
oval, pale staining bodies, seen in the epithelium
on the lateral aspects of papillae.
Cut section through posterior 1/3rd of tongue
presents:
a. Mucosa consisting of stratified squamous
nonkeratinized epithelium.
Fig. 45.3: Taste bud
b. Lamina propria has numerous lymphoid
follicles.
c. There are no papillae but mucosal membrane
presents with irregular surface projections due
to underlying lymphoid tissue.
Musculature: Major part of tongue consists of
interlacing bundles of striated muscle fibers which
are seen in longitudinal, circular and oblique
sections.
Functional Correlation
1. Filiform papillae increase friction between tongue
and food particles and hence facilitate their
movement along with the tongue within oral cavity.
Other papillae increase surface area and provide
for taste sensations.
2. The characteristic arrangement of muscle fibers
provides flexibility and coordinated precise
movements of tongue. It plays an important role in
ingestion, mastication (chewing of food) and
deglutition (swallowing of food). It is also important
for the proper speech of an individual.
SALIVARY GLANDS
Salivary glands are compound tubulo-alveolar type of
exocrine glands. They produce and secrete saliva which
is poured by their ducts in the oral cavity. The major
salivary glands are parotid gland, submandibular gland
and sublingual gland.
Structure of salivary gland: Salivary glands are tubulo-
alveolar type of glands. Each gland is enclosed by a
connective tissue capsule which sends numerous septae
into the substance of the gland dividing it into smaller
lobules. Each lobule has two parts namely:
 Digestive System 555

1. Secretory part: It consists of acinar, tubular, tubulo-
acinar, tubuloalveolar arrangement of glands which
are separated by connective tissue septae consisting
of elastic fibers, blood capillaries, lymphatic
capillaries, lymphocytes, plasma cells, fat cells and
nerve fibers.
2. Conducting part: It is made up of ducts which are
seen interspersed between acini as small ductules
and larger ducts, interlobular and interlobar ducts
interspersed in the connective tissue septae.
Histology of Salivary Gland
1. Secretory part: The basic secretory unit of secretory
part of the gland is acini with their intercalated
ducts. Acini are of three types:
a. Serous acini (Fig. 45.4): These are spherical to
ovoid structures made up of serous cells
arranged around a small lumen. Serous cells are
pyramidal in shape with a rounded nucleus
usually situated near the basal lamina. The apex
of pyramid faces the lumen. They secrete protein
granules and hence the cytoplasm is filled with
zymogen granules located towards apex. The
tubular than serous acini. The cells are columnar
with a flat nucleus located in the centre or below
the centre, towards basal lamina when full of
mucin. The apical cytoplasm is pale as it is full
of mucinogen granules. It does not taken up
the H and E staining as mucin is usually lost
during preparing paraffin sections.
c. Mixed acini: These are usually made up of
tubuloacinar arrangement of mucus cells with
few groups of serous cells seen in the acinar part.
Serous demilunes: These are presently thought to
be fixation artifacts. Aggregates of serous cells
overlying mucus cells in one part of acini and are
known as serous demilunes. They are seen on
microscopy of sublingual and occasionally of
submandibular glands.
Myoepithelial cells (Fig. 45.6): These are flat cells
with processes that lie between the basal lamina of
epithelial cells and plasma membrane of base of
cells. They are often identified on electron
microscopy. They are contractile in nature and help
in movement of secretions of acini towards the
ductules.

C H A P T E R-45
basal area appears darker with basophilic
appearance due to nucleus while the apical areas
lighter due to presence of secretory granules that
taken up eosin stain. However, these acini stain
darker than mucus acini due to numerous
secretory granules which takes up stain.

Fig. 45.6: Diagrammatic representation of myoepithelial cell

2. Conducting part: It consists of the duct system of

the gland that conducts the secretions from acini to
the oral cavity. The various types of ducts are:
Fig. 45.4: Diagrammatic representation of serous acinus a. Intercalated ducts (Fig. 45.7): These arise from
acini. They are small ducts lined by low cuboidal
b. Mucus acini (Fig. 45.5): These are made up of cells located near acini.
mucin secreting cells arranged around a lumen.
The acini are slightly larger and appear more

Fig. 45.7: Diagrammatic representation of intercalated duct

b. Striated ducts (Fig. 45.8): These are lined by

cuboidal or columnar cells with central nucleus.
The cells present with multiple striations at the
Fig. 45.5: Diagrammatic representation of mucous acinus base seen on high magnification. On electron
 556 Human Anatomy For Dental Students

microscopy, it is seen that the striations are

actually infoldings of the basal plasma
membrane of cells which enclose mitochondria
within them.
c. Excretory ducts (Interlobular ducts): These are
small ducts which joined to form larger ducts.
They are lined by simple columnar, pseudo-
stratified columnar and stratified columnar as
Fig. 45.8: Diagrammatic representation of striated duct the size of duct increases and approaches the
oral cavity.
S E C T I O N-3

Fig. 45.9: Transverse section of parotid gland (stain-hematoxylin-eosin under low magnification)

Fig. 45.10: Transverse section of parotid gland (stain-hematoxylin-eosin under low magnification)
 Digestive System 557

Microscopic Appearance of Parotid Gland feature of parotid gland. Plasma cells secret IgA rich
(Figs 45.9 and 45.10) secretory complexes which provide local immunity.
The glandular part presents with cluster of serous
Parotid gland is a predominantly serous type of
acini arranged as lobules.
branched acinar gland.
A layer of fine connective tissue with lymphocytes
It is surrounded by a capsule of dense connective
and plasma cells and intercalated ducts of acini are
tissue. Septae arising from the capsule divide the
seen around the acini within the lobules.
gland into lobes and lobules.
The connective tissue septae contain small blood
Microscopic Appearance of Submandibular Gland
vessels (capillaries), lymphatic plexus, lympho-
(Figs 45.11 and 45.12)
cytes, plasma cells, small ducts and large excretory
ducts. Significant amount of fat cells are present in Submandibular gland is a branched tubulo acinar
the connective tissue which is the characteristic gland.

C H A P T E R-45
Fig. 45.11: Transverse section of submandibular gland (stain-hematoxylin-eosin under low magnification)

Fig. 45.12: Transverse section of submandibular gland (stain-hematoxylin-eosin under low magnification)
 558 Human Anatomy For Dental Students
Fig. 45.13: Transverse section of sublingual gland (stain-hematoxylin-eosin under low magnification)
The secretory part is made up of serous and
S E C T I O N-3
mucinous acini.
It is surrounded by a dense connective tissue layer.
Numerous septae arising from the capsule divide
it into lobules. The septae consist of blood vessels,
lymphatics, plasma cells and lymphocytes with
ducts.
Each lobule is made up of numerous serous acini
with few mucous acini. Serous demilunes are
characteristic feature of the gland. The serous cells
secret the enzyme lysozyme which inhibits bacterial
invasion.
Microscopic Appearance of Sublingual Gland (Fig. 45.13)
Sublingual gland is a branched tubulo acinar gland
made up of serous and mucus cells. It is made up
of predominantly mucous acini.
It is surrounded by a dense connective tissue layer.
Numerous septae arising from the capsule divide
it into lobules. The septae consist of blood vessels,
lymphatics, plasma cells and lymphocytes with
ducts.
Each lobule is made up of mucous tubuloacinar
glands with few serous acini.
GASTROINTESTINAL TRACT (GIT)
Structural organisation of GIT: The gastrointestinal
tract from the esophagus to anal canal is a fibromuscular
tube made up of the following four layers:
1. Mucus membrane
2. Submucosa
3. Muscularis externa
4. Adventitia or serosa
1. Mucus Membrane: It further consists of:
a. Epithelium with basement membrane: The
epithelium varies in different parts of GIT
according to the function of that part.
b. Lamina propria: It is the layer of connective
tissue that supports the epithelium. It consists
of fine collagen fibers, elastic and reticular fibers
with fibroblasts along with capillaries of blood
and lymph vessels and sensory nerve endings.
c. Muscularis mucosa: It is a thin layer of smooth
muscle fibers that is arranged is an inner circular
layer and an outer longitudinal layer. The
contractions of these fibers allow the mixing of
intraluminal food content and the ejection of
secretions of various intestinal glands.
2. Submucosa: It primarily consists of loose areolar
tissue with blood vessels and lymphatics. A
submucous plexus of nerves known as Meisseners
plexus is present circumferentially in this layer.
3. Muscularis externa: It is the definitive muscular
layer of the tract and causes the peristaltic
movements. It primarily consists of spirally
arranged smooth muscle fibers which can be
identified as an inner circular layer and outer
longitudinal layer. It is modified at sites to form
sphincters and taeniae in large intestine. A circum-
ferential plexus of nerves, myenteric plexus of
Auerbach is present between the circular and
longitudinal fasciculi of muscles.
4. Adventitia or serosa: The outermost layer of most
parts of GIT (except esophagus, posterior aspect of

ascending and descending colon) is made up of
visceral layer of peritoneum. It is seen as a single
layer of simple squamous epithelium over lying a
thin connective tissue layer. In parts which are not
intraperitoneal, adventitia forms the outermost
layer. It consists of dense connective tissue and the
branches of blood vessels, lymphatics and nerves
to the organ.
Fig. 45.14: Transverse section of esophagus (stain-hematoxylin-eosin under high magnification)
Digestive System 559
Histology of Esophagus (Fig. 45.14)
It consists of the following layers:
1. Mucosa: Lining epithelium is stratified squamous
non keratinized epithelium. The mucous membrane
is thrown into folds or papillae with a core of lamina
propria. Muscularis mucosa is not clearly defined
except its lower end. It mainly consists of
longitudinal muscle fibers of the lower end.
C H A P T E R-45
S E C T I O N-3 560 Human Anatomy For Dental Students

Fig. 45.15: Transverse section of stomach (fundus and body) (stain-hematoxylin-eosin under high magnification)
 Digestive System 561

C H A P T E R-45

Fig. 45.16: Transverse section of stomach (pyloric end) (stain-hematoxylin-eosin under high magnification)
 562 Human Anatomy For Dental Students
2. Submucosa: It has few mucus secreting tubulo-
alveolar glands and small lymphoid aggregations.
3. Muscularis externa: It consists of striated muscle
fibers in upper 1/3rd, striated and smooth muscle
fibers in middle 1/3rd and smooth muscle fibers
in lower 1/3rd.
4. Adventitia: It is the outermost layer made up of
dense connective tissue with blood vessels and
nerves.
Histology of Stomach (Figs 45.15 and 45.16)
It has the following four layers:
1. Mucosa: Mucosa is thrown into numerous gentle
folds or rugae which disappear when stomach is
distended. Lining epithelium is tall columar
epithelium with a basal oval nucleus. The apical
parts of columnar cells are filled with mucin
granules. The lining epithelium invaginates into
lamina propria at places to form pits called gastric
pits. These are lined by same tall columnar cells and
receive openings of gastric glands. Gastric glands
are tubular glands lined by following types of cells:
a. Chief cells or zymogen cells: These are cuboidal
or low columnar cells with granular, basophilic
S E C T I O N-3
cytoplasm and a central nucleus. They secrete
enzymes like pepsin.
b. Oxyntic or parietal cells: These are large ovoid
cells with bright eosinophilic cytoplasm and a
central nucleus, scattered between chief cells.
They secrete hydrochloric acid.
c. Mucus secretory cells: They are seen near the
opening of the gland and consists of tall
columnar cells with clear cytoplasm and basal
nucleus.
d. Argentaffin cells: They are few flattened
endocrine cells present at base of glands that
are seen only when stained with silver stain.
e. G cells
f. Basal cells
Lamina propria is full of these gastric glands
interspersed in connective tissue. Muscularis muco-
sae is well developed with an inner circular and
outer longitudinal layer of smooth muscle fibers.
2. Submucosa has connective tissue, blood vessels and
nerves.
3. Muscularis externa: It is made up of bundles of
smooth muscle fibres which are arranged in three
layers. Inner most layer consists of oblique
arrangement of fibres, middle layer has circularly
arranged fibres and outer most layer has
longitudinal muscle fibres. The circular fibers are
thickened and most abundant at the pyloric end
forming a sphincter.
4. Serosa (visceral layer of peritoneum): It is the
outermost covering made up of single layer of
squamous epithlieum overlying a thin layer of
connective tissue.
Difference between glands present in fundus, body
and pyloric part of stomach
Glands in fundus and body are straight. The deeper
2/3rd part of glands are secretory and upper 1/3rd are
conducting. Glands in the pyloric region are coiled and
deeper 1/3rd part are secretory and upper 2/3rd are
conducting. Glands in pyloric region primarily made of
mucus cells and few argentaffin cells.
Histology of Small Intestine (Figs 45.17 and 45.18)
The inner surface of intestine has numerous circular
folds which has a core of mucosa and submucosa (Fig.
45.17).
1. Mucosa: The lining epithelium is tall columnar
epithelium. The cells have cytoplasmic extensions
in the luminal side forming microvilli giving
appearance of brush border (seen only on electron
microscope magnification). In between columnar
cells are present mucus secreting goblet cells these
appear flask shaped, with an expanded upper end
containing mucinous granules and a flat basal
nucleus. The epithelium forms finger like project-
ions on the surface, called villi, which consist of a
core of lamina propria with few fibers of muscularis
mucosae. Villi are maximally seen in duodenum.
The lining epithelium invaginates into lamina
propria to form crypts named as crypts of
Leiberkuhn. The walls of crypts are lined by simple
columnar cells. Lamina propria extends into villi
and consists of loops of lymphatic and blood
vessels. Aggregates of lymphoid follicles called
Peyers patches are seen in lamina propria, most
common in ileum. Intestinal glands are present in
lamina propria. Muscularis mucosae is a thin layer
of inner circular and outer longitudinal muscle
fibers.
2. Submucosa: It consists of loose areolar tissue. In
duodenum, it presents with numerous acini of
tubulo-alveolar glands known as Brunners glands.
The cells lining the acini are columnar cells with a
flat basal nucleus and cytoplasm filled with mucus.
3. Muscularis externa: It consists of bundles of smooth
muscle fibres which are arranged as an inner
circular layer and an outer longitudinal smooth
muscle layer. Fibres of myenteric plexus of nerves
may be seen between the two layers of smooth
muscles.
4. Serosa (visceral layer of peritoneum): It is the
outermost covering made up of single layer of
squamous epithlieum overlying a thin layer of
connective tissue.
 Digestive System 563

C H A P T E R-45

Fig. 45.17: Transverse section of small intestine (duodenum) (stain-hematoxylin-eosin under high magnification)
S E C T I O N-3 564 Human Anatomy For Dental Students

Fig. 45.18: Transverse section of small intestine (jejunum and ileum) (stain-hematoxylin-eosin under high magnification)

Fig. 45.19: Transverse section of colon (stain-hematoxylin-eosin under high magnification)
Histology of Large Intestine
There is marked variation in structure of various parts
of intestine and is described below:
Colon (Fig. 45.19)
1. Mucosa: The lining epithelium consists of tall
columnar cells with brush border. A number of
goblet cells are interspersed in between columnar
cells. The epithelium invaginats into lamina propria
to form crypts of Leiberkuhn. Lamina propria has
connective tissue, blood vessels and scattered
lymphatic follicles. Muscularis mucosae is a thin
layer of inner circular and outer longitudinal
smooth muscle fibers
2. Submucosa has loose areolar tissue with blood
vessels and nerve fibers.
3. Muscularis externa is made up of bundles of
smooth muscle fibres that are arranged as an inner
Digestive System 565
C H A P T E R-45
circular and an outer longitudinal layer. The
longitudinal muscle is thicked at regular intervals
in the circumference to form three longitudinal
bands called taenia coli.
4. Serosa: The outermost lining consists of visceral
peritoneum in most parts except the posterior
aspects of ascending and descending colon which
are covered with adventitia.
Appendix (Fig. 45.20)
1. Mucosa: Lining epithelium consists of tall columnar
cells with few small crypts of Leiberkuhn. Lamina
propria has numerous scattered lymphoid follicles.
Muscularis mucosae is poorly defined.
2. Submucosa: It is made of loose areolar tissue and
is characterized by the presence of numerous
lymphatic nodules just below the mucosa which
may bulge into the lumen.
S E C T I O N-3 566 Human Anatomy For Dental Students
Fig. 45.20: Transverse section of appendix (stain-hematoxylin-eosin under high magnification)
3. Muscularis externa consists of a thicker inner
circular smooth muscle layer and a thinner outer
longitudinal smooth muscle layer with intervening
connective tissue. There are no taniae.
4. Serosa (visceral layer of peritoneum): It is the
outermost covering made up of single layer of
squamous epithlieum overlying a thin layer of
connective tissue.
Rectum (Fig. 45.21)
1. Mucus membrane: It presents with a number of
folds. Lining epithelium has tall columnar cells with
scattered goblet cells. It forms crypts that dips into
lamina propria, crypts of Leiberkuhn. Lamina
propria has connective tissue, lymphatics, blood
vessels and nerves. Muscularis mucosae is a thin
layer of inner circular and outer longitudinal
smooth muscle fibers.
2. Submucosa: It has connective tissue, lymphatics,
blood vessels and nerve fibers.
3. Muscularis externa: It has a well defined layer of
inner circular and outer longitudinal layer. There
are no taeniae.
4. Adventitia is the outer most connective tissue
covering except at upper anterior part of rectum
where there is serosa.
Anal Canal
1. Mucus membrane: Lining epithelium varies from
above downwards:
a. It is simple columnar epithelium with crypts of
Leiberkuhn in upper 1/3rd.
 Digestive System 567

C H A P T E R-45
Fig. 45.21: Transverse section of rectum (stain-hematoxylin-eosin under high magnification)

b. In middle 1/3rd it is made of stratified 4. Adventitia is the outermost connective tissue

squamous non keratinized epithelium. covering which contains blood vessels and nerves.
c. The lower 1/3rd it is made up of keratinized
stratified squamous epithelium. LIVER
Lamina propria and muscularis mucosae are thin
Liver is the largest gland present in the body. It is
layers.
enclosed by a thin, fibrous connective tissue capsule all
2. Submucosa: It has areolar tissue with mucus
around which is named as Glissons capsule. External
secreting glands. It presents with venous plexuses
to the capsule, a layer of mesothelium is present which
in lower .
is the visceral peritoneum.
3. Muscularis externa: In upper 3/4th, it consists of
inner well defined circular layer of smooth muscle
fibers forming internal sphincter and an outer Histology of Liver (Figs 45.22 to 45.25)
longitudinal layer. In lower 1/4th it consists of Liver is made up of parenchymal cells, connective
striated muscle fibers forming external anal tissue stroma, sinusoids, bile canaliculi, portal triads
sphincter. and tributaries of veins.
 568 Human Anatomy For Dental Students

Fig. 45.22: Transverse section of liver (stain-hematoxylin-eosin under high magnification)

S E C T I O N-3

Fig. 45.23: Transverse section of liver (stain-hematoxylin-eosin under high magnification)


Fig. 45.24: Hepatic lobule with six portal triads
On microscopic examination, characteristic feature
of liver is the polygonal (usually hexagonal) shaped
hepatic lobules made up of parenchyma. Each
lobule is separated by thin connective tissue septa.
Hepatic lobule: Each hexagonal lobule consists of
mass of cells (hepatocytes) which are arranged in
single sheets in a radial manner surrounding a
central vein. The central vein is tributary of hepatic
vein. The space between two radial sheets of hepatic
cells is occupied by sinusoids. Sinusoids are lined
by discontinuous flat epithelium and receive blood
from portal venules and hepatic arterioles. In
between the epithelium are present large deeply
staining cells, Kupffers cells. Kupffers cells are
part of the reticulo-endothelial system.
Hepatocytes are large, polygonal cells having a
large vesicular nucleus with eosinophilic
cytoplasm. Small intercellular channels are present
between two adjacent hepatocytes. These are bile
canalculi and are not seen on H and E staining
(stained by osmic acid stain).
At the corners of the polygonal lobule, are present
portal triads.
Portal triads (canals) are interlobular. Each triad
consists of a tributary of portal vein, hepatic artery
and bile duct (Fig. 45.24).
Portal lobule (Fig. 45.25) is the term given to the
polygonal territory of the liver cells centered around
a portal triad. Three adjacent hepatic lobules meet
at the portal triad. Hence, the corners of this
polygonal portal lobule will contain three
neighbouring central veins. The portal lobule
becomes clearly demarcated in conditions with high
hepatic pressure.
Digestive System 569
Fig. 45.25: Portal lobule
Liver acini (of Rappaport): This term is given to
the diamond or oval shape arrangement of
C H A P T E R-45
hepatocytes around a terminal branch of hepatic
arteriole and portal venule.
GALL BLADDER
Gall bladder is a pear shaped, hollow organ. The broad
end is like a blind pouch and the other end tapers to
form the cystic duct that joins with common bile duct.
Histology of Gall Bladder (Fig. 45.26)
The cut section of the wall of gall bladder presents the
following layers from inside outwards:
1. Mucosa: It is lined by single layer of columnar
epithelium. The cells have short microvilli at their
luminal surfaces. There are no goblet cells. A thin
connective tissue layer is seen beneath the
epithelium known as lamina propria. It is made up
of a rich network of capillaries and veins. It does
not have any lymphatics. Numerous lymphocytes
and plasma cells are present in the lamina propria.
The mucosa presents with irregular folds into the
lumen.
2. Fibromuscular coat: It lies outside the lamina
propria and is made up of bundles of collagen and
elastic fibers with smooth muscle cells. The smooth
muscle fibers are arranged in longitudinal, circular
and oblique bundles.
3. Adventitia or serosa: The external most covering
of most of gall bladder wall is a thick layer of
connective tissue made up of elastic fibers, adipose
tissue, blood vessels, lymphatics and nerves. The
 570 Human Anatomy For Dental Students

Fig. 45.26: Transverse section of gall bladder (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3

fundus of gall bladder however, presents with a
mesothelial lining consisting of flattened epithelium
over a thin connective tissue layer as the outer most
covering.
PANCREAS (Figs 45.27 and 45.28)
has an exocrine and an endocrine part. The exocrine part
produces and secretes pancreatic enzymes which are
delivered to the 2nd part of duodenum via the pancreatic
duct. The endocrine part primarily synthesizes and
secretes two hormones namely, insulin and glucagon
into the circulation.

Pancreas is an oblong shaped gland which has a broad Histology of Pancreas

medial end (head) and a gradually tapering body The major part of pancreas is occupied by exocrine
laterally which ends as the tail of pancreas. The gland part which is a tubuloacinar type of serous gland

Fig. 45.27: Transverse section of pancreas (stain-hematoxylin-eosin under high magnification)


Fig. 45.28: Transverse section of pancreas (stain-hematoxylin-eosin under high magnification)
tissue. Clusters of endocrine cells are interspersed
between the exocrine part. These clusters are more
in number in the tail region of pancreas.
Pancreas is devoid of a definitive fibrous capsule.
Parenchyma of the pancreas is seen to be arranged
in lobules surrounded by thin connective tissue
septae known as interlobular septae. These septae
consist of blood vessels, nerves and duct systems
of the gland.
The exocrine part of pancreas is predominant and
is madeup of numerous serous acini within a
delicate connective tissue network. Each acinus has
a narrow lumen which is lined by tall columnar or
pyramidal shaped cells with a basal nucleus. The
basal areas of the cells are darkly stained due to
presence of abundant rough endoplasmic reticulum
while the apices show eosinophilic stain due to
presence of zymogen granules.
Cut section of intercalated ducts (small ducts
draining acini) are seen close to acini. They are seen
as narrow spaces lined with flattened epithelium
along the acini.
Few small and large ducts are seen interspersed in
the connective tissue of parenchyma. Small ducts
Digestive System 571
C H A P T E R-45
are lined by cuboidal epithelium while larger ducts
are lined by low columnar or columnar epithelium.
Larger ducts are surrounded by loose connective
tissue containing circularly arranged smooth
muscle fibres.
The endocrine part is seen as spherical or ellipsoid
shaped clusters of cells. These clusters are known
as islets of Langerhans. They are made up of large,
spherical to polygonal cells with pale staining
cytoplasm and a central, vesicular nucleus. The
cells are arranged in cords. Each cluster is
surrounded by a network of capillaries seen as
narrow, clear spaces external to the islets. Specific
cells like cells, cells etc of the islets can only be
identified by special stains like silver stain and
Mallory Azan dye stain under high magnification
(> 360).
Functional correlation
The zymogen granules of acinar cells are packages
of various digestive enzymes in the proenzyme
(inactive) form.
The endocrine cells directly pour their secretions
into the surrounding capillaries.
 Chapter
46
Urinary System
INTRODUCTION
Urinary system is primarily concerned with removal of
end products (waste products) of metabolism and
maintaining the fluid and electrolyte balance of the body.
It consists of a pair of kidneys, a pair of ureters, one
urinary bladder and a urethra.
KIDNEYS
Each kidney is present on either side of the vertebral
column, in the retroperitoneum of posterior abdominal
wall. It extends vertically from T12 to L3 vertebra.
Structure of Kidney
Each kidney is a bean shaped organ. It is enveloped by
the perirenal fascia which is a dense connective tissue
Fig. 46.1: Structure of nephron
layer surrounded by a layer of adipose tissue. On cut
section, the kidney presents with an outer dark reddish
brown cortex and an inner, lighter medulla.
Kidney is made up of numerous uriniferous tubules
supported by fine connective tissue containing blood
vessels, lymphatics and nerves. A uriniferous tubule
consists of two parts namely:
a. Excretory part: Nephron
b. Collecting part: Collecting tubule
C H A P T E R-46
Nephron (Fig. 46.1)
Nephron is the functional unit of kidney (Fig. 46.1). There
are about 1.3 million nephrons in each kidney. Each
nephron consists of two parts namely: renal corpuscle
and renal tubule.
 574 Human Anatomy For Dental Students
1. Renal corpuscle: It is made up of a tuft of capillaries
known as glomerulus surrounded by a cup shaped,
double layered capsule known as Bowmans
capsule.
a. Glomerulus: It is made up of a plexus of
capillaries formed by afferent and efferent renal
arterioles which project into the Bowmans
capsule. It is supported by loose areolar
connective tissue known as mesangial tissue.
Capillaries are made up of fenestrated
endothelium with pores of diameter of 70 to
90 nm lying on a basement membrane. Large
irregular cells known as mesangial cells are
present inner to the basal lamina of the
endothelium of glomerular capillaries.
Mesangial cells secrete the surrounding
connective tissue known as mesangium. They
are contractile and control the blood flow
through the glomerular loop. These cells
provide structural support to the endothelium
and are also phagocytic in nature.
b. Bowmans capsule: It is the proximal dilated,
blind end of the renal tubule which is
S E C T I O N-3
invaginated by the glomerular capillaries. Thus
it is in the form of a double layered sac consisting
of a parietal layer and a visceral layer.
The outer parietal layer is made up of simple
squamous epithelium resting on its basal lamina
supported by a thin layer of reticular fibres. The
inner visceral layer is made up of specialised
epithelial cells known as podocytes. These are
polyhedral cells arranged in a discontinuous
manner over the basal lamina and have primary
and secondary processes that surround the
glomerular capillaries.
Space between the parietal and visceral layers
is known as urinary space and receives the
ultrafiltrate from the capillaries.
Filtration of blood occurs across the semipermeable
glomerular membrane which is made up of:
a. Endothelium of capillaries: it is fenestrated
with pores of 70 to 90 nm diameter.
b. Glomerular basement membrane: It is a thick
basal lamina formed by basement membrane of
endothelium and basement membrane of
podocytes.
c. Visceral layer of Bowmans capsule.
The passage of substances across this membrane
depends upon their size and electrical charges. The
membrane allows free passage of neutral
substances less than 4 nm while inhibits passage of
substances above 8 nm.
2. Renal tubule: Each renal tubule is made up of three
parts namely, proximal convoluted tubule, loop of
Henle and distal convoluted tubule.
a. Proximal convoluted tubule (PCT): It is a highly
convoluted tubule with a diameter of 40 to 60
m. It is lined by cuboidal or low columnar cells
that have a prominent brush border due to
presence of numerous microvilli. The cells have
a central euchromatic nucleus with an
eosinophilic cytoplasm. The cells show
numerous basal striations (seen on high
magnification). On electron microscopy these
striations are actually the infoldings of the basal
lamina which enclose the numerous mito-
chondria.
Functional correlation: Presence of microvilli
increases the surface area which facilitates
transport of ions and molecules. Proximal
convoluted tubules are responsible for reabsorp-
tion of 90% of the filterate.
b. Loop of Henle: It is made up of a thin descend-
ing limb, and a thick ascending limb. It varies
from 15 to 30 m in diameter. It is lined by low
cuboidal (thick ascending limb) or squamous
epithelium (thin limbs).
c. Distal convoluted tubule (DCT): It is 20 to 50
m in diameter and is lined by cuboidal
epithelium. The cells have few microvilli and
hence do not present any brush border. Basal
striations are few but longer.
Juxta Glomerular Apparatus (Fig. 46.2)
It is the term given to the collection of specialised cells
of renal tubule and the associated afferent arteriole of a
nephron. It consists of the following parts:
1. Juxta glomerular cells (JG cells): These are
modified endothelial cells of afferent arterioles.
They are seen in the anteriole just before they enter
the glomerulus. These cells are rich in endoplasmic
reticulum, mitochondria and ribosomes. These cells
synthesize and store the enzyme Renin. They are
innervated by the sympathetic nerves and respond
to pressure changes between the afferent arterioles
and interstitium of kidney. Hence, they act as
baroreceptors.
2. Macula densa cells: These are specialized tubular
cells located at the junction of thick ascending limb
of loop of Henle and distal convoluted tubule, lying
in close apposition to the afferent arteriole. They
act as chemoceptors. They respond to the changes
in Na+ load reaching them.
3. Mesangial cells or Lacis cells: These cells lie
between the capillary loops in relation to both JG
cells and macula densa cells.

Fig. 46.2: Juxta glomerular apparatus
Collecting Tubules (CT)
The distal convoluted tubules coalesce to form collecting
ducts. Each duct is about 20 mm long and passes from
cortex to medulla. It ends into the pelvic calyces of
kidneys. It is lined by cuboidal cells consisting of
principal (P) cells and intercalated (I) cells. P cells are
involved in Na+ reabsorption while I cells are concerned
with HCO3 transport.
On higher magnification following features are seen:
Histology of Kidney (Figs 46.3A, 46.3B and 46.4)
On low power microscopy (routine H and E staining)
the following features are seen:
Cut section of kidney presents with an outer cortex
and an inner medulla.
Urinary System 575
C H A P T E R-46
Cortex is made up of clusters of renal corpuscles
alongwith cut sections of various parts of the tubule.
These form the cortical labyrinths which are
separated by medullary rays. Each medullay ray is
made up of aggregations of collecting tubules and
collecting duct.
Medulla consists of mostly collecting ducts of
varying sizes alongwith few renal tubules (cut
sections of long nephrons) and fine capillary
network, the vasa recta.
Cortex presents with cut sections of clusters of renal
corpuscles. Each renal corpuscle is a round to oval
structure with a central tuft of capillaries
surrounded by a thin clear space, the urinary space
between the visceral and parietal layers of
Bowmans capsule. The clear space is outlined by a
 576 Human Anatomy For Dental Students

Fig. 46.3A: Transverse section of kidney (stain-hematoxylin-eosin under low magnification)

S E C T I O N-3

Fig. 46.3B: Transverse section of kidney (stain-hematoxylin-eosin under high magnification)

single layer of flattened epithelium which is the
parietal layer of Bowmans capsule.
Blood vessels can be identified close to the renal
corpuscles.
Cut sections of proximal convoluted tubules, distal
convoluted tubules and loop of Henle are seen
interspersed between the renal corpuscles.
Proximal convoluted tubules are relatively larger
with round, oval, irregular lumen (due to its highly
convoluted shape) lined by cuboidal to low
columnar epithelium with brush border. The cells
are large. Distal convoluted tubules are smaller with
rounded lumen surrounded by cuboidal
epithelium. The cells are smaller and hence are more
in number than the number of cells in proximal
convoluted tubules. Cut sections of loop of Henle
are identified as round to oval spaces lined by
flattened epithelium.
 Urinary System 577

Fig. 46.4: Transverse section of kidney showing cortex and medulla (stain-hematoxylin-eosin under high magnification)

Medullary rays are identified in between the
clusters of renal corpuscles and tubules. They are
seen made up of clusters of cut sections of collecting
ducts with few distal segment of convoluted
tubules. Collecting ducts have a round lumen and
are lined by flat to cuboidal epithelium.
Medulla of kidney stains lighter than cortex and is
made up of cut sections of collecting ducts of
varying sizes. The part closer to cortex consists of
cut sections of juxtamedullary nephrons
surrounded by the capillary network of vasa recta.
C H A P T E R-46
URETER
Ureters are thick walled, tubular structures that conduct
the urine produced by the corresponding kidney to the
urinary bladder.
Histology of Ureter (Figs 46.5 and 46.6)
It consists of a narrow lumen surrounded by a wall made
up of three layers. From within outwards they are:
1. Mucosa: The mucus membrane is made up of lining
epithelium known as urothelium and subepithelial

Fig. 46.5: Transverse section of ureter stain-hematoxylin-eosin under low magnification

 578 Human Anatomy For Dental Students
Fig. 46.6: Transverse section of ureter stain-hematoxylin-eosin under high magnification
S E C T I O N-3
connective tissue layer known as lamina propria.
The epithelium is transitional epithelium which is
5 to 6 layer thick. Lamina propria has predomin-
antly elastic fibers with scattered lymphocytes,
small blood vessels and nerve endings.
It is seen as a well defined layer on cut section and
is thrown into folds by the underlying lamina
propria.
2. Muscular layer or coat: It is the middle layer
consists of interweaving bundles of smooth muscle
fibers with good amount of connective tissue in
between. The muscular layer is arranged as an inner
longitudinal and an outer circular muscle layer. An
additional layer of longitudinal muscle fibers is
identified in lower 1/3rd of ureter.
3. Adventitia or outer fibrous coat: It is made of loose
connective tissue with blood vessels, lymphatic
vessels, nerve plexuses and adipose tissue merging
with surrounding tissue.
URINARY BLADDER
It is a distensible, muscular bag which acts as a reservoir
for urine. It receives openings of two ureters and
continues inferiorly (at the neck) as urethra via internal
urethral orifice.
Histology of Urinary Bladder (Figs 46.7 and 46.8)
The wall of urinary bladder is made up of three layers,
from within outwards they are:
1. Mucosa: It is made up of urothelium, i.e.,
transitional epithelium. Lamina propria is a thick
layer and consists of connective tissue fibers with
plexus of blood vessels. Few smooth muscle fibers
may be seen arranged as incomplete bands in the
lamina propria.
2. Muscular layer or coat: It is made up of interlacing
bundles of smooth muscle fibers. The fibers are
arranged in all directions, in a complex meshwork
like arrangement. However to some extent an inner
and an outer longitudinal arrangement with a
central circular arrangement of smooth muscle
fibers can be identified.
3. Adventitia: It is the outermost layer made up of
loose connective tissue derived from the
surrounding fascia. It contains blood vessels,
lymphatics, nerve fibers and adipose tissue.
The outermost layer on superior aspect of bladder
is made up of the visceral peritoneum which
consists of a single, flat layer of cells (mesothelium)
lying over a thin lamina propria.
Functional Correlation
1. Transitional epithelium is impermeable to salt and
water.
2. The detrusor muscle due to extensive interlacing
acts as a single functional unit which helps to empty
the bladder during micturition.
 Urinary System 579

Fig. 46.7: Transverse section of urinary bladder stain-hematoxylin-eosin under low magnification

C H A P T E R-46
Fig. 46.8: Transverse section of urinary bladder stain-hematoxylin-eosin under high magnification

URETHRA Histology of Male Urethra

It is a fibromuscular, tubular structure which carries
urine from bladder to exterior. In males it is a long 18 cm
tube that passes through prostate (prostatic urethra),
urogenital diaphragm (membranous urethra) and
corpus spongiosum of penis (spongy urethra) and opens
via external urethral meatus. In females it is a short, 4 cm
tube which is often embedded in a common fascia with
the lower part of anterior wall of vagina.
The wall of urethra surrounding the lumen is made up
of following layers from within outwards:
Mucosa is made up of transitional epithelium
(urothelium) in the proximal part of prostatic
urethra while in the other parts it is lined by
stratified columnar or pseudostratified columnar
epithelium with mucus secreting cells interspersed
in between. Stratified squamous epithelium is
present at external urethral orifice. A thin layer of
 580 Human Anatomy For Dental Students
lamina propria is present under the epithelium. It
has a rich vascular network in prostatic part of
urethra. Distal end of urethra is lined by stratified
squamous epithelium.
Smooth muscle coat is not well defined. Few
bundles of smooth muscle fibres may be seen in
prostatic urethra.
Outer most layer is made up of glandular part of
prostate proximally, striated or skeletal muscle
fibres in the membranous part and corpus
spongiosum in the penile part of urethra.
Histology of Female Urethra
The wall of urethra surrounding the lumen is made up
of following layers from within outwards:
S E C T I O N-3
The epithelium in proximal part is transitional
epithelium which changes to stratified squamous
epithelium distally. Stratified columnar epithelium
may also be seen in the middle part.
Lamina propria consists of well developed fibro
elastic connective tissue with numerous capillaries
and veins along with nerve plexuses.
Muscle coat is mostly made up of longitudinally
arranged smooth muscle fibres throughout the
length with few circular or oblique arranged fibers.
Striated or skeletal muscle coat is present in the
middle 1/3rd of urethra outer to smooth muscle
coat, mostly in the anterior half of circumference of
urethra.
 Chapter

47
Male Reproductive System
INTRODUCTION testis. Inner to tunica vaginalis, testis is surrounded by
a thick capsule of interlacing bundles of collagen fibers
The male reproductive organs are a pair of testes which
known as tunica albugenia. It forms a thick septum along
produce sperms. The sperms are carried by specialized
posterior border known as mediastinum testes. A
duct systems, epididymus and ductus deferens to the
number of septae pass into the substance of testis from
exterior. Accessory sex glands namely, seminal vesicles,
the mediastinum dividing the substance into numerous
prostate and bulbourethral glands produce secretions
lobules. Blood vessels, lymphatics and the duct systems
and help in nutrition and maintenance of sperms in duct
pass through the mediastinum to and from the testis.
system. Penis is the external organ that helps in
Inner to tunica albugenia is present a thin layer of
copulation and deposition of sperms (semen) into the

vagina in females.
TESTES
Testes are a pair of gonads situated in the scrotum,
suspended by spermatic cords. Each testis is invested
by tunica vaginalis externally. Tunica vaginalis is the
peritoneal covering i.e., processes vaginalis, extending
from the coelomic cavity to scrotum during descent of
C H A P T E R-47
loose connective tissue with plexus of blood vessels
known as tunica vasculosa.
Each lobule of testis consists of a group of 2-3 tubules
which produce sperms lying in a network of connective
tissue. These are known as seminiferous tubules. They
are highly convoluted in shape except at their distal ends
which lie on the posterior aspect of testis where they
form straight tubules and pass through mediastinum to
form rete testes.

Fig. 47.1: Transverse section of testis (stain-hematoxylin-eosin under low magnification)

 582 Human Anatomy For Dental Students

Fig. 47.2: Transverse section of testis (stain-hematoxylin-eosin under medium magnification)

S E C T I O N-3

Fig. 47.3: Transverse section of testis (stain-hematoxylin-eosin under high magnification)

Histology of Testis (Figs 47.1 to 47.5) A number of seminiferous tubules are seen in the
substance. They are round to oval structures with
The outer surface of testis if seen in the cut section
a central lumen. A thin layer of connective tissue is
presents with an outermost layer of flat mesothelial
seen in between the clusters of seminiferous
cells (peritoneal lining of tunica vaginalis)
tubules. Cut sections of the tubules appear in
underneath which is a thick layer of collagen
varying shapes and sizes with narrow to round to
bundles (tunica albugenia).
irregular shaped lumen due to the highly
A thin loose connective tissue with numerous blood
convoluted nature of tubules.
vessels is seen inner to collagen layer (tunica
The wall of tubules are made up of seminiferous
vasculosa).
epithelium resting on the basal lamina. A fine
 Male Reproductive System 583

Fig. 47.4: Transverse section of testis (stain-hematoxylin-eosin low low magnification)

C H A P T E R-47

Fig. 47.5: Transverse section of testis (stain-hematoxylin-eosin under high magnification)

connective tissue layer known as lamina (tunica) Seminiferous epithelium: It is made up of stratified
propria lies external to the basal lamina around each layer of spermatogenic cells alongwith supporting
tubule. cells or Sertoli cells.
 584 Human Anatomy For Dental Students
In active tubules the basal layer of epithelium has
spermatogonia which gradually mature to
spermatocytes, spermatids and finally spermatozoa
in a sequence. This forms a stratified layer of cells
from without inwards towards the lumen. The
details of spermatogenesis are given in chapter no. 55
(see page no. 645).
Sertoli cells are elongated, columnar to pyramidal
shaped cells extending from basal lamina to the
lumen and are present in between the
spermatogenic cells. They usually have an
elongated, pear shaped nucleus near the base.
Functinal correlation: They provide support, in form
of nutrition to spermatogenic cells and also remove
cellular debris by phagocytic activity. On electron
microscopy they present apical and lateral processes
that extend in between spermatogenic cells and form
intercellular junctions which act as blood testis
barrier.
Interstitial connective tissue is the peritubular
lamina propria made up of collagen fibrils,
peritubular flattened cells, vessels and nerve
plexuses. Interstitial or Leydig cells are seen
S E C T I O N-3
scattered in this tissue.
Leydig cells: These are seen as large, polygonal cells
with an eccentric nucleus and well defined nucleoli
(in high magnification). The cytoplasm appears pale
and eosinophilic.
Functional correlation: Leydig cells synthesize and
secrete testosterone which is responsible for
spermatogenesis in seminiferous tubules. The
contractions of peritubular flattened cells helps in
movement of spermatozoa and testicular fluid from
Fig. 47.6: Transverse section of epididymis (stain-hematoxylin-eosin under low magnification)
lumen of seminiferous tubules towards the duct
system.
Intratesticular ductules: Towards posterior aspect
of testis near mediastinum, the ends of seminiferous
tubules are straight and lined by simple cuboidal
epithelium (tubuli recti). These join the anastomotic
network of ductules in mediastinum known as rete
testes which are lined by low cuboidal epithelium.
At the upper pole of mediastinum emerge 15-20
efferent ductules (ductuli efferentes) that perforate
tunica albugenia and join the ducts of epididymis.
These ductules are lined by ciliated columnar
epithelium interspersed with few non ciliated
cuboidal to columnar cells and are surrounded by
a thin coat of smooth muscle fibers.
EPIDIDYMIS
It is made up of a single, highly coiled tube, known as
ductus epididymis, with the surrounding connective
tissue and vasculature. It receives the efferent ductules
from the testis. It is invested by tunica vaginalis
externally which passes from the testis except on
posterior border. It is closely related to vas deferens on
its medial side.
Histology of Epididymis (Figs 47.6 to 47.7)
It is made up of numerous closely packed, ovoid cut
sections of the ductus. Cut sections of the tube
appear in varying shapes and sizes with narrow to
round to irregular shaped lumen due to the highly
convoluted nature of the tube.
 Male Reproductive System 585

Fig. 47.7: Transverse section of epididymis (stain-hematoxylin-eosin under high magnification)

Wall of the duct is made up of pseudostratified endocytosis of fluid to remove cellular debris from

columnar epithelium surrounded by smooth muscle
fibres.
Pseudostratified columnar epithelium consists of
tall columnar cells known as principal cells and
smaller rounded cells known as basal cells scattered
in between the principal cells. The principal cells
present a brush border towards lumen, seen on high
magnification. On electron microscopy the brush
border is seen to be made up of microvilli known as
stereocilia.
Functional correlation: Principal cells are
responsible for absorption (hence they have
microvilli) of fluid from testicular secretions,
C H A P T E R-47
seminal fluid and secretion of glycoproteins for
maturation of spermatozoa. Basal cells are the
precursors of the principal cells.
A thin layer of circularly arranged smooth muscle
fibers are presents around the basal lamina of the
epithelium.
The tubules are separated by thin layer of loose
connective tissue with blood and lymphatic vessels.
DUCTUS DEFERENS
It is also known as vas deferens and is the distal
continuation of ductus epididymis. It is a straight,

Fig. 47.8: Transverse section of ductus deferens (stain-hematoxylin-eosin under low magnification)
 586 Human Anatomy For Dental Students

Fig. 47.9: Transverse section of ductus deferens (stain-hematoxylin-eosin under high magnification)
S E C T I O N-3

Fig. 47.10: Transverse section of ductus deferens (stain-hematoxylin-eosin under high magnification)

muscular tube that extends from the tail of epididymis Histology of Vas Deferens (Ductus Deferens)
and opens into the prostatic urethra along with duct of (Figs 47.8 to 47.10)
seminal vesicle. It presents a narrow lumen surrounded by a thick wall
made up of the following layers:
 Male Reproductive System 587

1. Mucosa: It is made up of simple columnar epithelium
proximally and pseudostratified columnar
epithelium with brush border (stereocilia) distally.
A thin layer of lamina propria with elastic fibers is
present under the epithelium. The mucosa presents
infoldings of the epithelium with a central core of
lamina propria into the lumen (these seen as
longitudinal mucosal folds on gross examination).
This gives a star shaped appearance to the lumen of
the duct.
2. Muscular coat: It is made up of relatively thick layer
of smooth muscle fibers arranged as inner circular
sheets and outer longitudinal sheets. In proximal
part, an additional innermost layer of longitudinal
sheets of smooth muscle fibers is seen.
Functional correlation: Vas deferens act as conducting
passages for the sperms. Presence of abundant
musculature is responsible for peristaltic movements
that help to expel spermatozoa distally during
ejaculation.
SEMINAL VESICLES
Each seminal vesicle is a sacculated structure made up of
an irregularly coiled tube. It is located posterior to base of
bladder. The upper end is a blind pouch and the lower

C H A P T E R-47
Fig. 47.11: Transverse section of seminal vesicle (stain-hematoxylin-eosin under low magnification)

Fig. 47.12: Transverse section of seminal vesicle (stain-hematoxylin-eosin under high magnification)
 588 Human Anatomy For Dental Students

Fig. 47.13: Transverse section of seminal vesicle (stain-hematoxylin-eosin under low magnification)

end narrows to form a straight tube which joins the distal PROSTATE
end of vas deferens to form the ejaculatory duct.
S E C T I O N-3

It is a pyramidal shaped glandular organ with a

fibromuscular coat present. It lies just distal to the neck
Histology of Seminal Vesicles (Figs 47.11 to 47.13) of bladder, surrounding the most proximal part of male
Cut section through a seminal vesicle reveals the urethra.
following features on microscopy. Prostate is made up of 30-50 branched tubuloalveolar
A number of round, ovoid to elongated cut sections glands with good amount of fibromuscular tissue. It is
of the tube are seen with irregular lumen (though a encapsulated with a thin fibrous capsule (derived from
number of lumen are seen, they belong to a single pelvic fascia) that encloses a rich plexus of prostatic veins
tube which is coiled upon itself). internally. The capsule sends in numerous septae into
The wall of seminal vesicle is made up of the the gland that divide it into lobules.
following layers from within outwards,
1. Mucosa: It is made up of mostly pseudostratified Histology of Prostate (Figs 47.14 to 47.16)
non-ciliated columnar epithelium with few
The glandular parenchyma is made up of numerous
cuboidal cells overlying the basal lamina. A thin
follicles of variable shapes and sizes which are seen
layer of lamina propria is present outer to the basal
as round, oval, tubular, branched tubular structures
lamina . Lamina propria is made up of elastic fibers.
with irregular lumen.
The mucosa presents numerous irregular infoldings
The gland follicles are lined by simple columnar
into the lumen creating a labyrinthine pattern.
epithelium with few areas of pseudostratified
2. Muscular coat: It is made up of a thin layer of smooth
columnar or cuboidal epithelium.
muscle fibers which are arranged in an inner circular
The lumen is irregular as the lining epithelium is
and an outer longitudinal manner.
thrown into folds. There may be present small
3. A connective tissue layer lies between the adjacent
collections of eosinophilic material known as
cut sections and it has blood vessels and lymphatics.
corpora amylacia in the lumen of an occasional
Functional correlation: The secretory cells of seminal
follicle. These are calcified proteinaceous secretions
vesicles contain numerous secretory granules (seen on
and are seen more often in the elderly.
electron microscopy) and produce several proteins,
The follicles are separated by a delicate network of
fructose, inositol, and prostaglandins. The secretions are
connective tissue with smooth muscles fibers and
in the form of a thick yellow fluid and which contributes
blood vessels.
upto 85% of seminal fluid. They do not store sperms. The
Ducts of prostate glands are seen in between clusters
musculature helps to propel the secretions into the
of follicles. They are rounded structures with a
ejaculatory duct during ejaculation.
central lumen. The lining epithelium of the ducts is
 Male Reproductive System 589

Fig. 47.14: Transverse section of prostate gland (stain-hematoxylin-eosin under low magnification)

C H A P T E R-47
Fig. 47.15: Transverse section of prostate gland (stain-hematoxylin-eosin under medium magnification)

made up of two layers of cells, inner columnar and
basal cuboidal cells.
An irregular slit like cut section of prostatic urethra
may be seen in cut sections of prostate including it.
Three zones of prostatic glands can be identified
around the urethra. These are
1. Paraurethral zone made up of mucosal glands
having small ducts.
2. Central or transitional zone which is made up
of branched glands and ducts opening into
prostatic sinuses and colliculus seminalis.
3. Outer peripheral zone made up of long
branched glands with long ducts opening into
prostate sinuses.
Functional correlation: Prostate gland secretes prostatic
acid phosphatase, fibrinolysins, citric and prostate
specific antigen. These enzymes are pumped from lumen
of the gland follicles and prostatic ducts into prostatic
urethra by the contractions of the fibro-muscular stroma
of prostate during ejaculation. Fibrinolysin helps to liquefy
the semen after ejaculation.
 590 Human Anatomy For Dental Students

Fig. 47.16: Transverse section of prostate gland (stain-hematoxylin-eosin under medium magnification)
S E C T I O N-3

PENIS nework of septae extend from the tunica albugenia

Penis is a cylindrical organ that is made of three elongated
erectile masses attached to the perineum on one side with
a free ending pendulous body. These erectile masses are,
a pair of corpora cavernosa and one corpus spongiosum.
Each corpora cavernosa arises from crus penis on
ischiopubic ramus and pass forwards, in close opposition
throughout the length, enclosed in a common fibrous
envelope. The ventral aspect, known as urethral aspect,
has a median groove which lodges the corpus
spongiosum arising from bulb of penis. Corpus
spongiosum is surrounded by its own fibrous capsule.
The three corpora are enclosed by skin. Urethra passes
through corpus spongiosum.
inwards surrounding clusters of spaces septae are
made of collagen fibers, elastic fibers and smooth
muscle fibers, with nerves and lymphatics.
Cut section of spongy part of urethra is seen around
the central part of corpora spongiosum.
A layer of connective tissue with collagen fibers and
blood vessels is seen to enclose the three corpora
external to the tunica albugenia.
The external most covering structure is skin.
Functional correlation: During erection these vascular
spaces fill up with blood and expand resulting in the
erected positon of penis.

Histology of Penis (Fig. 47.17)

The cut section of penis presents
pair of ovoid masses of erectile
tissue dorsally, the corpora caver-
nosa and a median, ventral ovoid
mass of corpus spongiosum.
Each corpora is surrounded by
dense sheath of collagen fibers,
elastic fibers and few smooth
muscle fibers known as tunica
albugenia. The tunica albugenia
of corpus spongiosum is thinner.
Each ovoid erectile tissue mass is
characterized by presence of
network of vascular spaces lined
by endothelium i.e., flat,
squamous epithelium. A delicate Fig. 47.17: Transverse section of penis (stain-hematoxylin-eosin under medium
magnification)
 Chapter

48
Female Reproductive System

INTRODUCTION 2. Myometrium: It is the thick muscular layer of wall

Female reproductive organs consist of uterus with two
uterine tubes, a pair of ovaries and vagina. The chapter
also includes mammary glands, placenta and umbilical
cord.
UTERUS
Uterus is a thick walled, pear shaped organ with a
narrow central cavity situated in the pelvis of females,
of uterus.
3. Perimetrium: It consists of the outer layer of visceral
peritoneum covering the uterus. In lower part of
anterior surface of uterus the outer most layer is
adventitia (as it is not covered by peritoneum).
Microscopic Structure of Endometrium
Endometrium or mucosa of uterus is made up of

C H A P T E R-48
between urinary bladder and rectum. It is the organ
epithelium and lamina propria.
which receives fertilized ovum and provides a bed for
The epithelium consists of simple columnar
the growth, and development of the fetus. It can be
epithelium with interspersed ciliated columnar cells
divided anatomically and structurally into two parts:
and secretory cells.
1. Body of uterus: It is the larger, pear shaped upper
Lamina propria is a well developed layer of
part.
connective tissue. It is also named as endometrial
2. Cervix of uterus: It is the smaller, cylindrical lower
stroma. It is made up of highly cellular loose
part of uterus, that extends from body of uterus and
connective tissue with blood vessels and lymphatic
opens into the vagina.
vessels.
Histology of Body of Uterus (Figs 48.1 and 48.2) The epithelium invaginates into the stroma to form
The wall of uterus is composed of three layers namely: simple tubular endometrial glands. The glands are
1. Endometrium: It is the mucosal layer of uterus. seen as tubular spaces perpendicular to surface

Fig. 48.1: Transverse section of uterus (proliferative phase) (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3 592 Human Anatomy For Dental Students
Fig. 48.2: Transverse section of uterus (proliferative phase) (stain-hematoxylin-eosin under low magnification)
epithelium in between stromal tissue. They enlarge
and become tortuous in shape, filled with secretions
during the secretory phase of menstrual cycle (that
is after ovulation under influence of progesterone).
The endometrium undergoes cyclical changes
during the menstrual cycle and can be divided into
two zones:
a. Pars functionalis: It is the superficial zone of
endometrium which is shed during
menstruation. It is made up of endometrial
epithelium with subjacent lamina propria
containing superficial or distal parts of uterine
glands. The pars functionalis increases in
thickness during the menstrual cycle with the
increase in stromal blood vessels and glands.
b. Pars basalis: It is the deeper zone present just
inner to the myometrium. It consists of
endometrial stroma and proximal parts of
endometrial glands. It is not shed during
menstruation and helps in regeneration of pars
functionalis.

Functional correlation: The endometrium is 12 mm
thick just after menstruation. It is made up of cuboidal
cells with short straight glands and dense thin lamina
propria. Under effect of estrogen the endometrium
proliferates and is lined by columnar epithelium with
long tubular and branched glands. The stroma increases
wtih lengthening of spiral arteries. After ovulation the
glands accumulate secretions and spiral arteries show
coiling.
Microscopic Structure of Myometrium
It is the thickest layer of wall of uterus. It is made
up of numerous smooth muscle fibers. It lies
between the endometrium and perimetrium.
Smooth muscle fibers are arranged into an inner
and an outer layer of longitudinal muscle bundles
with a middle layer of smooth muscle fibers
arranged in circular and spiral fashion. The middle
layer is thickest and has numerous blood vessels
and lymphatic vessels.
In between the muscle fiber bundles is present loose
connective tissue with rich network of blood
vessels, lymphatic vessels and nerves.
Functional correlation: The musuculature undergoes
hypertrophy and proliferation during pregnancy to
accommodate the growing fetus. It functions as a
syncytium undergoing regular rhythmic contractions
during labour to expel the fetus. Retraction of the
musculature after delivery allows the uterus to get back
to its original size.
Microscopic Structure of Perimetrium
In most cross sections, the outermost coat of uterus is
seen to be made up of a single layer of flattened
mesothelial cells with a thin layer of loose connective
tissue underneath (mesothelium).
Histology of Uterine Cervix
The wall of cervix is made up of mucosa
surrounded by a coat of fibroelastic tissue.
Mucosa of endocervix is lined by single layer of
columnar cells interspersed with few areas of
ciliated columnar cells. The ectocervix is lined by
stratified squamous non keratinized epithelium
which is continuous with the vagina. Area of
transformation zone, where the lining changes from
simple columnar to stratified squamous epithelium
may be seen.
The endocervical epithelium invaginates into the
stroma and forms branched tubular glands. These
are seen as irregular, narrow to wide spaces
surrounded by secretory columnar cells within the
stromal tissue.
Female Reproductive System 593
Outer coat is made up of dense connective tissue
with a network of elastic fibers. It has few
interspersed bundles of smooth muscle fibers.
An occasional wide space filled with eosinophilic
material may be seen lined with flattened cells.
These are nabothian cysts. These occur due to
blockage of of surface opening of the cervical gland
leading to accumulation of secretions within. They
are more commonly seen under transformation
zones or stratified squamous epithelium, i.e.,
ectocervical area.
Functional correlation: The endocervical glands secret
mucus that helps in sperm motility. The mucosa of cervix
does not undergo significant change during menstrua-
tion. The elastic component allows the cervix to expand
during labour.
UTERINE TUBES (Figs 48.3 and 48.4)
They are delicate, tubular structures with a narrow
lumen. One tube arises from each of the lateral angles
of uterus at junction of fundus and body of uterus and
passes laterally towards the ovary.
C H A P T E R-48
Histology of Uterine Tubes
The wall of uterine tubes present the following three
layers from within outwards:
1. Mucosa: It is made up of epithelium and lamina
propria. The epithelium consists of simple, tall
columnar epithelium. It is mostly made up of
ciliated columnar cells with few interspersed non
ciliated cells. The latter are known as peg cells and
are secretory in nature.
Lamina propria is a layer of fine connective tissue
under the basal lamina. It has numerous blood and
lymphatic capillaries.
The mucosa is thrown into numerous folds into the
lumen that give a characteristic appearance to the
lumen. These mucosal folds are longitudinally
placed along the length of tube and are more
numerous in ampulla and infundibular regions of
the tube. There is no submucosa.
2. Muscular coat: This layer consists of bundles of
smooth muscle fibers arranged as an inner circular
(or spiral) muscle layer and an outer longitudinal
muscle layer.
3. Serosa: This is the outermost layer of tubal wall which
is made up of mesothelium single layer of flatte-
ned cells overlying a thin layer of connective tissue.
Functional Correlation
1. The non ciliated peg cells are active around
ovulation and produce secretion that provide
nutrition to the ovum (secondary oocyte) as it passes
in the tube.
 594 Human Anatomy For Dental Students

Fig. 48.3: Transverse section of uterine tube (proliferative phase) (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3

Fig. 48.4: Transverse section of uterine tube (proliferative phase) (stain-hematoxylin-eosin under low magnification)

2. The coordinated movements of the cilia of the ciliated OVARIES

cells help to move the secondary oocyte from infudi-
They are a pair of reproductive organs of females.
bulum of tube to the uterine opening of the tube.
Ovaries are ovoid structures, located one on each side
3. Propulsion of oocyte is also aided by the
in the ovarian fossa on lateral pelvic wall fascia. They
characteristic arrangement of smooth muscle fibers.
 Female Reproductive System 595

appear pearly white and have a lobulated external
surface (due to repeated ovulation) in adult women.
Histology of Ovaries (Figs 48.5 to 48.8)
The cut section of ovary has a characteristic appearance:
Outer surface is covered by a single layer of
cuboidal epithelium known as germinal epithelium.
Some parts may show flattened epithelium.
Underneath the epithelium is present a thick layer
of collagenous tissue known as tunica albugenia.
The inner parenchyma is divisible into an outer
cortex and an inner medulla.
Cortex of ovary: It forms the major part of ovary
and is made up of numerous ovarian follicles in
various stages of development, scattered within a
dense stroma made up of collagen fibers, stromal
cells which appear as fusiform fibroblast like cells
and few strands of smooth muscle fibers.
The various follicles identified are:

C H A P T E R-48
Fig. 48.5: Transverse section of ovary (stain-hematoxylin-eosin under low magnification)

Fig. 48.6: Transverse section of ovary (stain-hematoxylin-eosin under medium magnification)

 596 Human Anatomy For Dental Students
Fig. 48.7: Transverse section of ovary (stain-hematoxylin-eosin under low magnification)
S E C T I O N-3
Fig. 48.8: Transverse section of ovary (stain-hematoxylin-eosin under medium magnification)
a. Primordial follicles: They are made up of a
primary oocyte (25 m) surrounded by a single
layer of flat, squamous cells. Primary oocyte
appears as a small round cell with eccentric
nucleus. These follicles are scattered just below
tunica albugenia.
b. Primary follicles: These are first stage of
activated follicles which start growing under
influence of gonatotrophins. Primary follicles in
various stages of development are seen:
Early primary follicles: The ova is larger
(30-50 m) and is surrounded by multiple
layers of cuboidal cells.
Late primary follicles: The ova increases in
size further (50-80 m). The outer follicles
cells show stratification and consists of outer
most layer of columnar cells with inner
multiple layers of cuboidal cells. These are
now known as granulosa cells. The stromal
cells surrounding the follicle start
proliferating and form a layer of spindle
shaped cells. This layer is known as theca
interna. It also contains fibroblasts, collagen
fibers and network of capillaries. External to
this is a second layer made up of connective
tissue cells (fibroblasts), smooth muscle fibers
and collagen fibers. This is the theca externa.
Another characteristic feature of primary
follicles is presence of zona pellucida. It is
seen on high magnification as a darkly
stained membrane surrounding the plasma
membrane of oocytes (ova) and forms the
inner most layer of granulosa cells.

c. Secondary follicles: They are also known as
antral follicles. They are characterized by
presence of clear fluid filled cavities amongst
the layers of granulosa cells. These follicles
lie deeper in cortex. The follicle size is about
200m with ova of 80 m size. The cavities
coalesce to form a single antrum. Thus late
secondary follicles are bigger in size (about
1 cm) with a central fluid filled space
surrounded by outer layer of granulosa cells,
stratum granulosum. The ova is placed
eccentrically in the cavity surrounded by a
cap of granulosa cells now named, the
cummulus oophorus. The theca interna and
theca externa are seen as well defined layers.
d. Tertiary follicle: It may be seen in sections
of ovary if taken at the time of ovulation. It is
usually a single large follicle, about 2 cm in
size, located close to the surface of cortex. It
resembles secondary follicle except that the
antral cavity is larger and the stratum
granulosum is thinner. The mature ova, now
120-125 m is usally seen in centre of antral
cavity, not attached to the stratum granulosum.
It lies free surrounded by cells of cummulus
oophorus which are seen to be arranged
radially around it and hence are named corona
radiata. Zona pellucida is identified.
Medulla: It is a small central core of the ovary made
up of loose connective tissue with elastic fibers and
smooth muscle fibers with numerous blood vessles,
lymphatics and nerves.
Functional Correlation
1. Under the influence of gonadotropins, mainly FSH
the primordial follicles start growing to form
Fig. 48.9: Longitudinal section of vagina (stain-hematoxylin-eosin under medium magnification)
Female Reproductive System 597
primary follicles. The theca interna cells have LH
receptors and start producing androgens under
influence of LH which diffuse to the granulosa cells
where they are taken up and transformed to
estrogen. Estrogen has a role in stimulating
endometrial proliferation.
2. Zona pellucida starts appearing in early primary
follicle. It is a thick layer made up of extra-cellular
proteoglycan rich material secreted by maturing
ova external to its basal lamina. It persists 5-6 days
after ovulation. Mature functional spermatozoa
bind to the zona pellucida receptors for triggering
the acrosome reaction which facilitates their entry
across zona pellucida. Many spermatozoa may
penetrate zona pellucida but only one can fertilize
the ova.
3. The primary oocyte in tertiary follicle completes its
first meiotic division to form one large secondary
oocyte (haploid cell) and a small first polar body.
The secondary oocyte gets arrested in metaphase
of 2nd meiotic division which is completed only
after fertilization.
C H A P T E R-48
VAGINA
Vagina is a fibromuscular, tubular passage that extends
from cervix to exterior i.e., the introitus (vestibule).
Histology of Vagina (Fig. 48.9)
The cut section of wall of vagina presents with the
following layers on microscopy:
1. Mucosa: It is the innermost layer. It is made up of a
thick layer of stratified squamous nonkertinized
epithelium overlying a lamina propria. The
epithelial cells appear empty as the cells are filled
 598 Human Anatomy For Dental Students
with glycogen which is lost in preparation of tissue.
Nuclei are present in all layers of epithelium. There
is no keratin. There are no glands in vagina. The
lamina propria is loose connective tissue with
predominantly formed by elastic fibers. This
underlying connective tissue layer forms
projections called papillae and this gives rise to
numerous folds of mucosa placed transversely in
the walls of vagina. They are known as rugae.
2. Muscular layer: It is made up of mostly longitu-
dinally arranged smooth muscle fibers and
relatively indistinct circularly arranged smooth
muscle layer inner to it. In section obtained from
external most part of vagina a layer of striated
muscle fibers belonging to bulbospongiosis muscle
is present outermost.
3. Adventitia: This is the outer most layer made up
of dense connective tissue with numerous elastic
fibers that provide strength and elasticity to vagina
besides blood vessels, lymphatics and nerves.
Functional correlation: As there are no glands in vaginal
S E C T I O N-3
wall the secretions of cervical glands and the greater and
lesser vestibular glands help lubricate mucosal lining of
vaginal wall. During menstrual cycle in the follicular
phase the vaginal epithelium accumulates glycogen
under influence of estrogens. The cells are continuously
desquamated or shed into lumen and the glycogen is
utilized by the bacteria present in vagina (Doderlines
bacteria) which form lactic acid and help maintain an
acidic pH of vagina. This acidic medium helps provide
first line of defence against bacterial infections.
Fig. 48.10: Transverse section of mammary gland (during proliferation and early pregnancy) (stain-hematoxylin-eosin under
medium magnification)
MAMMARY GLANDS
Mammary glands are a pair of modified sweat glands
that develop under the influence of sex hormones. In
males they remain rudimentary while in females during
puberty they increase in size under influence of estrogen
and progesterone due to growth of glandular tissue and
deposition of adipose tissue and connective tissue.
Structure of Female Mammary Gland
The mammary gland is lined by skin and is made
up of about 15-20 lobes separated by bands of
fibrous connective tissue from under skin of nipple.
Each lobe is made up of a branched tubuloalveolar
gland separated by dense connective tissue with
abundant adipose tissue.
The external most layer is skin. It consists of
epidermis made up of stratified squamous
keratinized epithelium and dermis with hair
follicles, sebaceous and sweat glands. The skin from
nipple and areola is highly pigmented and has
prominent sebaceous glands (known as glands of
Montgomery).
Just beneath the skin of areola and nipple are
radially arranged smooth muscle fibers all around
the circumference. They help in erection of nipple.
The alveoli and their ductules are arranged into
lobules with each lobule separated by their
connective tissue. The ducts from various lobules
join together to form the lactiferous duct which
drains at the nipple. Each lactiferous duct presents
a dilatation just below areola known as lactiferous
sinus and then constricts to open at the nipple. Each
lactiferous duct is lined by variable epithelium
 Female Reproductive System 599

Fig. 48.11: Transverse section of mammary gland (during lactation) (stain-hematoxylin-eosin under low magnification)

C H A P T E R-48
Fig. 48.12: Transverse section of mammary gland (during lactation) (stain-hematoxylin-eosin under medium magnification)

which changes from external most stratified
squamous to stratified cuboidal in lactiferous sinus
to simple columnar and cuboidal in rest of duct
system. Myoepithelial cells are present between
duct epithelium and their basal lamina.
Histology of Breast (Fig. 48.10 and 48.12)
On microscopy the breast tissue presents with following
features
The gland presents lobules of glandular tissue
separated by dense connective tissue. The
connective tissue appears as eosinophilic band of
collagen fibers with scattered nuclei of fibroblasts
along with aggregates of fat cells (adipose tissue).
The lobules are made up of ductal elements
without sections of ducts of varying sizes lined by
cuboidal or columnar epithelium separated by
loose connective tissue made up of fine collagen
fibers and scattered lymphocytes and plasma cells.
The glandular element is made up of alveoli which
are not clearly identified in an inactive mammary
gland.
During pregnancy and lactation the mammary
gland undergoes changes that are characterized by
proliferation of glandular elements. The ducts
branches and alveoli start developing. The
connective tissue element decreases. Alveoli
increase in size and start accumulating secretions
in their lumen. The lobules increase in size with
 600 Human Anatomy For Dental Students
ducts and alveoli accompanied by intense infiltera-
tion of lymphocytes, plasma cells and eosinophils.
The breast shows variation in structure with
numerous lobules separated by connective tissue
bands. Lobules present cut sections of ducts of
varying sizes which end blindly. The larger ducts
are lined by stratified cuboidal or tall columnar
epithelium while smaller ducts are lined by simple
cuboidal epithelium. Lobules are made up of
glandular elements which vary in structure
depending on age, menstrual cycle, pregnancy and
lactation and following menopause. In active breast
the terminal ends of ductules branch and form
alveoli.
Intralobular tissue is loose allows expansion of
lobule during activity as pregnancy and lactation.
Interlobular tissue is dense with variable amount
of adipose tissue.
PLACENTA
Placenta is the organ which is responsible for exchange
of metabolites, gases and nutrients between maternal
circulation and fetal circulation during pregnancy. It is
derived from trophoblasts (syncytotrophoblasts and
S E C T I O N-3
cytotrophoblasts) of the blastocyst.
Structure of Placenta
Placenta is a disc shaped organ that is about 500 gm in
weight with diameter of 15 to 20 cm and thickness of 10
to 40 mm.
The fetal surface is smooth, covered with amnion.
The umbilical cord is attached around the center of this
fetal surface under the amnion. It presents branching
blood vessels in a thick connective tissue mass. This is
the chorionic plate derived from extra embryonic
mesoderm. The maternal surface is irregular and can
be divided into about 15 to 20 lobes known as cotyledans
Fig. 48.13: Chorionic villi of placenta at term
(stain-hematoxylin and eosin high magnification)
by shallow fissures which are made by placental septae
that arise from maternal side and are incomplete. The
septae are made up of collagen fibers and extracellular
matrix with decidua, blood vessels and fetal cytotro-
phoblast cells.
Histology of Placenta (Fig. 48.13)
On microscopy the following features are seen:
The amnion may be seen in some sections. It is seen
as a layer of simple cuboidal epithelium overlying
on thin loose connective tissue layer
Chorionic plate is seen as a dense layer of
connective tissue with branches of umbilical
vessels.
Most part of section presents with clusters of cut
sections of chorionic villi of varying sizes.
Branches of umbilical vessels two umbilical artery
and one umbilical vein surrounded by connective
tissue are seen in between clusters of villi.
UMBILICAL CORD
Umbilical cord is the connecting stalk between fetus and
placenta. The cord of a term baby usually varies from
45-50 cm in length with 1.5-2 cm diameter. It is
enveloped by the amnion and encloses primarily the
umbilical vessels, two umbilical arteries and one
umbilical vein in mass of mesenchyme. The
mesenchyme is derived from somatopleuric and
splanchnopleuric extra embryonic mesoderm. These
fuse together to form a loose connective tissue mass
known as Whartons jelly.
Histology of Umbilical Cord (Fig. 48.14)
Cut section of umbilical cord presents with:
A mesenchymal core consisting of loose connective
tissue made up of interconnecting meshwork of fine
collagen fibers in extracellular matrix (made up of
glycosaminoglycans).
Scattered elongated nuclei of fibroblasts are seen
between fibers.
Three umbilical vessels, two umbilical arteries and
one umbilical veins are present. The lumen is
narrow with a well developed muscular coat. The
arteries and vein appear similar in structure.
Fig. 48.14: Transverse section of umbilical cord
(stain-hematoxylin and eosin high magnification)
 Chapter

49
Endocrine System
INTRODUCTION part of larynx and upper part of trachea. The two lobes
are connected with a thin band of tissue known as
Endocrine system consists of organs that synthesize and
isthmus. The gland is enclosed in a fibrous connective
secrete hormones. The hormones work as signals that
tissue capsule which sends extensions in the form of
control activities of various cells, tissues and organs of
septae into the gland substance and divides it into
the body. The secretions of the endocrine glands are
irregular lobules of variable sizes.
directly poured into the vascular system and carried to
the target organs. Hence, unlike exocrine glands they
do not have ducts to carry the secretion. They are also Histology of Thyroid Gland (Figs 49.1 to 49.5)
known as ductless glands. Thyroid gland is surrounded by a thin, fibrous

C H A P T E R-49
capsule. The capsule sends in numerous septae into
THYROID GLAND the parenchyma of gland and divides it into lobules.
Each lobule is made up of cluster of follicles.
Thyroid gland is an important endocrine gland which
Thyroid follicles are the structural and functional
is located on the anterior aspect of lower part of neck
units of thyroid gland.
(level of C5 to T1). It secrets two important hormones,
Each follicle is a spherical or ovoid shaped space
thyroid hormones and calcitonin.
which is lined by simple cuboidal epithelium
resting on the basal lamina. Cytoplasm of these
Structure of Thyroid Gland cuboidal cells is light basophilic with a prominent
Thyroid gland is a bilobed gland located on anterior round central nucleus. Lumen of each follicle is
aspect of lower part of neck overlapping sides of lower filled with a homogenous, eosinophilic appearing

Fig. 49.1: Transverse section of thyroid gland (stain-hematoxylin-eosin under low magnification)
 602 Human Anatomy For Dental Students

material known as colloid. Inactive follicles are
lined by tall columnar cells and have little colloid
material in the lumen.
The follicular epithelium consists of two types
of cells:
1. Principal cells or follicular epithelial cells. These
are cuboidal to columnar cells which are
responsible for production of thyroid hormones.
2. Parafollicular or C-cells. These are small,
rounded pale staining cells present either singly
or in small clusters between follicular cells over
S E C T I O N-3
the basal lamina. They do not reach the lumen
of follicle. The C-cells produce the hormone,
calcitonin.
Follicles are surrounded by a delicate connective
tissue stroma with rich capillary network. The
stroma also contains lymphatic channels and nerve
plexuses.
Functional Correlation
1. The central colloid matter of the thyroid follicle is
an iodinated glycoprotein, the thyroglobulin. It acts

Fig. 49.2: Transverse section of thyroid gland (stain-hematoxylin-eosin under low magnification)

Fig. 49.3: Transverse section of thyroid gland (stain-hematoxylin-eosin under high magnification)
 Endocrine System 603

Fig. 49.4: Transverse section of thyroid gland (stain-hematoxylin-eosin under low magnification)

Fig. 49.5: Transverse section of thyroid gland (stain-hematoxylin-eosin under high magnification)
as an inactive storage form of thyroid hormone
secreted by follicular cells. It has several enzymes
that are responsible for iodination of its tyrosine
residues. It thus acts as a template for synthesis of
the thyroid hormones, T3 and T4. The hormones are
poured into the surrounding capillary network and
carried to the circulation.
2. The C-cells synthesize and secrete the hormone
calcitonin.
PITUITARY GLAND
The gland is a ovoid body of about 0.5-1 gm situated in
the hypophyseal fossa on superior surface of body of
C H A P T E R-49
sphenoid bone which is attached by a small stalk, known
as infundibulum, to the hypothalamus at the base of the
brain.
Structure of Pituitary Gland
It is made up of two parts which are structurally and
functionally different. These are:
1. Adenohypophysis (anterior lobe): It is made up of
highly vascular glandular tissue. It can be further
divided into two parts namely pars distalis (pars
anterior) and pars intermedia. Part of pars distalis
which surrounds the infundibular stem is named
as pars tuberalis.
 604 Human Anatomy For Dental Students

2. Neurohypophysis (posterior lobe): It is made up of
neuro-secretory axons. It includes pars posterior
(neural lobe), infundibular stem and median
eminence.
Histology of Pituitary Gland (Figs 49.6 to 49.8)
Pituitary presents the following features:
Adenohypophysis: It presents with glandular
(epithelial) cells arranged in cords or small nests
S E C T I O N-3
within a loose connective tissue framework. The
groups of cells are separated by thin walled vascular
sinusoids and capillaries. The capillaries are seen
as relatively large spaces lined by flattened
epithelium, around the clusters of cells.
The secretory cells are primarily of two types,
according to their ability to taken up stain:
a. Chromophils: They have high affinity for
staining dyes and hence appear darkly stained.
They are further divided into acidophils (cells

Fig. 49.6: Transverse section of pituitary gland (hypophysis cerebri) (stain-hematoxylin-eosin under low magnification)

Fig. 49.7: Transverse section of pituitary gland (hypophysis cerebri) (stain-hematoxylin-eosin under high magnification)
 Endocrine System 605

Fig. 49.8: Transverse section of pituitary gland (hypophysis cerebri) (stain-hematoxylin-eosin under low magnification)

staining with eosin) and basophils (cells staining medium polygonal cells. This part represents the

with haemotoxylin).
b. Chromophobes: These have minimal affinity for
dyes. They are seen as polygonal shaped, pale
staining cells within clusters of secretory cells.
Acidophils and chromophobes are predominant in
most parts of pituitary while basophils are more in
number in the central part of the gland.
Pars intermedia: This presents with spaces usually
filled with colloid material (eosinophilic
homogenous material) surrounded by small to
C H A P T E R-49
rudiment of Rathkes pouch and is rudimentary in
humans.
The pars intermedia is identified as a narrow band
of tissue between pars distalis and pars nervosa. It
is characterized by presence of small cleft like spaces
(remnants of Rathkes pouch) filled with
eosinophilic colloid material surrounded by
epitheloid cells arranged in cords or follicles.
Basophil cells and chromophobes are predominant
in this region.

Cell type Cell character Hormone secreted Stimulatory or inhibitory factor

Somatotrophs: Form 50% of
cells population stain with
orange-G dyes
Lactotrophs: Form 15-20%
of all population stain with
azocarmine dye
Corticortrophs: Form
15-20% of all population
PAS positive
Gonadotrophs: Form
10% of all population
PAS positive
Thyrotrophs: Form
5% of cell population
Oval, medium size Growth hormone 1. Growth hormone
cells with central releasing factor
nucleus. They are 2. Somatostatin (Growth
acidophilic. hormone inhibitory factor)
Large polygonal cells Prolactin 1. Dopamine (Prolactin
with oval nucleus. inhibitory factor)
They are acidophilic. 2. Thyrotropin releasing
hormone
Medium size ACTH CRH (Corticotropin releasing
polygonal cells with hormone)
round eccentric. They
are basophilic.
Small oval cells with LH and FSH 1. Gonadotropin releasing
eccentric nuclei. hormone
They are basophilic 2. Gonadotropin inhibitory
hormone
Large, polygonal cells TSH Thyrotrophin releasing
with eccentric nucleus hormone (TRH)
They are basophilic.
 606 Human Anatomy For Dental Students
Pars tuberalis may be seen in some histology
sections. It is actually an extension of pars distalis
that surrounds the infundibular stem. It is a highly
vascular area with numerous sinusoids and
capillaries. It is identified by the presence of
numerous blood filled spaces lined with flattened
epithelium. These are fenestrated sinusoidal
capillaries which are surrounded by clusters of
secretory cells and few undifferentiated cells.
Pars nervosa is made up of numerous non
myelinated nerve fibers. These are axons of the
neuronal cells of nuclei of hypothalamus. It is
identified as a pale staining area made up of thin
fibers and few cells. It does not have endocrine cells.
The cells of pars nervosa are mostly pituicytes.
These are small round to oval cells with irregular
cytoplasmic processes resembling astrocytes. The
processes lie in close proximity to vascular
capillaries. They are considered as the supporting
neuroglial cells. On routine H and E staining, they
are seen as flattened nuclei present parallel to the
axons. Few fibroblasts and mast cells may also be
seen in between. A network of fenestrated
S E C T I O N-3
capillaries are seen in between axons and cells.
On electron microscopy, it can be seen that the
neurons are filled with secretory granules and they
end on the capillaries. Pituicytes are also associated
with capillaries.
A thin irregular connective tissue capsule may be
seen as outermost envelope in some sections.
Functional correlation: These neuronal axons actually
carry the neurosecretory vesicles containing the
Fig. 49.9: Transverse section of pineal gland (stain-hematoxylin-eosin under low magnification)
hormones, ADH (vasopressin) and oxytocin from
hypothalamus to the pituitary. They are released from
posterior pituitary into the circulation when desired.
PINEAL GLAND (EPIPHYSIS CEREBRI)
Pineal gland is a small, cone shaped body attached to
the diencephalon, located at posterior wall of 3rd
ventricle, between the two superior colliculi.
Histology of Pineal Gland (Figs 49.9 and 49.10)
The external most covering is the piamater which
is seen on one side of the section as a thin layer of
connective tissue.
A number of fine connective tissue trabeculae
extend from the capsule into the gland parenchyma
dividing into irregularly arranged lobules. The
septae are identified by the presence of vascular
capillaries and nerve fibres extending in them.
The parenchyma of pineal gland is made up of
primarily pinealocytes which are arranged as cords
or clusters with few astrocyte like neuroglial cells.
The parenchyma has two types of cells:
1. Pinealocytes: They are most predominant. They
are actually modified neuronal cells. They
appear rounded with a spherical euchromatic
(light staining) nucleus and prominent
nucleolus. They have two or more cellular
processes (seen on special stains on electron
microscopy.
2. Neuroglial cells mainly astrocytes. They are
rounded cells with intensely stained nuclei.

Fig. 49.10: Transverse section of pineal gland (stain-hematoxylin-eosin under high magnification)
On electron microscopy the pinealocytes present
numerous dendritic cytoplasmic processes with
knob like endings associated with the surrounding
blood capillaries. These processes and endings have
endoplasmic reticulum, mitochondria and secretory
vesicles which suggest a strong neuroendocrine
activity of the gland.
A network of capillaries is present in between the
cell clusters.
An additional feature that may be seen, is the
presence of basophilic stained material, seen as
basophilic spots, within the parenchyma. These are
just calcified concretions and are known as brain
sand or corpora arenacea.
Fig. 49.11: Transverse section of parathyroid gland (stain-hematoxylin-eosin under low magnification)
Endocrine System 607
PARATHYROID GLANDS
C H A P T E R-49
Parathyroid glands are minute ovoid structures present
along the posterior aspect of thyroid gland within its
capsule. They are four in number, two superior and two
inferior parathyroids.
Histology of Parathyroid Glands (Figs 49.11 and 49.12)
The parathyroid gland is surrounded by a thin
connective tissue capsule which may be seen on one
side of slide.
A number of incomplete septae extend into the
parenchyma dividing it into lobules, though not
well defined.
 608 Human Anatomy For Dental Students

Fig. 49.12: Transverse section of parathyroid gland (stain-hematoxylin-eosin under high magnification)

The parenchyma of parathyroid gland consists of Histology of Suprarenal (Adrenal) Gland (Figs
S E C T I O N-3

closely packed glandular cells arranged in cords 49.13 to 49.16)

and clusters.
The suprarenal gland presents an outermost layer
Two types of epitheloid cells can be identified:
of thick connective tissue capsule.
1. Principal or chief cells: They are small, round
A number of thin connective tissue septae pass
to polygonal cells with prominent central
inwards from surface to the parenchyma carrying
nucleus and lightly staining eosinophilic
blood vessels and nerves inside.
cytoplasm (due to presence of secretory
The parenchyma of adrenal gland can be divided
vesicles). They are arranged in columns and are
into two parts:
seen as cords of darkly stained clusters of
1. Adrenal cortex: It lies subjacent to the capsule
rounded nuclei. They form most of the
and forms 90% of total parenchyma of gland.
parenchyma. These cells secrete parathormone.
2. Adrenal medulla: It lies inner to cortex:
2. Oxyphilic or eosinophilic cells: They are fewer
Adrenal cortex: The cortex further consists of three
in number and are arranged singly or small
zones of cells from without inwards, these are:
clusters. The cells are rounded, larger than
a. Zona glomerulosa: It is a narrow region of
principal cells with a distinct eosinophilic
small, polyhedral cells arranged in ovoid
cytoplasm (due to presence of numerous
clusters beneath the capsule. The cytoplasm of
mitochondria) and a centrally placed small
zona glomerulosa cells is basophilic with a
nucleus. They appear around puberty and are
densely staining central nucleus. A network of
non secretory in nature.
fenestrated sinusoidal capillaries surrounds
A dense network of capillaries in a thin layer of
each cluster.
connective tissue is present in between various
b. Zona fasciculata: It is the thick (forms 80% of
columns of cells.
cortex), middle zone. It is made up of larger,
Scattered adipose cells are also seen within the
polyhedral cells with central light staining
parenchyma. These increase with age.
nucleus. The cells are arranged in one to two
cell thick columns separated by fenestrated
ADRENAL GLANDS
sinusoidal capillaries arranged parallel to the
Suprarenal or adrenal glands are small glandular columns.
structures, present in relation to superior pole of kidney. c. Zona reticularis: It is the thin innermost zone
One gland is present on each side and lies enclosed of cortex consisting of small round cells
within the renal fascia. Right adrenal gland is triangular arranged in cords. The nuclei are central and
in shape while left is semilunar. deeply stained.
 Endocrine System 609

Fig. 49.13: Transverse section of suprarenal gland (stain-hematoxylin-eosin under low magnification)

C H A P T E R-49
Fig. 49.14: Transverse section of suprarenal gland (Adrenal) (stain-hematoxylin-eosin under medium magnification)

Adrenal medulla: It is the innermost, central
part of gland. It is characterized by presence of
large, pale staining epitheloid cells with large
nuclei. The cells are arranged in clusters or small
cords and separated by wider venous sinusoids
(blood filled spaces lined by flattened
epithelium.) The cells are named chromaffin
cells. A few ganglion cells are seen interspersed
between the chromaffin cells. They are larger,
polyhedral, neuronal cell bodies. Axons of these
cells extend to the cortex along the connective
tissue septae.
 610 Human Anatomy For Dental Students

Fig. 49.15: Transverse section of suprarenal gland (Adrenal) (stain-hematoxylin-eosin under high magnification)
S E C T I O N-3

Fig. 49.16: Transverse section of suprarenal gland (Adrenal) (stain-hematoxylin-eosin under high magnification)
Chapter
50
Review of Histology
Q. What are basiophilic and acidophilic
structures?
Ans. The components that stain with basic dyes are
known as basophilic while the components that
stain with acidic dyes are known as acidophilic.
Q. Enumerate basophilic structures of cells?
Ans. 1. Nucleic acids (nucleus) and rough
endoplasmic reticulum of cells
2. Glycosaminoglycans and acid glycoproteins
of extracellular matrix.
Q. Give examples of basic dyes?
Ans. 1. Haemotoxylin
2. Toludine blue
3. Methylene blue
Q. Enumerate acidophilic structures of cells?
Ans. 1. Cytoplasm, mitochondria, lysosomes and
secretory granules of a cell
2. Collagen fibers of extra cellular matrix.
Q. Give example of acidic dyes?
Ans. 1. Eosin
2. Orange G
3. Acid fuchsin
Q. What is the resolving power of human eye?
Ans. The resolving power of human eye is 0.2 mm.
Q. What is the resolving power of compound light
microscope.
Ans. Modern day light microscopes have a resolution
limit of 0.2 to 0.4 m. This is approximately
1/10th of the diameter of the human
erythrocyte. These microscopes utilise day light
for illumination or have an inbuilt electrical
illumination system.
Q. What are the types of light microscope?
Ans. They are of two types:
1. Simple microscope
2. Compound microscope
a. Bright-field type microscope (Fig. 36.1)
b. Phase contrast microscope
c. Differential interference contrast micro-
scope
d. Fluorescence light
Q. What are characteristic features of epithelium?
Ans. 1. It is made up of one or more layer of cells.
2. The epithelial cells lie on a basement
membrane or basal lamina.
3. There is minimal or no intercellular
substance. The cells are closely opposed to
each other by means of specific cell to cell
adhesion molecules. Thus, they are seen as
sheets of cells which act as barriers.
4. Epithelium is avascular. Cells get their
C H A P T E R-50
nutrition through diffusion from underlying
capillaries.
Q. What are functions of basement membrane?
Ans. 1. It acts as a barrier providing the property of
selective permeability to the epithelium.
2. Basal lamina helps anchor the cells to each
other at their bases and to the underlying
connective tissue. This helps to provide
stability to the sheets of cells.
3. It plays a role in development and repair of
epithelial cells, also influencing their organi-
zation and cell division.
Q. What are exocrine glands?
Ans. The secretions of these glands are carried
through ducts to the target surface, e.g., parotid
gland.
Q. What are endocrine glands?
Ans. The secretions of these glands are directly
poured into the circulatory system. These are
ductless glands. Secretion is carried to the distant
target cells by circulation, e.g., Pituitary gland.
Q. What are paracrine glands?
Ans. These glands are similar to endocrine glands but
their secretions diffuse locally to cellular targets
in the immediate surrounding.
Q. What are merocrine glands?
Ans. The cells of merocrine glands produce secretions
that are packaged into vesicles. The vesicle
membranes fuse with the plasma membrane to
release their contents to the exterior, e.g., simple
sweat glands.
 612 Human Anatomy For Dental Students

Q. What are apocrine glands?
Ans. In these glands the secretions are present as free
droplets within the cytoplasm of the cells and
some of the apical cytoplasm along with cell
membrane is also extruded along with the
secretions, e.g., mammary gland.
Q. What are holocrine glands?
Ans. Cells are filled with secretory products and the
entire cell disintegrates to release its secretions,
e.g., sebaceous glands.
Q. What are types of cells present in connective
tissue?
Ans. Resident cells:
1. Fibroblasts
2. Adipocytes
3. Mesenchymal stem cells
4. Cartilage has special resident cells named
chondroblasts and chondrocytes while bone
is made up of osteoblasts, osteocytes and
osteoclasts.
Migrant cells: These cells are:
1. Macrophages or histocytes
2. Plasma cells
S E C T I O N-3
4. In the form of ligaments, binds the bones.
5. Attaches muscle to the bone with the help of
tendons and facilitates a concentrated pull.
6. Facilitates venous return in lower limb with
the help of deep fascia.
7. Helps in wound repair due to the presence
of fibroblasts.
8. Aponeurosis is a regular dense connective
tissue associated with the attachment of
muscles. It is made up of densely arranged
collagen fibres.
Q. Describe the microscopic structure of skeletal
muscle fiber.
Ans. Skeletal muscle fiber is a multinucleated,
elongated, cylindrical shaped cell surrounded
by cell membrane named sacrolemma. Each
fiber is made up of myofibrils formed by
filaments of contractile proteins. Thick filaments
are made up of myosin and thin filaments are
made up of actin, troponin and tropomyosin.
They are arranged in a manner that gives rise
to appearance of alternate light and dark bands
under microscope known as cross-striations

3. Mast cells (Fig. 40.5).

4. Pigment cells Q.
5. Lymphocytes and monocytes Ans.
6. Basophils
7. Neutrophils
8. Eosinophils Q.
Q. Where do you find type I collagen fibres? Ans.
Ans. They are found in bone, fibrocartilage, dermis
of skin, connective tissue, tendon, ligaments,
fasciae, aponeurosis and meninges. Q.
Q. Where do you find type II collagen fibres? Ans.
Ans. These fibres are present in hyaline cartilage and
vitreous humor.
Q. Where do you find type III collagen fibres?
Ans. They are present in spleen, ligaments, bone
marrow, liver, glands and basement membrane.
Q. Where do you find type IV collagen fibres? Q.
Ans. They are present in the basal lamina of basement Ans.
membrane and in the capsule of lens of eye.
Q. Where do you find mucoid tissue?
Ans. It is the fetal or embryonic type of connective
tissue which consists of mesenchymal fibroblasts
and loose areolar connective tissue with mucoid
matrix. It is present in Whartons jelly, vitreous
body of the eye, nucleus pulposus of interverte-
bral disc and in the pulp of developing tooth.
Q.
Q. What are functions of connective tissue?
Ans.
Ans. 1. Binds together various structures.
2. Facilitates passage of neurovascular bundle. Q.
3. In the form of deep fascia, connective tissue Ans.
keeps the muscles and tendons in position, Q.
gives origin to muscles and forms different Ans.
functional compartment of muscles. Q.
What is A-band?
It is a relatively darker band which is formed
by the thick filaments made up of myosin
(Fig. 40.2).
What is I-band?
It is a relatively lighter band, formed by arrange-
ment of thin filaments, that is actin and
tropomyosin (Fig. 40.2).
What is H-band?
It is a slightly lighter band seen in the middle of
A band. This is the area of relaxed muscle consis-
ting of thick filaments only, where there is no
overlapping of thick and thin filaments. The
width of H-band decreases during contraction
of muscle (Fig. 40.2).
What are M and Z-lines?
M-line: It is the line seen in centre of H-band.
Myosin filaments extend on either side from this
line.
Z-line: It is a dark line seen in the centre of I-
band. It appears dark due to a high refractive
index. The actin filaments extend from each side
of Z-line towards the myosin filaments till edge
of H-zone. When muscle contracts the two
adjacent Z-lines move closer.
Which muscle cell has nucleus in the periphery?
Skeletal muscle.
Which muscle cell is spindle shaped?
Smooth muscle.
Intercalated disc is a feature of which muscle?
Cardiac muscle (Fig. 40.13).
What are neuroglial cells?

Ans. There are primarily three types of glial cells in
central nervous system known as neuroglia.
These are:
1. Astrocytes
2. Oligodendrocytes
3. Microglia
Q. What are functions of astrocytes?
Ans. The astrocytes form an interconnected network.
They are believed to:
1. Support the neuronal tissue
2. Regulate the movement of metabolites and
ions there by maintaining the intercellular
communication and activity of neurons.
3. Help to maintain the tight junction of
capillaries that form blood brain barrier.
4. They proliferate at site of injury and form glial
scar.
Q. What are functions of oligodendrocytes?
Ans. Oligodendrocytes provide myelin sheath to
nerve fibers. Myelin is a lipid rich lipoprotein
structure that surrounds the axons and helps in
insulation of the electrical conduction through it.
Q. What are functions of microglia?
Ans. Their exact function is unclear but they are seen
to proliferate at sites of injury or damage in the
central nervous system, may be helpful in repair.
Q. What are functions of Schwann cell?
Ans. They lay down the myelin sheath in peripheral
nervous system. One Schwann cell myelinates
part of only one axon while one oligodendroglia
can myelinate many axons. Schwann cells also
proliferate at site of nerve injury and provide a
path for regeneration of nerve while oligoden-
droglia are not involved in nerve repair
(Fig. 41.2).
Q. What are nodes of Ranvier?
Ans. The myelin sheath is interrupted between
adjacent Schwann cells. These points are called
nodes of Ranvier and at these points the
neurilemma is in contact with the axon.
Q. Does myelin sheath stain with H and E stain?
Ans. No, Myelin sheath is made up of phospholipids
and hence can be stained with osmic acid stain.
It is not seen on routine H and E staining. On
osmic acid staining, it appears as a thick, black
band surrounding a lighter, central axon.
Q. Describe the histological structure of a blood
vessel?
Ans. Blood vessels are tubular structures with a
central lumen surrounded by three concentric
layers of vessel wall. The three layers are (from
within outwards) (Fig. 42.1)
1. Tunica intima: It consists of following layers:
a. Endothelium
b. Subendothelial layer
c. Internal elastic lamina
Review of Histology 613
2. Tunica media: It is the middle layer and is
made up of concentrically arranged layers of
smooth muscle fibers with variable amounts
of elastic fibers and reticular fibers.
3. Tunica adventitia: It is the outermost
connective tissue layer made up of primarily
collagen fibers (type I) and few elastic fibers
and large vessels. It presents with fibroblasts,
macrophages, nerve fibers and blood and
lymphatics supplying it.
Q. Describe the histological features of capil-
laries?
Ans. 1. They have a very narrow lumen surrounded
by a single layer of flat, polygonal cells lying
on a basal lamina.
2. Basal lamina is surrounded by a thin layer of
subendothelial connective tissue.
3. On electron microscopy few flat cells known
as pericytes may be seen inserting between
endothelial cells and basal lamina.
Q. Name the types of capillaries?
Ans. Capillaries are of three types: The following
features are primarily identified on electron
C H A P T E R-50
microscopy:
1. Continuous capillaries: These are the most
common type of capillaries found in various
tissues (Fig. 42.8).
2. Fenestrated capillaries: These present with
wide fenestrations, upto 80 to 100 nm, in
walls of endothelial cells. These act as
channels across capillary walls. The basal
lamina is intact all over. They are typically
seen in endocrine glands and gastrointestinal
tract where active secretion or absorption of
metabolites is happening (Fig. 42.9).
3. Discontinuous capillaries: They are also
known as sinusoids and are found in liver,
spleen and bone marrow. These have a
relatively large lumen, 30 to 40 , surrounded
by discontinous arrangement of endothelial
cells (Fig. 42.10).
Endothelial cells are made up of single layer
of relatively larger, spindle shaped cells with
intercellular gaps. The basal lamina is also
deficient at such gaps.
Q. What are features of venules?
Ans. They usually have a lumen of 10 to 30 m with
thin walls made up of one layer of flat, oval to
polygonal cells lying on basal lamina and a thin
layer of adventitia with connective tissue
consisting of collagen fibers and fibroblasts.
Muscular layer consisting of smooth muscle
fibers is present in larger venules above 50 m
in diameter.
Q. What are identifying features of lymph node
on histological section?
 614 Human Anatomy For Dental Students
Ans. 1. Outer most covering is connective tissue
capsule with presence of subcapsular sinus
2. It is divided into outer cortex and inner
medulla (Fig. 43.1).
3. Lymphoid follicles are present in cortex
4. Medulla is made up of cords of cells with
intervening network of venous sinuses.
Q. What are identifying features of thymus gland
on histological section?
Ans. 1. Outer most covering is connective tissue capsule
2. Cut section shows number of lobules
surrounded by connective tissue septae
3. Each lobule has an outer cortex made up of
closely packed lymphocytes and an inner
medulla made up of loosely arranged
lymphocytes and ephithelioid cells. It does
not show typical lymphatic follicles.
4. Hassalls corpuscles are identified in medulla
Q. What are identifying features of spleen on
histological section?
Ans. 1. Outermost covering is connetive tissue
capsule. There is no subcapsular sinus.
2. Parenchyma of spleen is made up of red pulp
and white pulp. It is not divided into medulla
S E C T I O N-3
and cortex.
3. Red pulp is made up of a network of reticular
fibers with cells arranged as irregular cords
known as Bilroths cords. These enclose
spaces containing blood.
4. White pulp is made up lymphoid follicles,
consisting of densely packed lymphocytes
and plasma cells.
5. An eccentrically placed cut section of splenic
arteriole is seen in the lymphoid follicle of
white pulp
Q. What are identifying features of palatine
tonsils on histological section?
Ans. 1. Presence of dense connective tissue capsule
without subcapsular sinus .
2. Mucosa is lined by non-keratinized stratified
squamous epithelium and forms crypts.
3. Presence of lymphoid follicles under the
mucosal lining.
4. Absence of cortex and medulla.
Q. Where do you find olfactory epithelium?
Ans. Olfactory epithelium is present on the roof of
nasal cavity and extends to the superior nasal
concha on each side.
Q. What is lining epithelium of respiratory tract?
Ans. Pseudostratified ciliated columnar epithelium
with goblet cells.
Q. Which type of epithelium is present in
epiglottis?
Ans. Anterior surface of epiglottis is covered by non
keratinized stratified squamous epithelium and
posterior surface is covered by pseudostratified
ciliated columnar epithelium with goblet cells.
Q. Where do you find stratified squamous epithe-
lium in respiratory tract?
Ans. Vocal cords.
Q. What all types of cells are present in respira-
tory tract?
Ans. Ciliated columnar cells, brush cells, goblet cells,
serous cells, Clara cells, argyrophilic cells,
pneumocyte-I and II macrophages.
Q. What is the function of type II pneumocytes?
Ans. Pneumocyte type II cells secrete surfactant.
Q. Relatively high smooth muscle content is seen
in which part of lung?
Ans. Bronchiole.
Q. Low cuboidal epithelium is present in which
part of respiratory tract?
Ans. Respiratory bronchiole.
Q. What are cells present in pituitary gland?
Ans. Chromophil cells (acidophil cells, basophil
cells), chromophobes and folliculostellate cells.
Q. Which cells secrete calcitonin?
Ans. Parafollicular cells in thyroid gland.
Q. What are cells present in parathyroid gland?
Ans. Chief cells and oxyphil cells.
Q. What are zones of suprarenal cortex?
Ans. Zona glomerulosa, Zona fasciculata and Zona
reticularis.
Q. Which cells secrete testosterone?
Ans. Leydig cells or interstitial cells present in the
interstitium of seminiferous tubules of testis.
Q. Which cells secrete estrogen?
Ans. Theca interna and outer granulosa cells of
developing follicles in ovary secrete estrogen.
Q. Which cells secrete progesterone?
Ans. Corpus luteum of ovary, placenta of pregnancy,
adrenal cortex and testes in small amounts.
Q. Describe the histological structure of gastro-
intestinal tract?
Ans. GIT is a fibromuscular tube from esophagus to
anal canal and is made up of four layers
(Fig. 45.14):
1. Mucus membrane
2. Submucossa
3. Muscularis externa
4. Adventitia or serosa
Q. What are cells present in gastric glands?
Ans. Chief cells or zymogen cells, oxyntic or parietal
cells, mucus secretory cells, argentaffin cells, G-
cells, and basal cells.
Q. What is characteristic feature of duodenum on
histological section?
Ans. Columnar epithelium with microvilli, presence
of villi and presence of Brunners glands in
submucosa (Fig. 45.17).
 Section-4: Genetics
51. Cell Division .............................................................. 617-622
52. Cytogenetics, Chromosome and Chromosomal
Abnormalities ............................................................ 623-630
53. Molecular Basis of Genetics ..................................... 631-636
54. Review of Genetics.................................................... 637-640
 Chapter

51
Cell Division
CELL CYCLE Each chromosome consists of a pair of chromatids
It is the period extending from the formation of a cell M phase cyclin is accumulated
from its parent cell to its own division that further gives Enzyme P34 kinase is present
rise to daughter cells (Fig. 51.1). The cell cycle is divided G2 phase
into four phases namely: It is a short phase that precedes the M phase
1. G1 phase Cell prepares for division and nuclear membrane
2. S phase breakdown occurs
3. G2 phase Onset of chromosome condensation is seen
4. M phase M phase cyclin is accumulated

C H A P T E R-51
G1, S and G2 phases together form the interphase. This Enzyme P34 kinase is present
period lies between successive mitosis (M phase) in M phase
dividing cells. Complete cell cycle is seen in dividing In this phase the cell divides and gives rise to two
cells while in non-dividing cells, e.g., neurons, the cells daughter cells
arrest in G1 phase and enter the G0 or non-cyclic stage. Enzyme P34 kinase is present
Characteristic features of different phases of cell cycle
G1 phase Regulation of Cell Cycle
It starts at the end of M phase
Cell cycle is regulated by the protein cyclin and the
Metabolites required to complete cell division are
enzyme P34 kinase. Decision for division of a cell is taken
formed in this phase
during the G1 phase.
This phase regulates the division of cells
G1 phase cyclin is accumulated
Enzyme P34 kinase is present CELL DIVISION
S phase Cell division involves both division of nucleus called
This phase is present between G1 and G2 phases karyokinesis and division of cytoplasm known as
DNA replication occurs and by the end of this phase cytokinesis. There are two types of cell division namely:
DNA content of the cell is doubled Mitosis
Meiosis or maturation division

MITOSIS
It is also known as homotypical or equating division
because the two daughter cells obtained after mitotic
division of a cell contain the same number of chromo-
somes and the identical distribution of genes as the
parent cell. It occurs in most somatic cells and in
immature germ cells (Fig. 51.2) .

Characteristic Features of Mitosis

Mitosis results in 2 daughter cells.
Fig. 51.1: Cell cycle
 618 Human Anatomy For Dental Students
Fig. 51.2: Stages of mitosis
S E C T I O N-4
Chromosome number remains the same in
daughter cells as in the parent cell.
Mitosis is preceded by DNA synthesis in S-phase
and the dividing cell becomes tetraploid with each
chromosome consisting of two identical strands
known as chromatids.
It is responsible for the growth of an individual and
helps in repair and replacement of old cells.
The duration of mitosis is generally 1 to 2 hours.
Mitosis can be further divided into the following
four successive phases primarily based on the
nuclear changes seen in each.
Stages of Mitosis (Fig. 51.2)
1. Prophase
2. Metaphase
3. Anaphase
4. Telophase
Prophase (Fig. 51.2)
Nuclear Changes
Individual chromosomes are visualized due to
condensation.
Each chromosome is made up of two chromatids
joined at the centromere.
Nucleoli and nucleolar RNA disappear from
cytoplasm.
Nuclear envelope disintegrates into small vesicles
and releases chromosomes into the cytoplasm.
Cytoplasmic Changes
A pair of centrioles separate and move to opposite
poles of the cell. Duplication of each centriole
occurs.
Microtubules are synthesized which radiate from
the migrating centrioles and form a meshwork
known as aster.
Metaphase (Fig 51.2)
Nuclear Changes
Chromosomes move towards the equator of the
spindle or the equatorial plate of the cell.
They get attached to the microtubules with the help
of their centromeres forming the mitotic spindle.
A star shaped ring is seen at the equator due to the
attachment of chromosomes via centromeres to the
microtubules at the equator.
The chromosomes are maximally contracted in this
phase and hence easily visible under microscope.
Cytoplasmic Changes
Part of spindle that lies at the equator is known as
the equatorial plate or the metaphase plate.

There is equal distribution of mitochondria and
other organelles on each side of the cell.
Anaphase (Fig 51.2)
Nuclear Changes
The centromere of each chromosome splits
longitudinally and the two chromatids separate to
form two new chromosomes.
One chromosome from each pair of the newly
formed chromosomes separates and migrates to
opposite poles due to the contraction of spindle
fibres.
Cytoplasmic Changes
There is infolding at the cell equator and a cleavage
furrow appears which progresses further.
Telophase (Fig 51.2)
Nuclear Changes
The newly formed chromosomes are grouped at
each end of the cell.
Nuclear envelope reappears.
Nucleoli reappear.
Spindle remnants disappear.
Cytoplasmic Changes
The cleavage furrow divides the cell into two.
The remains of spindle and the dense cytoplasm at
the level of cleavage furrow forms the midbody.
This midbody disappears later.
MEIOSIS
It is also called reduction or heterotypical division. It
occurs during the maturation division of sex cells i.e.,
the primary oocytes and spermatocytes (Fig. 51.3).
Characteristic features of meiosis
Meiosis results in four daughter cells.
Meiosis consists of two consecutive cell divisions,
meiosis I and meiosis II. There is a very short
interphase or no interphase between meiosis I and
meiosis II.
During meiosis I the chromosome number is
reduced to haploid but DNA content is diploid in
each of the two resultant cells.
Cell Division 619
After meiosis II, the daughter cells have haploid
(n) number of chromosomes and haploid DNA.
This helps to restore the diploid (2n) number of
chromosomes after fertilization.
There is exchange of genetic material between the
homologous chromosomes in meiosis I.
The duration of meiosis is 24 days in males and it
lasts for many years in females.
Meiosis I is divided into the following four phases
1. Prophase I
2. Metaphase I
3. Anaphase I
4. Telophase I
Prophase I (Fig. 51.3)
The prophase of meiosis I is a complex and prolonged
process. It is divided into 5 stages namely leptotene,
zygotene, pachytene, diplotene and diakinesis.
Leptotene: Long thin thread like chromosomes are
C H A P T E R-51
visible due to condensation. They have a beaded
appearance due to presence of chromomeres. One end
of each chromosome is seen attached to the nuclear
envelope.
Zygotene: There is pairing of homologous chromo-
somes. One chromosome is of maternal origin and other
is paternal. These homologous chromosomes come
together lengthwise, side by side, with a point to point
relationship. This process is known as synapsis. The
homologous chromosomes are held together at various
points by fibrillar bands known as synaptonemal
complexes. The X and Y chromosomes however, have
limited pairing segments and therefore lie together end
to end.
Pachytene: Each chromosome splits into two chromatids
which are known as the sister chromatids. There is
crossing over of chromatin material between two sister
chromatids of a homologous pair. This occurs in the
forms of breaks in the DNA which then cross over to
the opposite chromatid and reunite at a similar site.
Diplotene: Homologus chromosomes start separating
except at the site of crossing over (chiasmata).
Diakinesis: Chiasmata disappear and the two
homologus chromosomes separate from each other
completely.
At the end of the prophase I the nuclear membrane
disappears and spindle formation take place.
S E C T I O N-4 620 Human Anatomy For Dental Students

Fig. 51.3: Stages of meiosis

Metaphase I (Fig. 51.3) Anaphase I (Fig. 51.3)

Homologus chromosomes are arranged around the There is no division of centromere. The homologous pair
equator in a bivalent arrangement that is, one member of chromosomes separate from each other and migrate
is present on either side of equator. towards the two opposite poles of the spindle.

Telophase I (Fig. 51.3)
Two cells are formed at the end of telophase. Each
daughter cell has half the number of chromosomes
(haploid number) with a pair of chromatid each (thus
diploid DNA).
Meiosis II (Fig. 51.3)
The second division of meiosis is more like mitosis
except, it is not preceded by DNA replication.
Therefore, there is no S phase of the cell cycle before
meiosis II.
Other important point of differentiation between
mitosis and meiosis II is that, the chromatids which
separate in metaphase are genetically dissimilar.
Meiosis II also consists of four phases, prophase,
metaphase, anaphase and telophase. Ultimately
meiosis gives rise to 4 daughter cells with haploid
number of chromosomes and haploid DNA.
CLINICAL AND APPLIED ANATOMY
The largest round cell in the human body is Ovum.
It measures about 120 to 140 micron.
Crossing over during meiosis varies according to
the type of chromosomes. Small, medium and large
size chromosomes usually show 1, 2 and 3 crossing
over sites respectively during meiosis. 50
recombinations are the average number of crossing
over per meiosis per gamete.
Cells that do not divide after birth are:
a. Neurons except olfactory neurons.
Cell Division 621
b. Muscle cells
In oogenesis a primary oocyte gives rise to one
haploid ovum and three polar bodies. These polar
bodies are biologically inert. In spermatogenesis a
primary spermatocyte give rise to 4 spermatids and
ultimately four functional spermatozoa.
Meiosis results in the following:
a. Reduction of number of chromosome to
haploid (n) in daughter cells.
b. Recombination of genetic material.
c. Random assortment of chromosomes (Mendels
3rd law).
This ultimately gives rise to haploid cells with a
variant composition from the parents which is
responsible for the genetic diversity in the human
species. This also enables in reproduction and
maintenance of the species. The diploid number is
restored after fertilization.
Colchicine is a drug that arrests mitosis of cells in
the metaphase by affecting the formation of
microtubules. It is added to cell cultures during
C H A P T E R-51
preparations for study of chromosomes as they are
maximally visible during metaphase.
Apoptosis: Apoptosis is the programmed death of
a cell. It is decided by the genetic programming of
each cell. There is activation of intracellular
enzymes and degranulation of lysosomes leading
to degeneration of cell components and its death.
The examples of these are cyclical breakdown of
endometrium of uterus causing menstruation,
removal of old cells of intestinal epithelium etc.
 Chapter
Cytogenetics, Chromosome
52 and Chromosomal
Abnormalities
CHROMOSOME Tissue used for cell culture
Rapidly dividing cells are best used for cell culture.
The word chromosome is derived from the Greek words
Lymphocytes derived from blood are most commonly
chroma meaning colour and soma meaning body.
used for preparation. This is because they can be easily
Chromosomes are vehicles of inheritance which
obtained and easily cultured. Other cells that can be used
facilitate reproduction and maintenance of species. They
are
are thread like structures located in the cell nucleus and
1. Amniotic fluid cells
are made up of genes. Normal human cells contain 23
2. Chorionic villous trophoblasts
pairs of chromosomes, a total of 46, one member of each
3. Skin fibroblasts
pair is inherited from each parent. Body characters and

functions are regulated by genes on 22 pairs of
chromosomes known as autosomes. The 23 rd pair
consists of sex chromosomes. These are of two types,
namely X and Y, based on their role in sex determination.
In females there are 22 pairs of autosomes plus XX
chromosomes while in males 22 pairs of autosomes plus
XY chromosomes are present.
Cytogenetics
The study of chromosomes and cell division is known
as cytogenetics.
Karyotyping
It is the characterization of chromosomes according to
their size, shape and the distribution of stain taken up
by them. Each pair of homologous chromosomes are
arranged in a sequence and the chromosomal
constitution of a cell is studied.
C H A P T E R-52
4. Bone marrow cells
5. Cells within hours of death of an individual e.g.
blood from fetus following spontaneous abortion
has also been used occasionally.
Method of chromosome preparation
A peripheral blood sample is added to the culture
medium containing fetal calf serum, phytohaemagglu-
tinin, streptomycin and penicillin antibiotics in a culture
tube. Now the culture tube is kept in an incubator for 72
hours, at 37C. At the 69th hour, cholchicine or any of
its component is added to arrest mitosis in metaphase.
After 72 hours, the culture tube is shifted out of the
incubator and cells are harvested. These cells are first
treated with hypotonic solution of KCl and then the
fixative, a mixture of methanol and glacial acetic acid is

Preparation of Chromosomes for Karyotyping (Fig. 52.1)

Principle
Chromosomes are easily visible during metaphase.
Human cells are cultured in vitro and cell division is
arrested in the stage of metaphase. Cultured cells are
then treated with hypotonic solution which helps in
formation of a chromosomal spread. Slides are made
from this chromosomal spread and stained with
different methods. Chromosomes can be now identified
under high power of microscope and according to their
characters a karyogram is formed after taking micro-
photographs. Fig. 52.1: Setting of lymphocyte cell culture for Karyotyping
 624 Human Anatomy For Dental Students

added. A small drop of this suspension is poured on to Now these slides are stained with different stains for
a clean slide and allowed to dry at room temperature. karyotyping.

Fig. 52.2: Giemsa stainingFemale chromosomal spread Fig. 52.3: Giemsa stainingMale chromosomal spread
S E C T I O N-4

Fig. 52.4: G-Banding Fig. 52.5: C-Banding

Fig. 52.6: Ag-NOR Staining Fig. 52.7: Reverse Banding

 Cytogenetics, Chromosome and Chromosomal Abnormalities 625

Different staining procedures and their importance

Staining Importance
Giemsa stain Is used for the identification and numbering of chromosomes.
(Figs 52.2 and 52.3) It is used to identify the short and long arms according to the position of centromere.
G-Banding It is the most common method used in karyotyping. Chromosomes are first treated
(Giemsa banding) with trypsin and then stained with giemsa. Trypsin denatures the chromosomal
(Fig. 52.4) protein and the chromosomes stain in a pattern of dark and light bands.
1. It is used for the identification of chromosomes with the help of their banding pattern.
2. It also helps in the detection of deletion anomalies.
Q-Banding Chromosomes are stained with quinacrine mustard. When examined under
(Quinacrine banding) fluorescent microscopy each chromosome pair stains in specific bright and dim bands.
1. It is used for identification of chromosomes and their number.
2. It helps mainly in the identification of Y chromosome.
C-Banding (Fig. 52.5) 1. It is useful to visualize centromeres and other heterochromatic material.
(Centromeric 2. It is important for identification of acrosomes and satellites.
heterochromatin banding) 3. Also helps in detection of deletion and addition anomalies.
AgNoR staining (Fig. 52.6) It is useful in identifying the nucleolar organising region which marks the sites of
transcriptionally active ribosomal RNA genes.
R-Banding This banding is reverse to that of G-banding.

C H A P T E R-52
(Reverse banding) (Fig. 52.7) It is an important stain for identifying the telomeric region of the chromosome.
High resolution banding This is also known as prometaphase banding. It reveals 800 or more bands
per haploid genome.

CHROMOSOMAL ANALYSIS applied in the interphase for rapid diagnosis of

The stained preparations are studied under microscope
and the number of chromosomes in a specified number
of cells are counted. This is followed by analysis of the
banding pattern of the individual chromosomes. The
chromosomes are arranged as homologous pairs in
descending order of their sizes and karyotype is
prepared.
Other Techniques of Chromosomal Analysis
Flow Cytometry
It is also known as fluorescence activated cell sorting.
After the cells are ruptured they are stained with a
fluorescent dye which selectively stains the DNA. They
are then projected as a fine jet through a flow chamber
across a laser beam which excites the chromosomes to
fluoresence. This technique can be used to analyse and
separate out preparations of single chromosomes for
recombinant DNA work.
FISH Technique
Its full form is fluorescent in situ hybridisation. It is based
on the ability of a single stranded DNA probe to
hybridise with its complementary target sequence where
ever it is located in the genome. The DNA probe is
conjugated with a fluorescent label allowing it to be
visualized under ultraviolet light. This technique can be
chromosomal anomalies thus avoid the need for cell
culture, e.g., trisomy 21.
Structure of Chromosome
Each chromosome is made up of a double helix of DNA
molecule wrapped around on a framework of histone
proteins along with non histone proteins. In fact,
chromosome is a complex structure which consists of
coiled and supercoiled double stranded DNA along with
its packaging protein. Two types of nuclear protein
material are seen.
1. Non-histone proteins: These are highly mobile
group of proteins (HMG). Gene regulatory proteins,
DNA and RNA polymerases form the non histone
proteins.
2. Histone proteins: There are five histone proteins
namely H, H2A, H2B, H3 and H4. They are basic in
nature and are aggregated along with the DNA.
These packaging proteins along with the DNA coil
to form the following structures.
a. Nucleosomes: 2 molecules, each of H2A, H2B,
H3 and H4 histone proteins form an octomer.
This octomer forms a core around which 146
base pairs of helical DNA are wrapped forming
a nucleosome. Nucleosomes forms the structural
framework of a chromatin fibre of 10 nm
diameter.
 626 Human Anatomy For Dental Students
b. Solenoid: 6 nucleosomes radially arranged form
a solenoid. This is 30 nm thick.
c. Chromatin fibre: A series of solenoids form
chromatin fibre of 30 nm diameter. It is
composed of nucleosomes, histone H and DNA.
d. Chromatin loop: The 30 nm chromatin fibres
are further packed into a system of supercoiled
domains known as loops. Each loop contains
20,000 to 1,00,000 base pairs of DNA and are
formed at the non-histone protein binding sites
along the 30 nm fibre.
e. Chromosome: The highly condensed form of
chromatin loop is the chromosome.
Levels of coiling of DNA in the formation of a
chromosome
1. Primary coiling: The double helical structure of
DNA molecule is primary coiling
2. Secondary coiling: Coiling of DNA around histone
proteins to form nucleosomes is secondary coiling.
3. Tertiary coiling: It is the coiling of nucleosomes
forming solenoids and thence chromatin fibres.
4. Quaternery coiling: Is seen in chromatin loops.
S E C T I O N-4
Euchromatin
Chromatin is combination of DNA and histone proteins.
The uncoiled portion of a chromosome consisting of 10
nm chromatin fibre made up of nucleosomes forms the
euchromatin. It is so named because it stains lightly. It
is the genetically active site (site of transcription) of a
chromosome.
Heterochromatin
It is the coiled chromatin that is either devoid of genes
or has inactive genes. It is characteristically located
Fig. 52.8: Types of chromosomes according to the position of centromere
around the periphery of nucleus and nucleolus.
Heterochromatin remains condensed in the interphase
and replicates very late in the S phase of the cycle. It
stains darkly.
Types of Heterochromatin
There are two types of permanent hetero-chromatin
observed in human chromosomes.
1. Constitutive heterochromatin: These are located
around the centromere of all chromosomes, in the
long arm of the chromosomes and in the satellites
of acrocentric chromosomes. These hetero-
chromatin areas contain repetitive sequences of
DNA bases. These repetitive DNA sequences code
for ribosomal and transfer RNA.
2. Facultative heterochromatin: It is the euchromatin
which is temporarily in a transcriptionally inactive
state. In humans, the inactive X-chromosome in
females is the best example of facultative
hetrochromatin. In early embryogenesis both X-
chromosomes are actively involved in development
of ovaries. At around 15 to 16 days of gestation
inactivation of one X chromosome is initiated. Then
it becomes permanently inactive and forms a
heterochromatin known as the Barr body.
Appearance of chromosomes in the metaphase
Each pair of chromosome shows a common basic
structure during cell division. The following parts are
identified:
1. Chromatids: Each chromosome consists of two
parallel and identical filaments known as
chromatids. These two chromatids are also known
as sister chromatids.
2. Primary constriction: Both chromatids are held
together at a narrow region called as the primary
constriction.
 Cytogenetics, Chromosome and Chromosomal Abnormalities 627

3. Centromere: A pale staining area seen in the centre Chromosome pair number 13, 14, 15, 21 and 22
of the primary constriction is known as the possess satellite bodies which are responsible for
centromere. The centromeric proteins form the nucleoli formations. These chromosomes are
kinetochore which provides attachment to the known as sat - chromosomes. X chromosome is
mitotice spindle in metaphase. classified in group C and Y chromosome in
4. Telomere: The extremity of a chromosome is group G.
referred to as telomere. Telomere helps to maintain Paris conference (1972) classification: This
the stability of the chromosomes. It has a polarity classification is based on the banding pattern of each
that prevents other segments of the chromosome chromosome. It provides more accuracy to the
from joining with each other. Telomere also identification of parts of the each chromosome.
provides the template for priming the replication Different banding pattern and their importance has
already been discussed.
of the lagging strand during DNA synthesis.
Symbols and abbreviations used in karyotyping. This
5. Secondary constriction: Some chromosomes show
is in accordance with the ISCN (International system for
another constriction known as the secondary
human cytogenetic nomenclature).
constriction. This is related to the site of formation
of nucleoli. This region of chromosome is known
Symbol Abbreviation
as the nucleolar organising region. It is present in
chromosome numbers 13, 14, 15, 21 and 22. A-G Chromosome groups
1-22 Autosome number
X, Y Sex chromosome
CLASSIFICATION OF CHROMOSOMES (Fig. 52.8) 46, XX Normal female karyotype
Chromosomes are variously classified. 46, XY Normal male karyotype

C H A P T E R-52
46 / 47 Mosaic with 46 and 47
Classification according to the position of centromere chromosomes cell line
1. Acrocentric: In acrocentric chromosomes the del Deletion
centromere is present near one end. Therefore one dup Duplication
arm is very short and other is very long. fra Fragile site
2. Metacentric: Centromere is situated near the centre. i Isochromosome
3. Submetacentric: Centromere is situated between ins Insertion
the midpoint and at one end of the chromosome. inv Inversion
4. Telocentric: Centromere is situated at the end nar Marker chromosome
having only one arm. This type is not present in mat Maternal origin
human beings. mos Mosaic
p Short arm of chromosome
Denner-London System Classification pat Paternal origin
q Long arm of chromosome
It is the most common classification used in karyo- r Ring chromosome
typing. According to this system of classification rep Reciprocal
chromosomes are classified in different groups rec Recombinant chromosome
according to their length. The chromosomes are rob Robertsonian translocation
placed in 7 groups described below. t translocation

Denner-London system classification

Group Number of chromosome Character
A 1, 2, 3 Long, metacentric
B 4, 5 Long, sub-metacentric
C 6, 7, 8, 9, 10, 11, 12 and X Medium size submetacentric
D 13, 14, 15 Medium size, acrocentric satellite present
E 16, 17, 18 Short, submetacentric
F 19, 20 Short and metacentric
G 21, 22 and Y Very short acrocentric with satellite body except in Y
 628 Human Anatomy For Dental Students
CHROMOSOMAL ABNORMALITIES
Chromosomal abnormalities are classified as
1. Numerical abnormalities
2. Structural abnormalities
Numerical Abnormalities
Alterations in the chromosomal number constitute
numerical abnormalities. These are of two types:
1. Aneuploidy: It occurs as a result of the addition or
loss of one or more chromosomes. Most of the
aberrations of chromosomal number take place due
to non-disjunction.
Non-disjunction: It is the failure of separation of a
pair of bivalent chromosomes during meiosis I or a
pair of chromatids during mitosis.
It may involve either the sex chromosomes or the
autosomes.
Examples: Trisomy, Monosomy, Mosaicism
2. Polyploidy: It is the addition of one or more
complete haploid set of chromosomes to the normal
diploid number of chromosomes.
Clinical Conditions with Numerical Abnormalities
S E C T I O N-4
Trisomy
Presence of 3 copies of a chromosome instead of the
normal 2 in a cell is called trisomy. Trisomy of all the
autosomes has been recorded except in chromosome 1.
Cause and risk factors of trisomy
1. Trisomy occurs due to the non-disjunction of a
chromosome or a chromatid in one of the fertilizing
gametes. The frequency of non-disjunction is more
in oogenesis than in spermatogenesis.
2. Occurrence of trisomy increases with the age of the
mother.
The common conditions are described below:
1. Trisomy 21: This is also known as Downs
syndrome or Mongolism.
Cytogenetics: It usually follows fertilization of two
gametes out of which one has two chromosome 21
(usually a result of non disjunction during its
meiosis I). Rarely, it can occur due to the
translocation of long arm of chromosome 21 to a D
and G group of chromosome.
Clinical features of a child with Downs syndrome
a. Mental retardation (moderate)
b. Short stature
c. Brachycephaly
d. Presence of epicanthal folds
e. Protuding tongue, small ears and flat occiput
f. Flat nasal bridge
g. Brushfield spots in the eye (in the iris)
h. All males are infertile while females have
reduced fertility
Risk factors
a. Higher incidence with advancing maternal age
(aging effect on oocyte).
b. Family history of Downs syndrome (usually a
translocation abnormality).
c. Radiation injuries.
2. Trisomy 13: Also called Pataus syndrome. It is less
commonly seen. The newborn has central nervous
system malformations, cleft palate, hairlip and
lethal cardiac anomalies. There is profound mental
retardation in survivors.
3. Trisomy 18: This condition is also known as
Edward syndrome. Most trisomy 18 pregnancies
result in spontaneous abortions or still births. The
newborn has a small face with prominent occiput,
flat nose, low set ears, micrognathia, overlapping
of fingers and rocker bottom heels.
4. Klinefelters syndrome: This is trisomy of sex
chromosomes. The karyotype is 47, XXY. A young
boy with Klinefelter syndrome presents with a mild
developmental delay and behavorial immaturity.
The adult male presents with small testes,
dysgenesis of seminiferous tubules, gynecomastia
and poor musculature. Most males are infertile.
5. 47, XYY syndrome This condition occurs with the
same frequency as 47, XXY. Male presents with tall
stature and mild social problems.
6. 47, XXX female Majority of 47, XXX females have
no clinical manifestations. They have normal
fertility and normal off springs.
Monosomy
It is characterized by the presence of only one member
of the homologous pair of chromosomes in the
karyotype.
1. Autosomal monosomies are not seen in live births
or in early spontaneous abortions because they are
fatal to the conceptus.
2. Turners syndrome: Monosomy of the X-
chromosome (karyotype 45, XO)is the most
common form of monosomy seen. The patient is a
female (as there is no Y chromosome) and presents
with the following features
a. Short stature
b. Webbing of neck
c. Low hair line at the nape of neck
d. Primary or secondary amenorrhea
e. Streak ovaries
f. Majority are infertile
Causes and risk factor: Turners syndrome results
from the fertilization of two gametes out of which
one lacks its X-chromosome. This occurs due to
non-disjunction or anaphase lag during cell division
in which the X-chromosome is lost to the non
fertilizing daughter cell of the original germ cell.
 Cytogenetics, Chromosome and Chromosomal Abnormalities
Mosaicism
It is the presence of two or more cell lines with different
karyotypes in a single individual. It is usually in cases
of trisomy of 13, 18 and 21 chromosomes. Mosaic Turner
female has also been described. Cause and risk factors
of mosaicism It arises from the non-disjunction or
chromosome lag in the early cleavage stages of zygote
or during embryogenesis.
Polyploidyc
Two clinical conditions that occur in humans:
1. Triploidy: There are 69 chromosomes with XXX,
XXY or XYY sex chromosome complements. A
triploid conceptus generally aborts early in
pregnancy and very rarely does it lead to a live
birth. The fetuses have a relatively large head,
syndactyly and congenital heart defects and all die
soon after birth.
Cause of triploidy: Triploidy results from failure
of meiosis in a germ cell or from a fertilization defect
such as diaspermy (two sperms fertilizing one
ovum).
2. Tetraploidy: There are 92 chromosomes with XXXX
or XXYY sex chromosome complements. Most
tetraploid fetuses are lost in the first trimester of
pregnancy.
Cause of tetraploidy: It results from the failure of
completion of usually the first cleavage division of
zygote.
STRUCTURAL ABNORMALITIES
These abnormalities result from the breakage and
abnormal fusion of chromosome segments. Various
structural abnormalities are described below:
1. Deletion: It results from the loss of a segment of
chromosome. Deletion may be of the following two
types
a. Terminal deletion: It is the loss of a terminal
segment of a chromosome. It results from a
single break in the chromosome. The acentric
segments are later lost in the subsequent cell
divisions.
b. Interstitial deletion: It occurs due to two breaks
in the chromosome followed by the subsequent
fusion at the break site with loss of the interstitial
acentric fragment. Deletion can occur at two
levels.
i. Microscopic deletions: These are visualized
on microscopy, e.g., Cri-du-chat syndrome
(loss of short arm of chromosme).
ii. Microdeletion: These are small deletions
which require high resolution banding for
629
cytogenetic diagnosis. These can also be
detected by fluorescent in situ hybridization
studies, e.g., Prader-Willi syndrome.
Ring chromosome: A ring chromosome is a type
of deletion abnormality. It arises from breaks on
either side of the centromere of chromosome and
the subsequent fusion of the break points on the
centric segment. The distal acentric segments are
lost.
2. Isochromosomes: When the centromere divides
perpendicular to the long axis of a chromosome
instead of parallel to it, two chromosomes of
unequal length are obtained. The resultant
chromosomes, derived from the transverse splitting
of centromere, are known as isochromosomes. This
abnormality is usually encountered in X-
chromosomes.
3. Duplication: It is the presence of a portion of a
chromosome more than once. This results in
trisomy of segments of chromosomes. This
duplication results from gametogenesis in a carrier
of translocation or inversion abnormality (occurs
C H A P T E R-52
due to abnormal crossing over).
4. Inversions: Inversion is a reversal of the order of
chromatin between two breaks in the chromosome.
A part of the chromosome gets detached breaking
at two points and later reunites with the same
chromosome in an inverted position. They can
occur as a new mutation or may be present in
multiple generations of a family. Inversions are of
two types:
a. Pericentric inversion: When the breaks and
rearrangement occurs on both sides of the
centromere.
b. Paracentric inversion: When the breaks and
rearrangement occurs on the same side of the
centromere. Inversions rarely cause problems
in carriers unless one of the break points affects
an important functional gene. However, they
can cause significant chromosomal imbalance
during gametogenesis leading to duplications
or deletions after crossing over during meiosis.
It is significant in pericentric inversions and
mostly results is miscarrage of the conceptus.
5. Translocation: It is the exchange of segments
between two non homologous chromosomes.
Reciprocal Translocation
It results from breakage and exchange of segments
between chromosomes. There is no loss of genetic
material. The points of exchange can be at any location
along the chromosomes. This may be heterozygous or
homozygous. Balanced reciprocal translocations
 630 Human Anatomy For Dental Students

involving the long arms chromosomes 11 and 22 are the
commonest encountered abnormalities.
Robertsonian Translocation
It results from breakage in two acrocenteric chromo-
somes at or close to their centromeres and the subsequent
fusion of their long arms. The short arms are usually
lost. It usually involves 13 to 15, 13 to 14, 21 to 22
chromosomes.
Translocations may not affect the carrier however,
the variable segregation pattern during meiosis results
in various forms of unbalanced chromosome comple-
ments, e.g., monosomy, trisomy or translocation
abnormalities.

Various clinical conditions and their structural defects in chromosomes

Structural chromosomal anomaly Clinical condition Genetic constitution and clinical features
1. Deletion Cri-du-chat or cat cry syndrome It is due to deletion of the terminal portion
of short arm of chromosome 5 (5p-) The new
born presents with
Round face
A cry that resembles that of a cat
Hypertelorism
Micrognathia
Severe mental retardation
Cardiac defects
Wolf-Hirschhorn syndrome There is deletion of the short arm of chromosome
4 (4p-).
Infant has the following features
S E C T I O N-4

Prominent forehead and broad nasal root

2. Microdeletion
3. Interstitial deletion
Short philtrum
Mouth is downturned
Severe mental retardation
Cardiac defects
Growth failure
Prader-Willi syndrome This syndrome involves microdeletions of the
proximal part of long arm of chromosome 15 (15q).
The infant presents with:
Profound hypotonia
Mental retardation
Trunkal obesity
WAGR syndrome Chromosomal analysis shows an interstitial
deletion of a particular region of the short arm of
one of the chromosome no. 11.
The child usually develops
Wilms tumour
Aniridia
Genital abnormalities
Growth retardation
 Chapter
53
Molecular Basis of Genetics
Genetic information is stored in the DNA (deoxyribose
nucleic acid) helix which form chromosomes. Molecular
genetics deals with the study of this genetic material, its
structure, replication and the process of dissemination
of the genetic information by formation of RNA
(ribonucleic acid) and ultimately proteins.
STRUCTURE OF DNA (Fig. 53.1)
The DNA molecule consists of two long, parallel,
complimentary polynucleotide chains twisted about
Fig. 53.1: Structure of DNA
each other in the form of a double helix (twisted ladder
model).
Each chain is composed of nucleotides, each of which
contains a deoxyribose residue, a phosphate and a
pyrimidine or a purine base. The sides of the twisted
ladder consist of a backbone of deoxyribose residues
linked by phosphate bands while the rungs of ladder
are the bonds between the bases. The pyramidine bases
are thymine (T) and cytosine (C) and the purine bases
are adenine (A) and guanine (G). The two strands of
C H A P T E R-53
DNA run in opposite directions and are held together
by hydrogen bonds between the nitrogenous bases.
(Adenine forms two hydrogen bonds with thymine
while cytosine forms three hydrogen bonds with
guanine). There are 10 nucleotide pairs in a single
complete turn of the double chain. The ends of the DNA
strands are designated 5 and 3 depending on the
number of the free carbon in the deoxyribose sugar
residue at the terminal end. By convention the 5 end is
written on the left and it indicates the sequence closer
to the beginning of a gene. The 3 is written to the right
and it indicates the sequence closer to the end of the
gene. New DNA is synthesized in the 5 to 3 direction
during replication.
Mitochondrial DNA: Nuclear DNA forms the bulk of
DNA present in a cell. In addition to nuclear DNA, the
mitochondria also contain a ring shaped DNA molecule.
Mitochondrial DNA is entirely derived from the ovum.
Therefore it has maternal inheritance.
Classes of DNA: DNA is classified into two types of
sequences:
1. Repetitive DNA: It does not contain genes but is
present as either short or long interspersed,
repeated DNA sequences. These are of two types
a. Short interspersed repeated sequences or SINEs
b. Long interspersed repeated sequences or LINEs
Their function is largely unknown.
2. Non repetitive DNA or unique DNA sequences:
It constitutes only 5% of the total human genome
and consists of genes which code for mRNA and
the specific proteins.
 632 Human Anatomy For Dental Students
Genes
Genes are the units of hereditary. A gene consists of a
specific sequence of DNA which codes for a specific
sequence of amino acids forming a particular protein.
The various genes are arranged in a linear series within
the chromosomes.
Locus: The position of a gene in the chromosome is called
locus. It is described in reference to the centromere.
Alleles: Genes occupying identical loci in a pair of
homologous chromosomes are called as alleles or
allelomorphs. One pair of allelic genes regulate the
synthesis of a particular polypeptide chain and hence
are responsible for a particular character of an
individual.
Homozygous alleles: When both allelic genes regulating
a particular character or trait are similar, they are called
homozygous alleles, e.g., presence of two genes
representing tall height in an individual.
Heterozygous alleles: When both allelic genes
regulating a particular character are dissimilar, they are
called heterozygous alleles, e.g., presence of two genes
with one representing tall and other representing short
S E C T I O N-4
height in an individual.
Multiple alleles: When in a population, more than two
different alleles exist at a given locus of a chromosome.
Such alleles are said to be multiple. In a given individual
only two of these alleles are present. For example the
blood groups are coded by four alleles A1, A2, B and O
out of which only two, e.g., AO, AB, OO etc. are present
in a individual.
Organization of Genes
Genes are made up of exons and introns with following
characteristic features.
Exons: Exons are the functional portions of a gene
sequence that code for the protein.
Introns: Introns are the non-coding DNA sequences of
unknown function. The number and size of introns vary
in different genes.
Types of genes according to the Mendelian pattern of
inheritance
1. Dominant gene: An allele which is always
expressed both in the homozygous and the
heterozygous combination.
2. Recessive gene: When an allele is expressed only
in the homozygous state it is known as recessive
gene.
3. Carrier gene: In the heterozygous state, the
recessive gene acts as a carrier gene which is not
expressed in the individual but may be expressed
in subsequent generations.
4. Co-dominant genes: When both the allelic genes
are dominant but of two different types, both traits
may have concurrent expression. e.g., blood
group AB.
5. Sex-linked genes: The genes located on the X or Y
chromosomes are known as sex-linked genes.
6. Sex-limited genes: These genes are borne by the
autosomes, but the trait is expressed preferentially
in one sex only, e.g., baldness found predominantly
in males.
MODES OF INHERITANCE
Mendels laws of inheritance: Three principal laws of
inheritance were established on the basis of Mendels
plant experiments.
1. The law of uniformity: The crossing over between
two homozygotes of differing types results in
offsprings that are identical and heterozygotic. The
inherited characters do not blend.
2. The law of segregation: During formation of
gametes the two members of a gene pair separate
into different gametes. Therefore, in an individual
each of the allelic pair is originally derived from
separate parents.
3. Law of independent assortment: This law states
that different traits conveyed by members of
different gene pairs segregate to the offspring
independent of one another.
Lyons hypothesis: This hypothesis was given by Mary
F.Lyon. It proposed that in the somatic cells of female
mammals, only one X chromosome is active. The other
X chromosome is condensed and inactive. It is seen in
the interphase cells as the sex chromatin or Barr body.
The inactivation of chromosome occurs early in the
development during embryonic life at around 15th -16th
day of gestation. Normally either of the two X
chromosomes can be inactivated. The process of X
inactivation is often referred to as lyonization.
Classification of genetic diseases
1. Chromosomal abnormalities: It has been dealt in
chapter number 117.
2. Single gene disorders: This is usually a
consequence of a point mutation in the base pair of
a gene which may result in following changes in
gene expression.
a. No alteration in gene expression.
b. Altered protein synthesis with reduced or
complete loss of biological activity.
c. Termination of protein synthesis.
d. Increase or decrease in synthesis of particular
enzymes with subsequent effects.
3. Multifactorial disorders: Some diseases, e.g.,
diabetes mellitus and schizophrenia and some
conditions, e.g., cleft lip have a multifactorial
inheritance with interaction of many genes.
 Molecular Basis of Genetics 633

Location of various genes on human chromosomes

Chromosome No. Genes located in it
Chromosome 1 Rh factor, antithrombin III, coagulation factor V, SLE, congenital cataract, retinitis pigmentosa.
Chromosome 2 Immunoglobulins, K chain, collagen type III, Apolipoprotein B
Chromosome 3 Acute leukemia antigen, gangliosidosis, small cell lung cancer
Chromosome 4 Huntington disease, Hurler syndrome, coagulation factor XI
Chromosome 5 Complement type 6, 7 and 9, familial polyposis coli, coagulation factor XII
Chromosome 6 HLA genes, complement type 2 and 4, congenital adrenal hyperplasia (type I)
Chromosome 7 Craniosynostosis, collagen type I, osteogenesis imperfecta, cystic fibrosis
Chromosome 8 Retinitis pigmentosa, congenital adrenal hyperplasia
Chromosome 9 alphainterferon, galactosaemia, Friedreichs ataxia, nail patella syndrome, compliment 5, ABO
blood group
Chromosome 10 Multiple endocrine neoplasia syndrome
Chromosome 11 NiemannPicks disease, insulin gene, Wilms tumour, ataxia telangiectasia, acute intermittent
porphyria
Chromosome 12 Complement 1, collagen type II, phenylketonuria
Chromosome 13 Retinoblastoma, Wilsons disease, coagulation factor VII and X

C H A P T E R-53
Chromosome 14 Spherocytosis type I, heavy chain of immunoglobulin
Chromosome 15 Prader-Willi/Angleman syndrome, Marfans syndrome, Tay-sachs disease, gangliosidosis
Chromosome 16 Alpha thalassemia, polycystic kidney disease
Chromosome 17 Neurofibromatosis type I, collagen type I, breast cancer locus I
Chromosome 18 No specific genes recorded
Chromosome 19 Complement 3, familial hypercholesterolemia, myotonic dystrophy
Chromosome 20 Proto-oncogene (Roux-sarcoma virus)
Chromosome 21 Familial motor neuron disease, Downs syndrome, Alzheimers disease
Chromosome 22 Immunoglobulin, neurofibromatosis type II
Chromosome X In short armXg blood group, ocular albinism, Deuchennes muscular dystrophy, retinitis
pigmentosa locus 2.
Long armIsolated cleft palate, agammaglobulinemia, Lesch-Nyhans syndrome, coagulation
factors VIII and IX, Hunters syndrome, fragile X-syndrome, G-6PD deficiency.
Chromosome Y Testis determining factor HY antigen in long arm.

4. Acquired somatic genetic disease: Recent research
has identified the occurrence of various point
mutations occuring in the somatic cells during life
with no involvement of the germ cells. These
account for various diseases that occur in old age,
e.g., malignancies. These diseases are not inherited.
INHERITANCE OF SINGLE GENE DISORDERS
Most human disorders exhibit single gene unifactorial
inheritance or Mendelian inheritance. Studying the
pattern of inheritance of these disorders within families
enables the geneticist to assess the risk of transmission
of a particular disorder in future generations. This helps
in the genetic counselling of the affected parents before
they plan any future pregnancy.
Pedigree chart: It is a chart made from the data collected
from an individual or family which represents successive
generations, past and future. There are certain inter-
national conventional symbols used to draw the chart.
 634 Human Anatomy For Dental Students

Commonly used genetic symbols (Fig. 53.2)

Fig. 53.3: Family tree of autosomal dominant trait

S E C T I O N-4

Fig. 53.2: Commonly used symbols

1. Autosomal dominant inheritance (Fig. 53.3)

This occurs due to mutation in a dominant gene
on an autosome leading to a particular trait. Fig. 53.4: Family tree of autosomal recessive trait
This trait is transmitted from one generation to
the other equally to male and female offsprings
The risk of transmission of the trait by 2 carrier
(vertical transmission).
parents to their offspring is 25%. There is 50%
The risk of transmission of the disorder is 50%
risk of offsprings being carriers and 25%
if one of the parents has the dominant trait.
offsprings are normal.
The unaffected family members do not transmit
It is often associated with consanguinous
the disorder.
marriages.
2. Autosomal recessive inheritance (Fig. 53.4)
3. Sex-linked inheritance: X-linked recessive
The mutated gene is expressed only in a
disorders are the most common form of sex linked
homozygous state.
abnormalities. X-linked dominant and Y-linked
The affected individuals are usually siblings
traits are rarely encountered.
(horizontal transmission) with equal distri-
bution in males and females. X-linked recessive inheritance (Fig. 53.5)
Successive generations may skip having the The disorder affects only males while females are
disorder till two carrier partners meet. unaffected in families.
The parents of an affected individual are The disorder is transmitted by carrier females to
apparently healthy as they are heterozygotes. their sons.

Non-invasive Tests
Fig. 53.5: Family tree of X-linked recessive trait
The affected males, on survival, can transmit the
disorder to their male grandchildren via obligate
carrier daughters.
PRENATAL DIAGNOSIS
Invasive Tests
Genetic abnormalities in a conceptus can result in the
following
1. Spontaneous miscarriages: First trimester losses are
mostly associated with chromosomal abnormalities.
2. Gross congenital abnormalities in newborn: 2 to
3% of newborns have at least one major congenital
anomaly. This leads to high perinatal morbidity and
mortality.
3. Abnormalities in childhood and adult life, e.g.,
blindness, deafness, malignancies.
Congenital and genetic disorders are a great social
and economic burden to the society. Prenatal
diagnosis allows doctors to detect abnormalities in
an unborn child in high risk cases. This helps in
early detection and appropriate management. In
developed countries prenatal diagnosis offered to
each couple planning a pregnancy.
Indications of pre-natal diagnosis
1. Advanced maternal age at conception. It is already
known that Downs syndrome is characteristically
associated with maternal age more than 35 years.
2. Previous history of a genetically abnormal child or
child with gross congenital anomaly.
3. Multiple miscarriages.
4. Family history of genetic disorder.
5. Consanguinous couples.
6. Pre-implantation diagnosis in cases of in-vitro
fertilization.
PRENATAL DIAGNOSTIC PROCEDURES
They can be non invasive and invasive tests.
Molecular Basis of Genetics 635
1. History: A careful history can point to the pattern
of inheritance of a genetic disorder and the risk
associated. A pedigree chart helps in accurate
prepregnancy evaluation which further helps in the
proper counselling of the couples.
2. Ultrasound
It aids in the detection of structural anomalies
which could point towards a genetic anomaly.
A transvaginal scan (TVS) usually performed
at 11 to 14 weeks, can detect early skull and
spinal defects. Nuchal transluscency (NT),
thickness of skin and soft tissues at the nape of
neck, is a marker for Downs syndrome.
Trans abdominal scan (TAS) is usually
performed at 16 to 22 weeks for detection of
congenital defects.
It however requires expensive equipments and
an experienced operator.
C H A P T E R-53
1. Amniocentesis
It is the aspiration of amniotic fluid under
ultrasound guidance.
It is generally performed at 16 to 18 weeks of
gestation. About 10 to 20 ml of fluid is aspirated.
Amniotic fluid contains desquamated fetal cells
from skin, respiratory and gastrointestinal tract
besides water (98%) and electrolytes.
It is the most commonly performed procedure
because it is an easy technique with a risk of
fetal loss of only 0.5 to 1%.
The main disadvantage of this method is that
the cells thus obtained need to be cultured for
genetic analysis and results take 2 to 3 weeks.
Amniocentesis is now also performed at 10 to
14 weeks for earlier diagnosis.
2. Chorionic villus biopsy or sampling (CVS)
This enables prenatal diagnosis to be
undertaken during the first trimester.
It is carried out at 10 to 14 weeks of gestation.
CVS involves aspiration of trophoblastic
material from the placental site under
ultrasound guidance.
Detection of disorder in early pregnancy avoids
need for second trimester abortions.
The risk of fetal loss is however higher, upto 1-
2%. This method also requires an experienced
operator.
The chorionic villus sample can be obtained via
the transcervical or the transabdominal route.
 636 Human Anatomy For Dental Students
3. Percutaneous ultrasound guided fetal blood
sampling/cordocentesis
It is most useful in assessment of fetal
haemogram, fetal infection and provides high
quality karyotype in 48 to 72 hours.
It involves aspiration of fetal blood from the cord
near its insertion in the placenta.
Cordocentesis is performed at 18 to 20 weeks of
gestation.
4. Percutaneous ultrasound guided fetal skin biopsy:
It is performed at 18 to 20 weeks of gestation usually
to detect skin abnormalities.
5. Fetoscopy
It is the visualization of fetus by an endoscope.
Fetoscope is very rarely in use these days as
ultrasound has superseded its relevance.
METHODS OF DETECTION OF GENETIC
ABNORMALITY
The cultured cells obtained by various prenatal
diagnostic procedures are evaluated by one of the
following methods.
S E C T I O N-4
1. Karyotyping
2. Fluorescent in situ hybridization
3. Flow cytometry
4. Methods to detect DNA and RNA - These utilize
recombinant DNA Technology. They are briefly
described below:
a. Southern blot technique: It detects DNA
The sample to be tested is treated with special
restriction endonucleases which break the DNA
into specific fragments. They are then exposed
to an alkali and single stranded fragments are
obtained. These are transferred onto a
nitrocellulose paper by blotting. A specific
labelled DNA sequence (probe) is incubated
with the sample.
The probe gets hybridized with its comple-
mentary fragment whose presence can now be
identified.
b. Northern blot technique: This is similar to
southern blotting but helps in identifying RNA
in the samples.
c. Western blot technique: This technique is used
to identify the size and amount of abnormal
proteins that are present in a sample. It makes
use of antisera specific for the proteins.
Chapter
54
Review of Genetics
Q. What are the different phases of cell cycle?
Ans. Cell cycle is the period extending from the
formation of a cell from its parent cell to its own
division that further gives rise to daughter cells.
The cell cycle is divided into four phases. These
phases are as follows (Fig. 51.1):
1. G1phase
2. Sphase
3. G2phase
4. Mphase
Q. What are the characteristic features of mitosis?
Ans. Characteristic features of mitosis are (Fig. 51.2)
1. Chromosome number remains same in
daughter cells as in the parent cell.
2. Mitosis is preceded by DNA synthesis in S-
phase and the dividing cell becomes tetra-
ploid with each chromosome consisting of
two identical strands known as chromatids.
3. It is responsible for the growth of an
individual and helps in the repair and
replacement of old cells.
4. The duration of mitosis is generally 1 to 2
hours.
5. Mitosis results in 2 daughter cells.
Q. What are the characteristic features of meiosis?
Ans. Characteristic features of meiosis are (Fig. 51.3)
1. There is a very short interphase or no
interphase between meiosis I and meiosis II.
2. During meiosis I the chromosome number is
reduced to haploid but DNA content is
diploid in each of the two resultant cells.
3. After meiosis II, the daughter cells have
haploid (n) number of chromosomes and
haploid DNA. This ultimately helps to restore
diploid (2n) number of chromosomes after
fertilization.
4. There is exchange of genetic material
between the homologous chromosomes in
meiosis I
5. The duration of meiosis is 24 days in males
and it lasts for many years in females.
6. Meiosis results in 4 daughter cells.
Q. What is chromosome?
Ans. The word chromosome is derived from the
Greek words chroma meaning colour and
soma meaning body. Chromosomes are
vehicles of inheritance which facillitate
reproduction and maintenance of species.
Q. What is cytogenetics?
Ans. The study of chromosomes and cell division is
C H A P T E R-54
known as cytogenetics.
Q. What is Karyotyping?
Ans. It is the characterization of chromosomes
according to their size, shape and the
distribution of stain taken up by them. Each pair
of homologous chromosomes are arranged in a
sequence and the chromosomal constitution of
a cell is studied.
Q. What is principle of karyotyping?
Ans. Chromosomes are easily visible during
metaphase. Human cells are cultured in vitro
and cell division is arrested in the stage of
metaphase. Cultured cells are then treated with
hypotonic solution which helps in formation of
a chromosomal spread. Slides are made from
this chromosomal spread and stained with
different methods. Chromosomes can be now
identified under high power of microscope and
according to their microphotographs.
Q. What are tissue used for cell culture?
Ans. Amniotic fluid cells, chorionic villous
trophoblasts, skin fibroblasts, bone marrow
cells, cells within hours of death of an individual
e.g., blood from fetus.
Q. What is aneuploidy?
Ans. It occurs as a result of the addition or loss of one
or more chromosomes. Most of the aberrations
 638 Human Anatomy For Dental Students
of chromosomal number take place due to non-
disjunction.
Q. What is polyploidy?
Ans. It is the addition of one or more complete
haploid set of chromosomes to the normal
diploid number of chromosomes.
Q. What is trisomy?
Ans. Presence of 3 copies of a chromosome instead
of the normal 2 in a cell is called trisomy.
Trisomy of all the autosomes has been recorded
except in chromosome 1.
Q. What are cause and risk factors of trisomy?
Ans. Cause and risk factors of trisomy
1. Trisomy occurs due to the non-disjunction of
a chromosome or a chromatid in one of the
fertilizing gametes. The frequency of non-
disjunction is more in oogenesis than in
spermatogenesis.
2. Occurrence of trisomy increases with the age
S E C T I O N-4
of the mother.
Q. What is Downs syndrome?
Ans. This is also known as Mongolism
Cytogenetics: It usually follows fertilization of
two gametes out of which one has two
chromosome 21 (usually a result of non
disjunction during its meiosis I). Rarely, it can
occur due to the translocation of long arm of
chromosome 21 to D and G group of chromo-
some.
Clinical features of a child with Downs
syndrome
a. Mental retardation (moderate)
b. Short stature
c. Brachycephaly
d. Presence of epicanthal folds
e. Protuding tongue, small ears and flat occiput
f. Flat nasal bridge
g. Brushfield spots in the eye (in the iris)
h. All males are infertile while females have
reduced fertility
Q. What is Klinefelters syndrome?
Ans. This is trisomy of sex chromosomes. The
karyotype is 47, XXY. A young boy with
Klinefelter syndrome presents with a mild
developmental delay and behavorial immaturity.
The adult male presents with small testes,
dysgenesis of seminiferous tubules,
gynecomastia and poor musculature. Most
males are infertile.
47, XYY syndrome This condition occurs with
the same frequency as 47, XXY. Male presents
with tall stature and mild social problems.
47, XXX female Majority of 47, XXX females
have no clinical manifestations. They have
normal fertility and normal off springs.
Q. What is monosomy?
Ans. It is characterized by the presence of only one
member of the homologous pair of chromo-
somes in the karyotype.
Autosomal monosomies are not seen in live
births or in early spontaneous abortions because
they are fatal to the conceptus.
Q. What is Turners syndrome?
Ans. Monosomy of the X-chromosome (karyotype 45,
XO)is the most common form of monosomy
seen. The patient is a female (as there is no Y
chromosome) and presents with the following
features:
1. Short stature
2. Webbing of neck
3. Low hair line at the nape of neck
4. Primary or secondary amenorrhea
5. Streak ovaries
6. Majority are infertile
Causes and risk factor: Turners syndrome
results from the fertilization of two gametes out
of which one lacks its X-chromosome. This
occurs due to non-disjunction or anaphase lag
during cell division in which the X-chromosome
is lost to the non fertilizing daughter cell of the
original germ cell.
Q. What is cri-du-chat or cat cry syndrome.
Ans. It is due to deletion of the terminal portion of
short arm of chromosome 5 (5p-) The new born
presents with
1. Round face
2. A cry that resembles of a cat
3. Hypertelorism
4. Micrognathia
5. Severe mental retardation
6. Cardiac defects

Q. What is Wolf-Hirschhorn syndrome?
Ans. There is deletion of the short arm of
chromosome 4 (4p)
Infant has the following features
1. Prominent forehead and broad nasal root
2. Short philtrum
3. Mouth is downturned
4. Severe mental retardation
5. Cardiac defects
6. Growth failure
Q. What is Prader-Willi syndrome?
Ans. This syndrome involves microdeletions of the
proximal part of long arm of chromosome 15
(15q).
The infant presents with:
1. Profound hypotonia
2. Mental retardation
3. Trunkal obesity
Q. What is WAGR syndrome?
Ans. Chromosomal analysis shows an interstitial
deletion of a particular region of the short arm
of one of the chromosomes no.11.
The child usually develops
1. Wilms tumour
2. Aniridia
3. Genital abnormalities
4. Growth retardation
Q. What are genes?
Ans. Genes are the units of heredity. A gene consists
of a specific sequence of DNA which codes for
a specific sequence of amino acids forming a
particular protein. The various genes are
arranged in a linear series within the
chromosomes.
Q. What is Locus?
Ans. The position of a gene in the chromosome is
called locus. It is described in reference to the
centromere.
Q. What are Alleles?
Ans. Genes occupying identical loci in a pair of
homologous chromosomes are called as alleles
or allelomorphs. One pair of allelic genes
regulate the synthesis of a particular polypep-
tide chain and hence are responsible for a
particular character of an individual.
Review of Genetics 639
Q. What are homozygous alleles?
Ans. When both allelic genes regulating a particular
character or trait are similar, they are called
homozygous alleles, e.g., presence of two genes
representing tall height in an individual.
Q. What are Heterozygous alleles?
Ans. When both allelic genes regulating a particular
character are dissimilar, they are called
heterozygous alleles, e.g., presence of two genes
with one representing tall and other
representing short height in an individual.
Q. What is multiple alleles?
Ans. When in a population, more than two different
alleles exist at a given locus of a chromosome.
Such alleles are said to be multiple. In a given
individual only two of these alleles are present.
For example the blood groups are coded by four
alleles A1, A2, B and O out of which only two,
e.g., AO, AB, OO etc. are present in a individual.
C H A P T E R-54
Q. What are different types of genes?
Ans. Types of genes according to the Mendelian
pattern of inheritance
1. Dominant gene
2. Recessive gene
3. Carrier gene
4. Co-dominant genes
5. Sex-linked genes
6. Sex-limited genes
Q. What are Mendels Law?
Ans. Three principal laws of inheritance were
established on the basis of Mendels plant
experiments.
1. The law of uniformity: The crossing over
between two homozygotes of differing types
results in offsprings that are identical and
heterozygotic. The inherited characters do
not blend.
2. The law of segregation: During formation
of gametes the two members of a gene pair
separate into different gametes. Therefore, in
an individual each of the allelic pair is
originally derived from separate parents.
3. Law of independent assortment: This law
states that different traits conveyed by
members of different gene pairs segregate to
the offspring independent of one another.
 640 Human Anatomy For Dental Students
Q. What is Lyons hypothesis?
Ans. This hypothesis was given by Mary F.Lyon. It
proposed that in the somatic cells of female
mammals, only one X chromosome is active. The
other X chromosome is condensed and inactive.
It is seen in the interphase cells as the sex
chromatin or Barr body. The inactivation of
chromosome occurs early in the development
during embryonic life at around 15th-16th day
of gestation. Normally either of the two X
chromosomes can be inactivated. The process
of X inactivation is often referred to as
lyonization.
Q. What is Pedigree chart?
Ans. It is a chart made from the data collected from
an individual or family which represents
successive generations, past and future. There
are certain international conventional symbols
used to draw the chart.
S E C T I O N-4
Q. What is autosomal dominant inheritance?
Ans. 1. This occurs due to mutation in a dominant
gene on an autosome leading to a particular
trait.
2. This trait is transmitted from one generation
to the other equally to male and female
offsprings (vertical transmission).
3. The risk of transmission of the disorder is 50%
if one of the parents has the dominant trait.
4. The unaffected family members do not
transmit the disorder.
Q. What is autosomal recessive inheritance?
Ans. 1. The mutated gene is expressed only in a
homozygous state.
2. The affected individuals are usually siblings
(horizontal transmission) with equal distri-
bution in males and females.
3. Successive generations may skip having the
disorder till two carrier partners meet.
4. The parents of an affected individual are
apparently healthy as they are heterozygotes.
5. The risk of transmission of the trait by 2
carrier parents to their offspring is 25%. There
is 50% risk of offsprings being carriers and
25% offsprings are normal.
6. It is often associated with consanguinous
marriages.
Q. What is sex-linked inheritance?
Ans. X-linked recessive disorders are the most
common form of sex linked abnormalities. X-
linked dominant and Y-linked traits are rarely
encountered.
Q. What is X-linked recessive inheritance?
Ans. 1. The disorder affects only males while females
are unaffected in families.
2. The disorder is transmitted by carrier females
to their sons.
3. The affected males, on survival, can transmit
the disorder to their male grandchildren via
obligate carrier daughters.
 Section-5: Essentials of Embryology
55. General Embryology .......................................... 643-676
56. Development of Musculoskeletal System........ 677-684
57. Development of Head and Neck ...................... 685-698
58. Development of Nervous System ..................... 699-708
59. Molecular Regulation of Development ............ 709-710
60. Review of Embryology ....................................... 711-718
 Chapter
55
General Embryology
INTRODUCTION
Embryology: It is the study of formation and development
of the embryo and fetus till it is born as a new individual.
Reproduction: Process of reproduction is essential for
survival and existence of species and self. Reproduction
includes the following three phases in human life:
1. Embryogenesis
2. Growth
3. Sexual maturity
Embryogenesis: It starts with fertilization. Fertilization
is a process of fusion of male gamete, sperm with female
gamete, ovum. Male and female gametes are derived from
primordial germ cells. Primordial germ cells are derived
from epiblast in 2nd week of intrauterine life. In the 4th
week of intrauterine life, these cells migrate to the wall of
yolk sac. In 6th week of intrauterine life, the primordial
germ cells further migrate to the gonadal ridges. During
migration the cells undergo continuous mitosis so as to
increase their number.
In the gonads, these cells then undergo meiosis and
various processes of cytodifferentiation. This process is
known as gametogenesis. This process in male is known
as spermatogenesis and in female it is known as
oogenesis.
MALE GAMETE AND SPERMATOGENESIS
Male Gemete
It is also known as sperm, spermatozoon, spermatoid,
spermium. A single ejaculate contains upto 300 million
spermatozoa.
Morphology of Sperm (Fig. 55.1A)
Sperm is made up of head, neck and tail.
1. Head or caput: It is ovoid or piriform in shape. It is
4 in length and 3 in diameter.
It contains little cytoplasm. It primarily has an
elongated, flattened nucleus with densely
staining chromatin and a bilaminar acrosomal
cap which is placed anteriorly.
The acrosomal cap covers terminal 2/3rd of
nucleus and is derived from the Golgi apparatus
of spermatid. It contains the following enzymes:
a. Acid phosphatase
b. Hyaluronidase
c. Protease (Acrosomase)
Nucleus and acrosome are enveloped in a
continuous plasma membrane without any
intervening cytoplasm.
The chromatin present in the nucleus is
C H A P T E R-55
stabilized by disulphide bonds to prevent it from
injury during the journey of spermatozoon. The
chromatin has a strong affinity to basic stains.
2. Neck: It is a small constriction, 0.3 , present between
the head and middle piece of spermatozoon.
It has little cytoplasm and is covered with plasma
membrane, continuous with head and tail.
It presents two well formed centrioles, a proximal
centriole which lies in the center and a distal
centriole which is modified to form the basal body.
The axial filament complex, known as axoneme,
is derived from the basal body.
3. Tail or cauda: It is 45 to 50 in length. It is divided
into three parts namely, middle part, principal part
and end part:
a. Middle piece/part: It is cylindrical, 7 long and
1 in diameter. It consists of an axial bundle of
microtubules (axoneme) extending from the basal
body.
Outer to axoneme is a cylinder of nine dense
outer fibres. These are further surrounded by
a sheath of mitochondria arranged in a helicle
manner.
It is enveloped by cytoplasm and plasma
membrane.
At the caudal end of middle part lies an
electron dense body known as annulus or ring
centriole.
b. Principal part or tail: It is 40 long and 0.5 in
diameter.
It consists of central axoneme surrounded by
dense fibres which continue uninterrupted
from the middle part.
 644 Human Anatomy For Dental Students

Spermatogenesis
It is an orderly sequential process which gives rise to
spermatozoa from primordial germ cells. The entire
process is divided into the following 3 phases:
1. Spermatocytosis
2. Meiosis
3. Spermiogenesis
1. Spermatocytosis (Figs 55.1B and 55.2): Primodial
germ cells present in seminiferous tubules of testis
divide mitotically during embryonic, fetal and early
postnatal life to maintain their population and form
spermatogonia. This is known as spermatocytosis.
Spermatogonia are precursors of spermatozoa. At
puberty their population increases dramatically,
under influence of testosterone.
Three types of spermatogonia are recognized:
a. Dark type-A spermatogonia: They are
considered as progenitor cells.
They are large, rounded cells with dark
staining nucleoplasm and eccentric nucleolus.
Cells divide mitotically to maintain their
population and also give rise to light type A
S E C T I O N-5

spermatogonia.
b. Light type-A spermatogonia
Fig. 55.1A: Schematic diagram showing parts of spermatozoon They are large, rounded cells with light
staining nucleoplasm and eccentric nucleolus.
It is surrounded by cytoplasm and plasma They are derived from dark type A
membrane. spermatogonia.
c. End part or piece: It has the typical structure of Each divides to give rise to two type B
flagellum and consists only of the axial bundle spermatogonia.
of fibrils. It is 5 to 7 long.

Fig. 55.1B: Transerse section of testis showing spermatogenesis in seminiferous tubules


Fig. 55.2: Schematic diagram showing formation of spermatids from spermatogonia
c. Type B spermatogonia
They are large, rounded cells with a spherical
nucleus and central nucleolus. They are
derived from light type A spermatogonia
These cells are the ones that undergo the
spermatogonic cycle. They divide mitotically
and give rise to primary spermatocytes which
undergo the next step of meiosis.
2. Meiosis
The primary spermatocyte undergoes 1st meiotic
division and gives rise to two secondary
spermatocytes with (n) number of chromosomes.
The secondary spermatocytes then undergo
second meiotic division to give rise to a total of 4
spermatids with (n) number of chromosomes.
3. Spermiogenesis (Fig. 55.3)
It is a complex series of changes by which a
spermatid becomes spermatozoon. It is divided
into two phases:
a. Period of organogenesis of spermatid: It is
characterized by the formation and
enlargement of acrosomal vesicle with
acrosomal granule. The acrosomal vesicle is
derived from vesicles of Golgi apparatus
which coalesce to form a single vesicle and it
General Embryology 645
C H A P T E R-55
gradually expands to form a bilaminar cap
over the anterior 2/3rd of the nucleus.
The spermatid elongates and rest of Golgi
complex with cytoplasm migrate to
posterior part of cell.
The cell further elongates with formation
of axial fibrils from basal body of
spermatozoon. Basal body is derived from
the distal centriole of spermatid (proximal
remains unmodified).
Microtubules develop and are located in
perinuclear position
Annulus develops near basal body
Mitochondria assemble to form a helicle
sheath around bundle of fibrils.
b. Enlargement of tail: Final maturation of
spermatozoon is characterized by enlarge-
ment of tail.
A part of cytoplasm with some mitochondria,
golgi membranes and vesicles, RNA particles
and granules gets detached from the leading part
madeup of acrosome and nucleus. This is called
residual body.
The spermatids are surrounded by Sertoli cells
which engulf the residual bodies and
degenerating cells.
S E C T I O N-5 646 Human Anatomy For Dental Students

Fig. 55.3: Schematic diagram showing spermiogenesis

The spermatozoa are released from Sertoli cells. The exact mechanism of capacitation is still
The release is known as spermiation. uncertain. In the process of capacitation the
glycoprotein coat and seminal proteins lying over
Maturation of Spermatozoa
surface of spermatozoa get altered.
It is a complex process by which the spermatozoon
Capacitation is believed to occur in the uterine cavity
attains a specific pattern of independent motility.
or tube. It lasts for 7 hours in human being.
This maturation is believed to occur in epididymis.
There is an increase in sulphide cross linking of Effect of Temperature on Spermatogenesis
proteins in spermatozoa in epididymis which is The testes are present in scrotal sacs.
essential for attaining spermatozoons motility. The vascular supply in scrotal sacs has a counter
current mechanism of heat exchange from its arteries
Motility of Spermatozoa
and veins. This mechanism helps to maintain the
Spermatozoa are largely transported in genital tract
interior of scrotum at a temperature 4 to 5C below
by ciliary action, fluid currents and muscular
the actual body temperature. Thus, the scrotal
contractions.
temperature is around 32C. This is the ideal
On ejaculation, the spermatozoa display their
temperature that favours development of sperms.
characteristic pattern of motility.
Spermatogenesis is hampered in cases where there
Rate of travel of human spermatozoa is 1.5 to 3 mm
is alteration of temperature surrouding the testes.
per minute and they reach tubal ostia of uterus in
This is seen in cases of abnormal position of testes
about 70 minutes following ejaculation.
when it is lying in abdomen or in males exposed to
Constituents of semen derived from epididymis,
high temperatures due to tight clothes or hot baths.
testes, seminal vesicles and prostate may exert
influence in achieving final pattern of motility of
spermatozoa. FUNCTIONS OF MALE REPRODUCTIVE TRACT

Capacitation The male reproductive tract is primarily concerned with

It is the terminal event in the maturation of production of mature sperms, their transport and
spermatozoa by which it attains the capacity to ejaculation into the female copulating organ, that is
fertilize ova. vagina. The site of formation of sperms is testes. The

sperms are then transferred successively to epididymis,
vas deferens, ejaculatory duct, prostate, membranous and
penile urethra.
Functions of Testes
1. Testes produce sperms or spermatozoa.
2. Sertoli cells in the seminiferous tubules of testes are
responsible for following functions:
a. Provide nourishment (are rich in glycogen) and
support to the germ cells.
b. Synthesize androgen binding protein that
maintains high testosterone levels in testes.
c. Tight junctions between Sertoli cells forms the
blood testes barrier and prevents passage of any
large molecules from blood. This helps to
maintain the internal milieu of seminiferous
tubules. It also does not allow the germ cells to
enter circulation and prevents any autoimmune
reaction.
3. Testes produces 2 hormones :
a. Testosterone is the primary hormone.
b. Estrogen, in very small quantities
Testosterone: It is a steroid hormone secreted by the
interstitial Leydig cells of testes. To some extent it is
produced by adrenal cortex also.
Actions of Testosterone
1. It is responsible for development of gonads, male
internal and external genitalia in fetal life.
2. It stimulates spermatogenesis along with FSH.
3. It promotes and maintains growth of internal
genitalia at puberty.
4. It is responsible for development of secondary sexual
characteristics at puberty.
5. It exerts anabolic effects in the form of :
a. Increases synthesis and decreases breakdown of
proteins.
b. It causes mild retension of Na+, K+ and water.
c. Facilitates growth spurt at puberty.
Estrogen: Most of the circulating estrogen in males is
derived from peripheral conversion of testosterone. Little
estrogen is produced by Sertoli and Leydig cells.
Regulation of Testicular Function
The testicular function is regulated by pituitary
gonadotrophins, FSH and LH.
1. FSH: It helps in the growth and maintainance of
testes and Sertoli cells. It promotes spermato-
genesis with testosterone.
2. LH: It stimulates growth and secretion of Leydig
cells.
Inhibin produced by Sertoli cells inhibits FSH
secretion while testosterone inhibits LH secretion.
General Embryology 647
Functions of Penis and Scrotum
Penis is the copulating organ that deposits sperm
into vagina.
Scrotum encloses testes and epididymus. The
counter current venous flow mechanism in scrotum
maintains a temperature almost 4 to 5 C below body
level. This is ideal for development of sperms.
Functions of Seminal Tract
This is formed by epididymus, vasdeferens, and
ejaculatory duct. It stores the mature sperms before
ejaculation.
Functions of Accessory Male Glands
Accessory male glands are exocrine glands. They consist
of the following:
1. Seminal vesicles: They contribute about 60% of total
semen volume. They secrete thick, sticky fluid which
is rich in:
a. Potassium, fructose, phosphorylcholine, citric
C H A P T E R-55
acid and ascorbic acid which are energy sources
to spermatozoa.
b. Hyaluronidase that lyses mucopolysaccharides
and helps in penetration of cervical mucus.
c. Prostaglandins which produce contractions in
uterine musculature leading to movement of
sperm inside.
2. Prostate gland: It contributes to 20% of total semen
volume. It secretes a thin, opalescent fluid which is
acidic and gives semen its characteristic fishy odour.
The fluid contains:
a. Calcium
b. Ions like Na+
c. Zinc
d. Citric acid
e. Fibrinolysin
f. Acid phosphatase
3. Bulbourethral (Cowpers) glands: They produce a
mucoid, alkaline secretion which helps in
lubrication during coitus.
Semen
1. It is the fluid ejaculated from penile urethra during
coitus.
2. It contains sperms and secretions from the accessory
glands.
3. The volume of an ejaculate usually varies from 2.0 to
3.5 ml but decreases with frequent ejaculations.
4. The normal pH of semen is alkaline which favours
sperm motility.
 648 Human Anatomy For Dental Students
5. Fructose is an important constituent of semen and
provides the metabolic fuel to sperms.
6. Sperm count varies from 60 to 120 million/ml of
ejaculate.
7. Sperms remain viable for upto 24 to 48 hours in the
female genital tract.
Constituents of Seminal Fluid
1. Mucoprotein
2. Proteolytic enzymes
3. Bases like
a. Spermine
2. Growth and maturation of oocytes
b. Glyceryl phosphorylcholine
c. Ergothioneine
4. Organic acids, prostaglandins
5. Acids like
a. Citric acid
b. Ascorbic acid
c. Lactic acid
d. Pyruvic acid
6. Sugars like
a. Sorbitol
b. Inositol
S E C T I O N-5
c. Fructose is secreted by seminal vesicles and is
essential to provide energy, by anaerobic
glycolysis, for survival of spermatozoa.
FEMALE GAMETE AND OOGENESIS
Female Gamete
It is also known as mature oocyte or ovum. In a newborn
(female) the ovaries have about one million ova in the
primary oocyte stage which are arrested in stage of first
meiotic division. After birth there is no further mitosis
and hence the population of oocytes is fixed. This is in
contrast to the male gamete where in newborn (male) the
testes have spermatogonia which undergo mitosis under
the effect of testosterone at puberty. In healthy males
spermatocytes and spermatozoa are produced practically
life long while in female the oocytes are exhausted by the
age of 45 to 50 years (menopause).
Oogenesis (Fig. 55.4)
The process of formation of mature oocyte (ovum) from
primordial germ cell is known as oogenesis.
Development of mature oocytes is studied in 3 phases:
1. Establishing germ cell population
Germ cells migrate from yolk sac to the gonadal
ridges at 6th week post conception where they
proliferate and by 8 to 10 weeks of intrauterine
gestation about 6,00,000 oogonia are present in
the ovary.
At 12 weeks of gestation the oogonia start
differentiating to primary oocytes.
By 5th month of gestation, continuous
proliferation leads to presence of 70,00,000
primary oocytes in ovary.
At birth, only 1,000,000 remain and by puberty
there are about 40,000 primary oocytes in ovary.
In the reproductive span of a woman, only 400
oocytes finally ovulate.
It is believed that random anomalies acquired
during meiosis in the primary oocyte are
responsible for the large rate of atresion of
primary oocytes in fetus and new born.
Growth of oocytes: In the fetus, i.e., in intrauterine
life itself the primary oocyte is surrounded by a single
layer of squamous cells and this unit is called
primordial follicle.
Primary oocyte is about 35 micron in diameter
with a large vesicular nucleus and an eccentric
nucleolus.
The first signs of growth is enlargement of oocyte.
The surrounding cells also assume cuboidal
shape and proliferate to form granulosa cells.
Growth is stimulated by gonadotrophins
produced at puberty.
The final diameter of mature oocyte (ovum) is
120 microns. This is attained only after puberty.
Zona pellucida is formed. It is an amorphous
material surrounding the oocyte, inner to
granulosa cells (Figs 55.7 and 55.8).
Functions of Zona Pellucida
a. Forms a barrier between oocyte and granulosa
cells
b. Helps in triggering acrosomal reaction
d. Responsible for species specific recognition
of spermatozoa.
e. Helps in providing nutrition to oocyte through
diffusion.
Granulosa cells also increase and are
surrounded by flat elongated cells derived from
ovarian stroma. These are called theca cells.
Meiotic Division of Oocyte
The primary oocytes, seen as early as 12 weeks
of intrauterine gestation, undergo DNA
replication and enter 1st phase of meiotic
division.
Each primary oocyte gets arrested in the diplotene
stage of meiotic prophase from 20 weeks of
gestation till further stimulation. Thus a fully
grown primary oocyte contains double stranded
diploid number of chromosomes at birth.
Further stimulus to resume meiosis occurs only
after puberty and that to in the developing follicle
at the time of LH surge. At the time of ovulation
the primary oocyte completes the first meiotic
 General Embryology 649

Fig. 55.4: Transverse section of ovary showing development of ovarian follicles

C H A P T E R-55
Fig. 55.5: Primordial follicle

Fig. 55.8: Secondary or antral follicle

Fig. 55.6: Growing follicle

Fig. 55.7: Primary follicle Fig. 55.9: Tertiary or Graffian follicle

 650 Human Anatomy For Dental Students
division and gives rise to a large secondary oocyte
and a smaller polar body.
Secondary oocyte now has double stranded
haploid (n) number of chromosomes. It
immediately enters the 2nd meiotic division and
the division gets arrested in the metaphase of
2nd meiotic division, prior to ovulation.
The secondary oocyte completes its second
meiotic division only when it is fertilized.
3. Development of ovarian follicle (Figs 55.5 to 55.9)
a. Primordial follicle: Primary oocyte in fetal stage
is enveloped by single layer of squamous cells
and this unit is called as primordial follicle.
b. Primary follicle: After puberty, the oocyte grows
in size and the enveloping cells, called granulosa
cells, become cuboidal and also proliferate. It is
now called primary follicle.
c. Secondary (antral or vesicular follicle):
A cohort of about 15 to 20 primary oocytes
start growing under influence of
gonadotrophic hormones in each menstrual
cycle.
The granulosa cells proliferate, cavities form
S E C T I O N-5
in between them which coalesce to form a
single fluid filled space called antrum. The
Fig. 55.10: Ovulation
cells are further surrounded by spindle
shaped cells from ovarian stroma, called theca
cells.
At this stage the follicle is about 200 microns
and oocyte is 80 microns.
The antrum is surrounded by thin layer of
granulosa cells except at one pole where the
granulosa layer is thick enclosing the oocyte.
Theca cells also proliferate and are arranged
in two layers, theca interna and theca externa.
d. Tertiary follicle (also called Graffian follicle)
(Fig. 55.9)
Only one follicle out of the many secondary
follicles matures to tertiary stage. The antrum
enlarges, oocyte is surrounded by a cluster of
granulosa cells in the form of a cap known as
cumulus oophorous.
The mature fully grown oocyte breaks away
and floats in follicular fluid. It completes its
1st meiotic division at ovulation. A
perivitelline space is created beneath the zona
pellucida after extrusion of 1st polar body.
Cells immediately surrounding the oocyte are
called corona radiata.
 General Embryology 651

As mentioned earlier in a tertiary follicle the The follicle is called corpus luteum. These cells now
secondary oocyte is in the arrested phase of produce progesterone hormone.
second meiotic division at the time of The lutein cells undergo fatty degeneration and
ovulation. autolysis in the absence of fertilization and atrophy
by 12 to 14 days post ovulation
Ovarian Cycle Degeneration of corpus luteum leads to decreasing
The cyclical changes in ovary after puberty secretion of progesterone. Fall in progesterone levels
constitute ovarian cycle. is responsible for the onset of menstrual phase of
Under the influence of rising levels of FSH (follicle menstrual cycle of uterus.
stimulating hormone) secreted by anterior pituitary The next ovarian cycle restarts along side the
a cohort of primordial follicles are stimulated. menstruation phase. Decreasing levels of estrogen
The primordial follicles grow and form primary, and progesterone stimulate secretion of FSH and
secondary and tertiary follicles. initiation of next ovarian cycle.
The follicles secrete estrogen. Under the influence of
gonadotrophins and estrogen hormones one follicle
grows maximally to mature to Graffian follicle.
When estrogen levels attain a particular peak a
positive feed back mechanism is initiated which
stimulates the pituitary gland to secrete leutenizing
hormone (LH). This sudden increase in LH secretion
is called LH surge.
Ovulation occurs in response to LH surge. It is

C H A P T E R-55
characterized by rupture of follicle and release of
secondary oocyte from the ovary (Figs 55.10 to 55.13).
After ovulation the walls of ovarian follicle collapse
and fold (Fig. 55.11). The granulosa cells increase in
size and acquire a cytoplasmic carotenoid pigment,
leutin, which is responsible for their yellow color. Fig. 55.11: Formation of corpus luteum after ovulation

Fig. 55.12: Diagrammatic representation of changes in hormonal levels and corresponding changes in endometrium during
menstrual cycle
 652 Human Anatomy For Dental Students
Corpus luteum becomes atretic and is usually seen
as a white scar in the ovarian stroma after 2 months.
It is named corpus albicans.
Menstrual Cycle (Figs 55.12 and 55.13)
Menstrual cycle begins at puberty. The cyclical changes
in the endometrium of uterus, in response to ovarian
hormones constitute the menstrual cycle. It is divided into
the following 3 phases:
1. Proliferative phase
2. Secretory phase
3. Menstrual phase
1. Proliferative Phase: This is also known as follicular
phase.This phase follows the last menstrual phase.
It has the following characteristic features:
There is generalized active proliferation of
endometrium.
Endometrium grows from 1 to 3 mm.
Uterine glands increase in length and remain
straight.
Cells of endometrial stroma are arranged in
following three layers, from superficial to deep:
S E C T I O N-5
a. Stratum compactum: Superficial compact
layer
Fig. 55.13: Correlation of changes in uterine endometrium with changes in ovary
b. Stratum spongiosum: Intermediate spongy
layer
c. Stratum basale: Deep basal layer
Changes in this phase occurs under the influence
of estrogen derived from maturing ovarian
follicles.
This phase generally lasts for 14 days in a 28
days menstrual cycle.
2. Secretory phase: This is also known as progesta-
tional phase. It is characterized by the following
features:
There is futher growth of endometrium. It grows
upto 5 to 7 mm in thickness
Endometrial glands increase in size, are dilated
and become convoluted
There is increased amount of tissue fluid in the
endometrial stroma.
Size of stromal cells increases due to accumula-
tion of glycogen and lipid droplets in their
cytoplasm. This change in stromal cells is known
as decidual reaction.
This phase is influenced by the progestrone
hormone secreted by corpus luteum of ovary.
Secretory phase lasts for 14 days in a 28 days
cycle.

By the end of progesterone phase, regression of
endometrium starts due to decrease concentra-
tion of progesterone hormone.
3. Menstrual phase
Menstrual phase follows secretory phase and
lasts for 3 to 5 days (can vary from 2 to 7 days.).
It is characterised by shedding of stratum
compactum and stratum spongiosum of
endometrium along with some amount of blood.
The average amount of blood loss during
menstrual phase is about 50 to 60 ml (maximum
80 ml).
The onset of menstrual phase is due to
decreasing concentrations of progestrone,
following degeneration of corpus luteum.
The duration of mestrual cycle, on an average, is 28
days (can vary from 22 to 35 days). The duration of cycle
is calculated from the first day of the menstrual bleeding
to the onset of menstrual bleeding in the next cycle. It is
seen that the average duration of secretory phase remains
constant i.e., 14 days while the duration of proliferative
phase maybe variable. Variations in the proliferative
phase depend on variations in ovarian follicle
development, pituitary hormones, other hormonal
influences like thyroid, prolactin, etc. which decides the
length of menstrual cycle
Menstrual cycle starts at puberty at the age of 12 to 14
years (menarche) and ends at 45 to 50 years of age
(menopause).
FUNCTIONS OF FEMALE REPRODUCTIVE TRACT
Functions of Vagina
It acts as receptacle for the male copulatory organ,
penis, for deposition of sperm.
It forms a passage for birth of baby.
Functions of Uterus
Uterus after puberty undergoes cyclical changes.
These changes prepare uterus to receive fertilized
ovum and nourish the embryo and maintain
pregnancy till birth of baby.
Functions of Uterine (Fallopian) Tubes
They are the site for receiving the ovum from ovary,
fertilization of ovum and propulsion of the fertilized ova
to the uterus.
Function of Ovaries
Ovaries are the store house of oocytes in varying stages of
development. At birth ovaries contain about 1 to 2 million
primordial follicles which develop into primary follicles
at puberty. There are about 3 to 4 lakh primary follicles in
General Embryology 653
ovary at puberty. Ovary secretes two steroid hormones,
estrogen and progesterone.
Estrogen (Fig. 55.14): It is produced by the granulosa cells
of the developing follicles, in response to FSH. It is also
produced by placenta, adrenal and testes. Effects of
estrogen are as follows:
1. Stimulates changes in endometrium in a cyclical
manner.
2. Facilitates growth of ovarian follicles.
3. Increases motility of fallopian tubes.
4. Promotes and maintains growth of internal genitalia.
5. Increases secretion of thin cervical secretions
favouring penetration by sperms.
6. Promotes mitotic activity in vagina, increases
breakdown of glycogen and production of lactic
acid. This maintains an acid medium (pH 4.5) and
the integrity of epithelium, preventing invasion by
external organisms.
7. Promotes growth of external genitalia.
8. Provides negative feedback to pituitary for secretion
of FSH.
C H A P T E R-55
9. Provides positive feedback to pituitary for secretion
of LH causing LH surge.
10. Has an important role in maintaining pregnancy, in
growth of myometrium and also in labour.
11. Responsible for appearance and development of
secondary sexual characteristics in females
especially breast enlargement.
12. Effect on breast: It is responsible for growth of duct
system in breast resulting in breast enlargement
during puberty.
13. Miscellaneous actions
a. Causes salt and water retention.
b. Increases thin secretions of sebaceous glands
and keeps skin elastic.
c. Has anti atherogenic action by maintaining low
circulating cholesterol levels and promoting
endothelial vasodilatation.
Progesterone (Fig. 55.14): It is a steroid hormone primarily
secreted by the corpus luteum of ovary. It is also produced
by adrenal cortex and testes in small amounts . During
pregnancy placenta secretes large amount of
progesterone.
Actions of Progesterone
1. It produces secetory changes in uterine endometrium
which is primed by estrogen, making it receptive for
implantation of fertilized ovum.
2. It makes the cervical secretions thick and viscous.
This creates a barrier for entry of further
spermatozoa. It also protects against invasion by
organisms.
3. It promotes development of glandular tissue of the
breast increasing the alveolar mass.
S E C T I O N-5 654 Human Anatomy For Dental Students

Fig. 55.14: Regulation of FSH, LH, estrogen and progesterone secretion through hypothalamohypophysealovario
uterine axis

4. It antagonizes the following effects of estrogen: b. It stimulates secretion of estrogen and

a. Decreases myometrial contractility progesterone from corpus luteum.
b. Decreases estrogen receptors on myometrium c. LH is inhibited by estrogen and progesterone
5. Miscellaneous functions: levels.
a. Increases basal body temperature Hypothalamus secretes gonadotropin stimulating factors
b. Stimulates respiration which are called GnRH (gonadotropin releasing
hormones). GnRH secretions begin during puberty, from
Regulation of Ovarian Function (Fig. 55.14)
the hypothalamus, in a pulsatile fashion which stimulates
Synthesis and secretion of ovarian hormones is under
secretion of FSH and LH from pituitary. FSH stimulates
control of pituitary gonadotropins, FSH and LH.
development of ovarian follicles and the ovarian cycle.
1. FSH
Estrogen produced by the ovarian follicles in response to
a. It stimulates development of ovarian follicles and
FSH further stimulates proliferative changes in
production of estrogen.
endometrium of uterus (proliferative phase of menstrual
b. It is inhibited by high estrogen levels.
cycle). The increasing levels of estrogen gives a positive
c. Inhibin B produced by granulosa cells of ovary
feedback to the pituitary leading to sudden increase in
inhibits FSH secretion.
secretion of LH (LH surge). This leads to ovulation,
2. LH
formation of corpus luteum. Secretion of progesterone
a. It is responsible for ovulation.
 General Embryology 655

from corpus luteum stimulates the secretory changes in

endometrium of uterus (secretory phase of menstrual
cycle). The gonadotropin levels are lower at this phase.
In the absence of fertilization corpus luteum of ovary
degenerates and there is fall in levels of estrogen and
progesterone. This fall triggers degenerative changes in
endometrium which brings on the menstrual phase.
Decreasing levels of estrogen and progesterone again
stimulates pituitary to secrete FSH followed by LH and
this initiates next ovarian and menstrual cycle.

FERTILIZATION (Figs 55.15 to 55.21)

It is the fusion of mature spermatozoon and mature ovum
to form zygote.

Mechanism of Fertilization
Mechanism of fertilization can be studied in the following
stages:
1. Approximation of spermatozoon and ovum
(secondary oocyte) (Fig. 55.15)

C H A P T E R-55
It includes transport of sperms and secondary
oocyte to uterine tube.
After copulation, around 300 spermatozoa
ascend to finally reach the fallopian tube.
Secondary oocyte released from the ovary after
ovulation is picked up by fimbria of uterine tube.
The most common site of fertilization (union of
spermatozoa and secondary oocyte) is ampullary
region of uterine tube.
2. Fusion of spermatozoon and ovum
Secondary oocyte is surrounded by zona
pellucida, corona radiata and cummulus
oophorus.
Fig. 55.15: Approximation of spermatozoa and secondary
Spermatozoa undergo capacitation (in the uterus
oocyte
or the uterine tube) which helps in traversing
through the above three barriers. Fusion of sperm to oolemma propogates a weak
Spermatozoa traverse through cummlus depolarization wave which further leads to a
oophorus and corona radiata and reach the zona calcium wave.
pellucida. Increase in calcium concentration provides the
One spermatozoon binds to the specific signal for completion of the second meiotic
glycoprotein receptors, ZP3 and ZP2, on zona division in secondary oocyte and simultaneous
pellucida. setting up of the developmental programme that
Interaction of ZP3 with sperm head leads to an would lead to embryogenesis.
acrosomal reaction. Enzymes are released, Calcium wave also leads to fusion of the cortical
especially acrosin, which help to dissolve zona granules in oocyte with oolemma that stimulates
pellucida and the sperm reaches the perivitelline release of hydrolyzing enzymes from these
space. granules. The enzymes hydrolyze ZP3 receptors
The sperm now fuses with the oocyte microvilli on zona pellucida. Hence, any further entry of
via two disintegrin peptides present in sperm other sperms is prevented. This is known as zona
head and an integrin protein in the oolemma. reaction.
 656 Human Anatomy For Dental Students

Fig. 55.16: Entry of spermatozoon through zona pellucida Fig. 55.17: Penetration of spermatozoon in secondary oocyte
S E C T I O N-5

and stage of oocyte which has completed its second meiotic division

Fig. 55.19: Male and female pronuclei with centrosome

Fig. 55.18: Formation of male and female pronuclei

Fig. 55.20: Chromosomes arranged on spindle Fig. 55.21: Chromosomes split longitudinally
 General Embryology 657

Secretions of some cortical granules also modify

the vitelline layer and oolemma making them
less suspectible to oocyte sperm fusion. This is
known as vitelline reaction.
The second meiotic division of oocyte is
completed and second polar body is extruted.
The pronuclei of the sperm and ova now grow.
Actual fusion of the two does not take place. The
nuclear envelopes of the pronuclei disappear.
There is simultaneous replication of the DNA of
the nuclei and the two chromosome groups move
together to assume position on the first cleavage
spindle.
3. Effects of fertilization
Completion of second meiotic division of
secondary oocyte. Fig. 55.22: Preimplantation Development
Restoration of diploid number of chromosomes.
Determination of chromosomal sex.
Initiation of cleavage division of zygote. gives rise to a fluid filled cavity which is known
as blastocele. Embryo at this stage is known as

PREIMPLANTATION DEVELOPMENT (Fig. 55.22)
The zygote prior to implantation undergoes development
through the following stages:
1. Cleavage divisions (Figs 55.22)
A process of repeated mitotic divisions of zygote
occur within the zona pellucida which results
in increase in number of cells. These cells are
known as blastomeres.
First cleavage divisions occur around 24 hours
after fertilization.
During 8 cells stage compaction of cells occurs
in which the cells flatten and increase their
intercellular contact. This process is believed to
be important the development of cell diversity in
early embryo.
2. Morula stage (Fig. 55.22)
At about 12 to 16 cell stage, the mass is called as
morula. All the cells are approximately of same
size.
At this 16 cells stage the cell polarity is already
determined to form the outer trophoectoderm and
inner cell mass.
Inner cell mass gives rise to embryo in future
while the outer cell mass is destined to form the
fetal membranes including placenta.
3. Blastocyst (Fig. 55.22)
Cells in morula stage continue to divide.
Intercellular spaces appear between the inner cell
mass and outer cell mass. Fluid from uterine
cavity reaches these intercellular spaces and
C H A P T E R-55
blastocyst.
The inner cell mass is now known as
embryoblast and the outer cell mass forms the
trophoblast. It occurs at the 32 to 64 cell stage.
In the 107 cell blastocyst, it is seen that 69 cells
give rise to mural trophoblast, 30 cells give rise
to polar trophoblast and 8 cells form inner cell
mass.
IMPLANTATION (Figs 55.23 and 55.24)
Zygote enters the uterine cavity on the 3rd to 4th day of
fertilization. It is in the stage of morula. On the 6th to the
7th post ovulatory day, at blastocyst stage, zona pellucida
disappears and implantation occurs.
The blastocyst adheres to the uterine mucosa and
following changes take place:
Zona pellucida undergoes dissolution
The blastocyst orients along the endometrium and
adheres to it.
Trophoblast cells (outer cell mass) help in
penetration of blastocyst into the endometrium. The
trophoblast cells are rapidly proliferating cells
which spread on the leading part of blastocyst and
penetrate into the endometrium.
Blastocyst then migrates into endometrium.
Site of implantation is usually on the posterior
uterine wall, near fundus of uterus (Fig. 55.24).
Blastocyst is completely embedded in the
endometrium by 12th post ovulatory day.
 658 Human Anatomy For Dental Students
S E C T I O N-5
Fig. 55.23: Path of fertilized ovum till implantation and stages
during 1st week of development.
POST IMPLANTATION
Outer cell mass gives rise to trophoblast which
proliferates and leads to formation of two distinct
cell arrangements namely, cytotrophoblast and
syncytiotrophoblast. The proliferation is maximal
at the leading end of the embryo.
Cytotrophoblast and syncytiotrophoblast: At the site
of implantation, the outer cell mass of blastocyst
starts proliferating and gives rise to tropboblast.
Further multiplication of these cells forms two
distinct layers, outer syncytiotrophoblast and inner
cytotrophoblast. Syncytiotrophoblast layer is made
up of cells which loose their cell walls and it is seen
Fig. 55.24: Usual site of implantation
as a single multinucleated mass of cytoplasm. This
feature facilitates the penetration of uterine vessels
into the syncytium.
Cells of inner cell mass differentiate into 2 layers:
a. Hypoblast layer: This is made up of a layer of
small cuboidal cells adjacent to blastocyst cavity.
b. Epiblast layer: It is made up of high columnar
cells. A small cavity develops within epiblast
which later enlarges and gives rise to the amniotic
cavity. This occurs on 8th day of development.
The two layers, i.e., hypoblast layer and epiblast layer
form the germinal disc or embryonic disc (Fig. 55.26).
Decidua (Fig. 55.25A and B): During secretory phase
of menstrual cycle endometrial cells become
vacuolated and store glycogen and lipid. This is
known as decidual reaction. This reaction is
intensified after implantation and endometrium is
now known as decidua. The decidua is named
according to its position in respect of developing
embryo.
1. Decidua basalis: It is the part which lies deep to
developing embryo, it is the site of implantation
of leading part of embryo. It gives rise to the
maternal site of placenta.
2. Decidua capsularis: It is the part which covers
the embryo and separates it from the uterine
lumen.
3. Decidua parietalis (vera): It is the decidua lining
the rest of uterine cavity.
At the time of delivery of fetus the decidua is shed off
along with placenta.

B
Fig. 55.25A and B: Decidua after implantation A. Yolk sac in chorionic cavity B. Uterine cavity is obliterated and amnion and
chorion have fused
EXTRA EMBRYONIC TISSUE
It is defined as the tissue that does not contribute directly
to the formation of body of definitive embryo and fetus
(Fig. 55.28).
Extraembryonic mesoderm: It is derived from the epiblast
and hypoblast and comes to lie between primary yolk sac
and trophoblast. Formation of extra embryonic mesoblast
occurs in day 7 to 12 embryo.
FORMATION OF AMNIOTIC CAVITY, CHORIONIC
CAVITY, YOLK SAC AND CONNECTING STALK
A fluid filled space appears between the epiblast
layer and adjacent trophoblast layer even before
implantation. This forms the amniotic cavity which
is filled with the amniotic fluid. Cells lining this
General Embryology 659
C H A P T E R-55
cavity are derived from epiblasts and the trophoblast.
The cells of amniotic cavity continuous with
trophoblast cell are cuboidal while the cells of
epiblast adjacent to the hypoblast become tall
columnar (Fig. 55.26).
Hypoblast is made up of flattened cells which start
lining the blastocyst cavity from inside. These cells
form a membrane known as Heusers membrane.
The blastocyst cavity lined by flat hypoblast cells is
now called as primary yolk sac (Figs 55.27 and 55.28).
The cells of epiblast and hypoblast further give
origin to a mass of cells that comes to lie between the
flattened hypoblast lining primary yolk sac and the
trophoblast and is called the extraembryonic
mesoblast. Soon small cavities appear in this
extraembryonic mesoblast and they join together to
 660 Human Anatomy For Dental Students

Fig. 55.26: Formation of syncytiotrophoblast, cytotrophoblast and partially embedded blastocyst

S E C T I O N-5

Fig. 55.27: Primitive yolk sac, cytrophoblast, syncytiotrophoblast, trophoblastic lacunae and Heusers membrane

Fig. 55.28: Primary yolk sac, extraembryonic coelom, extraembryonic splanchnopleuric mesoderm, extraembryonic
somatopleuric mesoderm and formation of endoderm

Fig. 55.29: Formation of primary villi, secondary yolk sac, and chorion
form a large cavity. This cavity is called
extraembryonic coelom. Now, the extraembryonic
mesoblast splits into two layers. The part inside the
trophoblast and outside the amniotic cavity is known
as extraembryonic somatopleure. The part lining the
outside of yolk sac is known as extraembryonic
splanchropleure (Figs 55.28 and 55.29).
The extraembryonic coelom does not extend into the
part of extraembryonic mesoblast which attaches the
wall of the amniotic cavity to the trophoblast. This
unsplit part of extraembryonic mesoblast forms
connecting stalk (Fig. 55.29) of the developing
embryo. The developing embryo is suspended in the
extraembryonic coelom now.
With the appearance of extraembryonic coelom, the
yolk sac becomes smaller and is now called as
secondary yolk sac (Fig. 55.29). The cell lining of the
yolk sac now changes to cuboidal from initial
flattened cells.
The extraembryonic somatopleure and trophoblast
together form chorion. Epiblast derived cells with
the mesothelium lining the amniotic cavity forms
amnion.
FORMATION OF PLACENTA (Fig. 55.30)
Placenta is made up of of finger like processes known as
villi and intervillious spaces. Intervillous spaces contain
maternal blood and the villi form the essential functional
unit for exchange. Maternal blood bathes the surfaces of
General Embryology 661
C H A P T E R-55
the chorionic villi. Human placenta is thus haemochorial.
Fetal blood circulates through capillaries present in the
villi.
Formation of Villi
During implantation the syncytiotrophoblast
invades and engulfs the uterine glands and walls of
the branches of uterine vessels. The mass of
syncytium initially present with spaces lined by
trophoblast cells enclosing maternal blood. Later,
with the formation of villi, these spaces form the
intervillous space. The cytotrophoblast continues to
grow into the syncytiotrophoblast and comes in
contact with the decidua basalis and forms
anchoring villi.
Finger like processes arise from cytotrophoblast layer
as off shoots. These processes are covered from
outside by syncytiotrophoblast cells which have
already penetrated the decidua. The core of these
finger like processes contain extraembryonic
mesoderm and capillaries from fetus.
The villi are formed by syncytiotropblast,
cytotrophoblast, extraembryonic mesoderm and fetal
capillary. Villi are classified as primary, secondary
and tertiary.
1. Primary villus (Fig. 55.30): It consist of finger like
process made up of cytotrophoblast and covered
by syncytiotrophoblast from outside.
2. Secondary villus (Fig. 55.30): When this primary
villus is invaded by the extraembryonic
S E C T I O N-5 662 Human Anatomy For Dental Students
Fig. 55.30: Formation of placenta, primary, secondary and tertiary villi
mesoderm in the core, it is known as secondary
villus.
3. Tertiary villus (Fig. 55.30): When blood capillary
of fetus enters the secondary villus in the
extraembryonic mesodermal inner layer it
becomes tertiary villus.
Villi are also known as chorionic villi due to presence
of extraembryonic mesoderm and cytotrophoblast
in their core.
The chorionic villi initially develop all over the
trophoblast shell covering the embryo and invade
into decidua. Villi present in relation to decidua
capsularis are transient and disappear later on. This
part of chorion becomes smooth and known as
chorionic laevae. Villi present in relation to decidua
basalis help in formation of placenta. This part of
chorion is known as chorionic frondosum.
Growth of Villi
The syncytiotrophoblast expands to invade the
maternal spiral arteries of decidua basalis. A second
wave of growth leads to extention of trophoblast into
the inner 1/3rd of myometrium. The cytotrophoblast
cell migerate into the maternal vessels and replace
their smooth musculature with fibrinoid tissue
which allows expansion of these vessels creating a
low resistance flow.
The villi expand radially giving out 2nd order
(intermediate) and 3rd order (terminal) branches or
villi. These branches appear as out pouching with a
central core of mesenchyme containing fetal vessels.
Mesenchyme is covered with cytotrophoblast and
syncytiotrophoblast. These villi are bathed in
maternal blood in the intervillous space.
Intervillous space: Space between villi is known as
intervillous space. This space is lined by syncytio-
trophoblast and filled with maternal blood. This
intervillous space is invaded by septae from maternal
side which give rise to formation of lobes.
On its fetal aspect, it is bounded by a chorionic plate,
which consists of syncytial, cytotrophoblastic and
mesenchymal layers of the chorion. The mesenchyme
carrys branches of umbilical vessels. On its maternal
aspect it is bounded by a basal plate, which consists of
syncytiotrophoblast, with an outer cytotrophoblast which
extends into the maternal decidua.
The intervillous space from chorionic to basal plates
contains the main trunks of the villi with their divisions,
intermediate and terminal villi. The maternal blood
vessels open through gaps in the trophoblast shell of basal
plate into the intervillus space.
Anatomy of Placenta at Term (Figs 55.31 and 55.32)
Placenta is disc shaped and weighs around 500 gms
at term.
There are 15 to 20 lobes present in human placenta.
Each lobe contains a number of cotyledons. There

Fig. 55.31: Fetal side of full term placenta
are 60 to 100 cotyledons in mature placenta. Each
cotyledon consists of an anchoring villus and its
branches. After birth of child the placenta is shed off
along with decidua.
The fetal side of placenta is named chorionic plate
and is covered externally by amnion. The decidual
(materal) side is named basal plate and it is made
up of maternal decidua, fibrinoid matrix, remanants
of cytotrophoblast and syncytiotrophoblast.
Placental barrier or membrane: Intervillous space
contains maternal blood while fetal blood is present in
capillaries of tertiary villi. Maternal and fetal blood do
not mix and are separated from each other by the following
structures forming the placental barrier:
1. Endothelium of fetal capillary present in villi.
2. Basement membrane of fetal capillary present in villi.
3. Extraembryonic mesoderm of villi.
4. Cytotrophoblast and its basement membrane in villi.
5. Syncytotrophoblast of villi.
Functions of Placenta
1. Exchange of oxygen, from maternal to fetal blood.
2. Excretion of carbon dioxide, urea and other waste
products from fetal blood to maternal blood.
3. Exchange of nutrients, electrolytes and vitamins from
maternal blood to fetal blood.
4. Placenta helps in providing passive immunity to
fetus by facilitating transmission of IgG from
maternal blood to fetal blood.
5. Synthesis of human chorionic gonadotrophins
(HCG) takes place in placenta. This maintains corpus
luteum of pregnancy. It is secreted by syncyto-
trophoblast in first 8 weeks of pregnancy. Placenta
General Embryology 663
Fig. 55.32: Maternal side of full term placenta
produces progesterone. It helps in maintenance of
pregnancy after 4th month even if corpus luteum
degenerates. Placenta secretes estrogen especially
C H A P T E R-55
estriol. It helps in uterine growth and development
of mammary gland. Somatomammotrophin is also
secreted by placenta.
6. Placenta acts as a selective barrier and prevents
many bacteria and harmful substances from reaching
the fetus. However, viruses like poliomyelitis,
rubella, CMV and measles can pass through
placental barrier. Various drugs can cross placental
barrier. Some drugs like aminoglycosides
(gentamycin and amikacin) and anticonvulsants
(sodium valproate) can cause congenital
malformations.
FORMATION OF EMBRYONIC TISSUES
All the tissues of the embryo are formed from epiblast.
After formation of extraembryonic mesenchyme, caudal
end of epiblast presents with formation of primitive streak.
Gastrulation
Gastrulation is the process of establishment of the three
germ layers in the developing embryo namely ectoderm,
mesoderm and endoderm. All three layers are believed to
originate from the epiblast cells which give rise to
primitive streak which is the site of formation of cells of
the three germ layers. Gastrulation starts in 3rd week of
gestation. Formation of primitive streak is the beginning
of gastrulation. Primitive streak is clearly visible in 15th
to 16th day embryo. Gastrulation is the process where
epiblast gives rise to a trilaminar structure with a defined
cranio-caudal axis and formation of the embryonic shape.
 664 Human Anatomy For Dental Students

Fig. 55.33: Embryonic disc and primitive streak Fig. 55.34: Fate of epiblast cell passing through primitive
streak and node

Primitive Streak (Figs 55.33 to 55.35)

Embryonic disc becomes elongated. Primitive streak
appears as a midline proliferative region of the
epiblast cells, first seen in the caudal region of the
embryonic disc. The streak is oriented along the long
axis of the disc and determines the future
S E C T I O N-5

craniocaudal axis of the embryo.

At the cranial end of the streak, there is a curved
ridge of cells forming the primitive node or Hensons
node. It attains its maximum length by end of 3rd Fig. 55.35: Formation of primitive streak and primitive node
week of development.
Primitive streak and node represent as the organizer.
Hypoblast induces the formation of primitive streak. Notochord (Fig. 55.36)

Ingression: It is the process by which epiblast cells become
part of the primitive streak and then break away from it to
migrate away from it. The passage of epiblast cells
through the primitive streak gives rise to the following
(Fig. 55.34):
1. Embryonic endoderm
2. Notochord
3. Primordial germ cells
4. Mesoblast
5. Contribution to extraembryonic mesoblast and
placenta
Primitive Node or Hensons Node (Fig. 55.35)
It is located in the rostral end of the primitive streak. It
appears as a curved ridge of cells. Cells ingress from this
node and pass into the primitive pit. They migrate rostally
beneath the epiblast. Primitive node gives rise to
1. Prechordal plate
2. Notochord
3. Embryonic endoderm
4. Medial half of somites
The earliest cells migrating through primitive node
and streak give rise to endoderm and notochord.
Notochordal cells become epithelial after ingression
through primitive node. Notochordal cells form
epithelial rod between the epiblast and endoderm
extending from caudal part of prechordal plate to
primitive streak. This epithelial rod is known as
notochordal process. It has three parts:
1. Rostral part consists of cells continuous with
prechordal mesenchyme.
2. A middle part with cells arranged in a tube with
central canal.
3. A caudal part consists of notchordal plate
continuous with embryonic endoderm.
With subsequent development, the floor of the
notochordal canal breaks down and communicates
with the secondary yolk sac. At this stage amniotic
cavity and yolk sac are in continuation with each
other.
Gradually the wall of the canal becomes flattend and
give rise to notochord plate.
As the embryo enlarges the notochord elongates and
occupies the position which is occupied later by the

Fig. 55.36: Formation of notochord
vertebral column. It gets separated from the
alimentary tract by a mechanism similar to formation
of neural tube.
Most of notochord disappears but part of its persists
as nucleus pulposus in intervertebral disc.
Prechordal Plate
It is formed from the earliest population of endodermal
cells that ingress from the primitive streak and form a
General Embryology 665
C H A P T E R-55
localized thickening of the endoderm rostral to the
notochordal process. The appearance of the prechordal
plate determines the central axis of the embryo and helps
in distinguishing the future head and tail end.
Embryonic endoderm: The earliest cells migrating
through the primitive node and streak give rise to both
embryonic endoderm and notochord. The definitive
endoderm is derived from epiblast cells ingressing from
primitive node and rostral part of streak (Fig. 55.36).
 666 Human Anatomy For Dental Students
Intraembryonic mesoblast (Fig. 55.37): Cells ingress from
cranial and middle part of primitive streak become flask
shaped and develop lamellipodia and filipodia. These
cells come to lie between epiblast and embryonic
endoderm and are known as intraembryonic mesoblasts.
Fig. 55.37: Formation of intraembryonic mesoderm
Primordial germ cells: These cells arise from the caudal
end of primitive streak due to epiblast ingression.
Embryonic ectoderm: When the ingression of cells
S E C T I O N-5
through the primitive streak is completed the cells
remaining in the epiblast layer are embryonic ectoderm
cells. This layer contains neuroectoderm and surface
ectoderm.
Trilaminar Disc
The embryo at about 18 to 19 post ovulatory day has three
layers known as trilaminar disc. It is pear-shaped, broader
cranially than caudally and consists of the following:
1. Upper epiblast: Tall columnar pseudostratified
epithelial layer lying on basal lamina except at
primitive streak where cells are ingressing.
2. Lower endoderm: A simple squamous layer
developing basal lamina.
3. Middle mesoblast layer: Composed of free cells
migrating cranially, laterally and caudally from
primitive streak. They produce extracellular matrix.
Mesoblast extends all over between the epiblast and
endoderm except cranially at the prechordal plate
and the part which will become buccopharyngeal
membrane and caudally at the part which will
become cloacal membrane.
DEVELOPMENT AND DERIVATIVES OF ECTODERM,
MESODERM AND ENDODERM
Embryonic period extends from 3rd week of development
to 8th week of development. This period is also known as
period of organogenesis. Three germ layers i.e. ectoderm,
mesoderm and endoderm give rise to different tissues,
structure and organs during this period. Main organ
systems develop by the end of 8th week of intrauterine
life.
Development of Ectoderm
Under the influence of notochord and prechordal
mesoderm there is appearance of a thickened neural plate
in the epiblast along the mid sagittal axis cranial to the
primitive pit on day 18.
It is likely that neural plate develops in response to
inducing substances secreted by the underlying axial
mesodermal structures, i.e., by prechordal plate and
cranial portions of notochordal plate. These substances
diffuse into the overlying epiblast cells in which they
activate specific genes that cause the cells to differentiate
into a thick plate of columnar, pseudostratified
neuroepithelial cells (neuroectoderm). The neural plate
first appears at the cranial end of the embryo and then
differentiates cranio-caudally (Fig. 127.1).
By the beginning of the 4th week the neural plate
consists of a broad cranial portion that will give rise to
the brain and a narrow caudal portion that will give rise
to the spinal cord.
On day 22 the narrow caudal portions of the neural
plate ( future spinal cord) represents 25% of the length of
the neural plate, by 23 to 24th day the future spinal cord
occupies about 50% of the length of the neural plate and
by day 26 it occupies about 60%. The rapid lengthening
of the neural plate during this period is thought to depend
on the elongation of the underlying notochord.
In the 4th week, neural plate converts into neural tube
by a process of folding called neurulation.
Neurulation (Fig. 55.38)
At the end of the presomite period, the ectoderm
around the midline of the embryonic disc, dorsal to
notochord and cephalic to primitve streak
differentiates to form the neural plate. This is under
the inductive influence of notochord.
Neurulation commences as the neural plate begins
to crease ventrally along its midline forming the
neural groove. This neural groove is thought to
develop in response to induction by the closely
apposed notochord.
Neural folds are formed on each side of the groove.
Neural folds become concave and as they rotate the
lateral lips of the folds meet dorsally to form a tube
enclosing a space called the neural canal. As the
lips of the neural tube fuse, the junction between the
neuroepithelium and the adjacent surface ectoderm
is pulled dorsally. The opposing margins of surface
ectoderm also meet and fuse. As soon as the surface
ectoderm fuses, the neural tube separates from it and
sinks into the posterior body wall.
 General Embryology 667

C H A P T E R-55
Fig. 55.38: Transverse section of embryo showing formation of 3 germ layers and neurulation

The lips of the neural folds first make contact on day
22 in the area of the first five somites. The newly
formed neural canal communicates with the amniotic
cavity at either end through two large openings
called the cranial and caudal neuropore (Fig. 127.3).
As neurulation continues, the cranial and caudal
neuropores close on day 26. Closure of the cranial
neuropore is actually bidirectional and final closure
occurs in the area of the future forebrain. Closure of
the caudal neuropore is strictly craniocaudal and
finishes at the level of second sacral segment.
Neural tube has a broader cephalic end from which
brain develops and narrow caudal end which gives
rise to spinal cord.
The tips of the neural folds are lined by special cells
known as neural crest cells which migrate away
from the folds before the closure of neural tube
(Fig. 55.39).

Fig. 55.39: Formation of neural crest and its cells migration

 668 Human Anatomy For Dental Students

Derivatives of Neural Crest

Nervous tissue
1. Dorsal root ganglia
2. Sympathetic and
parasympathetic ganglia
3. Ganglia related to
V,VII, VIII, IX and X
cranial nerves
4. Meissners and
Auerbachs plexuses
5. Enteric neurons
S E C T I O N-5
Connective tissue
(Neural)
1. Schwann cells
2. Satellite cells of sensory
and autonomic ganglia
3. Glial cells in enteric
plexuses
4. Satellite cells in carotid
body
5. Cartilage, ligaments
Connective tissue Epithelial tissue
(Mesenchymal)
1. Pia and arachnoid 1. Peripheral sensory
mater (meninges) receptors
2. Sclera of eye 2. Parafollicular cells
3. Choroid of eye of thyroid
4. Vomer, maxilla, mandible 3. Melanocytes
nasal, palatine, frontal 4. Carotid body, type
parietal and temporal bones I and type II cells
5. Chromaffin cells
and tendons of head region.
6. Lacrimal, nasal, palatine,
labial, oral and salivary
glands
7. Suprarenal medulla
8. Dentine of tooth
9. Tunica media of aorta and
pulmonary

Derivatives of Surface Ectoderm Epithelium
1. Epidermis.
2. Secretory cells and duct-lining and myoepithelium
cells of the sweat, sebaceous and mammary glands.
3. Hair and nails.
4. Lens of the eye.
5. Enamel of the teeth.
6. Cells of gland and ducts of the lacrimal nasal, labial,
palatine, oral and salivary glands.
7. Epithelium of the cornea and conjunctiva.
8. Epithelium lining the external acoustic meatus and
external epithelium of the tympanic membrane.
9. Epithelium lining the paranasal sinuses, lips, cheeks,
gums and palate.
10. Epithelium of the membranous labyrinth, the
cochlear organ of Corti.
11. Adenohypophysis
12. Sensory ganglia of V, VII, VIII, IX, X cranial nerves.
13. Olfactory receptor cells and olfactory epithelium
14. Epithelium of the terminal male urethra.
Derivatives of Neural Plate Epithelium
1. Neurohypophysis
2. Cerebral hemispheres, basal nuclei, cerebral
peduncles, tectum, tegmentum, cerebellum, pons,
medulla oblongata and spinal cord.
3. All cranial and spinal motor nerves.
4. All CNS neurons, including preganglionic efferent
neurons, with somata within the CNS.
5. Astrocytes and oligodendrocytes.
6. Ependyma lining the cerebral ventricles, aqueduct
and central canal of brain and spinal cord.
7. Retina and optic nerve, epithelium of the iris, ciliary
body and processes.
Development of Mesoderm
Mesoderm lies between ectoderm and endoderm. It forms
a thin sheet of cells on either side of midline. Mesodermal
cells close to and on either side of midline proliferate and
form the paraxial mesoderm by 17th day of development.
Laterally, the mesoderm is thin and called as lateral plate
mesoderm. The part of mesoderm which connects
paraxial mesoderm and lateral plate mesoderm is known
as intermediate mesoderm (Fig. 55.38).
Paraxial Mesoderm
The cells of paraxial mesoderm organize themselves
into segments on either side of midline of embryo,
known as somitomeres. Somitomeres appear in
heads region first and proceed caudally.
Somitomeres in cephalic region give rise to
mesenchyme of head contribute to formation of skull.
Somitomeres extending from occipital region
caudally organize into solid blocks of cells and give
rise to somites.
 General Embryology 669

1st pair of somite appears in occipital region by 20th region of somites become polymorphic and migrate
day of development and approximately 3 pairs are towards notochord and surround it. These cells are
added each day till 42-44 pair of somites is present called as sclerotome which give rise to vertebral
by the end of 5th week. There are 4 occipital, 8 column. The cells present in dorsolateral position in
cervical, 12 thoracic, 5 lumbar, 5 sacral and 8 to 10 somites proliferate and give rise to dermomyotome.
coccygeal pairs of somites are present. Cells which migrate along ventral side form
The 1st occipital and 7 coccygeal somites disappear myotome and those are present dorsally form
and rest form axial skeleton. Age of embryo can be dermatome. Myotomes form muscles and
estimated by presence of number of somites during dermatomes form dermis of skin and subcutaneous
this period of intrauterine life. tissue. The derivatives of each dermatome and
myotome retain their nerve supply of respective
No. of somites Approximate age (Days) segment (from they are derived) even if the
14 20
derivatives of myotomes and dermatomes migrate
from original segment (Figs 55.40 and 55.41).
57 21
810 22
1113 23
1417 24
1820 25
2123 26

C H A P T E R-55
2426 27
2729 28
3033 29
3435 30

Somites further differentiate into a ventromedial part

known as sclerotome and a dorsolateral part known Fig. 55.40: Development of somites
as dermomyotome. The cells of ventral and medial

Fig. 55.41A and B: A. Development of somites B. Differentiation of somite to sclerotome and dermomyotome in transversection
of embryo
 670 Human Anatomy For Dental Students

Intermediate Mesoderm surrounding yolksac and later in lateral plate

mesoderm. These blood islands are comprise of
Intermediate mesoderm gives rise to structures of
hemangioblast cells arranged in centre and
urogenital system. It temporarily connects paraxial and
periphery. Hemangioblast cells lying in the
lateral plate mesoderm.
periphery of islands differentiate into angioblasts
cells which are precursors under the influence of
Lateral Plate Mesoderm
vascular endothelial growth factor (VEGF) secreted
Lateral plate mesoderm is made up of unsegmented by surrounding mesodermal cells give rise to
mesoblast which lies lateral to the paraxial endothelial cells. These endothelial cells later
mesenchyme. coalesce to give rise to primitive blood vessel. Once
Small cavities develop within lateral plate mesoderm primitive blood vessels are formed, the endothelial
which fuse together and give rise to the intra- cells proliferate and give rise to sprouts which later
embryonic coelom. The intraembryonic coelom splits become new vessels.
the lateral plate mesoderm into two layers, 2. Angiogenesis (Fig. 55.43): New blood vessels are
somatopleuric mesenchyme, subjacent to ectoderm formed as sprouts from existing vessels. As described
and splanchnopleuric mesenchyme, adjacent to above formation of blood vessels from primitive blood
endoderm. vessels.
Intraembryonic coelom becomes continuous with
extraembryonic coelom on either side of embryo. It
later gives rise to pericardial, pleural and peritoneal
cavities.
Somatopleuric mesenchyme gives rise to connective
tissue and bones and cartilages of the limbs and
S E C T I O N-5

pelvis; dermis of skin of ventral and lateral body

walls and limbs.
Splanchnopleuric mesenchyme gives rise to
connective tissue and musculature of gut and Fig. 55.43: Angiogenesis
respiratory tract.
Formation of blood: The hemangioblast cells which lie
Septum transversum: The mesenchyme that invaginates
in the centre of island form hemaopoietic stem cells and
from the middle of primitive streak and comes to lie cranial
are the precursors of the blood cells. The blood islands
to the buccopharyngeal membrane gives rise to pericardial
first arise in yolk sac but definite hematopoietic stem cells
coelom. With further proliferation and formation of head
arise from mesoderm surrounding the aorta, from where
fold the mesenchyme lies ventral to the developing heart
the cells migrate into liver. Liver becomes the major
and separates it from the developing foregut. This
hematopoietic organ of the fetus. Later, the stem cells from
mesenchyme is now labelled as septum transversum. It
liver migrate to the bone marrow to form the definite blood
gives rise to diaphragm, pericardium and sinusoids of
forming tissue.
liver.
Derivatives of Mesenchyme
Formation of Blood and Blood Vessels
1. Vertebrae and portions of the neurocranium, axial
Blood vessels develop in two ways:
1. Vasculogenesis (Fig. 55.42): Blood vessels arise from skeleton, appendicular skeleton, connective tissue
blood islands which are formed from mesodermal of limbs and trunk, including cartilage, ligaments
cells under the influence of fibroblast growth factors and tendons.
2 (FGF-2) to form hemangioblasts. During 3rd week 2. All voluntary muscles of the head, trunk and limbs.
of intrauterine life blood islands appear in mesoderm 3. Dermis of skin.
4. Connective tissue of gonads, mesonepheric and
metanepheric nephrons, smooth muscle and
connective tissues of the reproductive tracts.
5. Epicardium, fibrous pericardium, endocardium of
heart.
6. Smooth muscle and connective tissues of respiratory
tract and associated glands.
Fig. 55.42: Steps of Vasculogenesis

7. Smooth muscle and connective tissues of intestinal
tract, associated glands and abdominal mesenteries.
8. Smooth muscle and connective tissue of blood vessels
9. Mesenchyme of external genitalia.
10. Endothelium of blood and lymphatic vessels, vessels
of choroid plexus, sinusoids of liver and spleen,
circulating blood cells, microglia, tissue macro-
phages.
Derivatives of Coelomic Wall Epithelium
1. Myocardium, parietal pericardium.
2. Visceral, parietal and mediastinal pleura.
3. Visceral peritoneum of stomach, midgut and
hindgut, peritoneum of lesser and greater ometa,
falciform ligament, lienorenal and gastrosplenic
ligaments, the mesentery, transverse and sigmoid
mesocolon.
4. Parietal peritoneum.
5. Epithelium lining of vas deferens, epididymis,
seminal vesicles, ejaculatory duct, uretus, trigone of
urinary bladder.
6. Epithelium lining of uterine tubes, body and cervix,
vagina, broad ligament of uterus.
7. Germinal epithelium of gonads.
Development of Endoderm
Endodermal germ layer gives rise to primitive gut.
Endoderm forms the roof of yolk sac and covers the
ventral aspect of the embryo.
As the head and tail folds of embryo develop, an
endoderm lined cavity (primitive gut) is enclosed by
the body of embryo. Part of primitive gut lying in
head fold becomes foregut, part lying in tail fold
becomes hind gut. In the middle primitive gut is
continuous with yolk sac by broad stalk, the vitelline
duct. This part is known as mid gut. Foregut limited
anteriorly by buccopharygeal membrane and hind
gut caudally by cloacal membrane.
Buccopharyngeal membrane ruptures by 4th week
of intrauterine life establishing a communication
between foregut and amniotic cavity. Cloacal
membrane ruptures by the seventh week of intra-
uterine life forming an opening for anus.
Lateral body folds appear along with head and tail
folds due to rapid growth of somites. As the lateral
folds come closer to each other on the ventral side of
embryo, ventral body wall start forming and
embryonic disc acquire round shape.
With further development ventral body wall is formed
except at site of attachment of connecting stalk and
General Embryology 671
yolk sac. Gradually vitelline duct which is
connecting yolk sac to midgut disappears and gut
loses its connection with yolk sac.
By the 5th week, the vitelline duct, allantois and
umbilical vessels remain limited in the region of
umbilicus.
Endoderm gives rise to epithelial lining of primitive
gut, intraembryonic part of allantois, vitelline duct,
epithelial lining of respiratory tract, parenchyma of
thyroid gland, parenchyma of parathyroid gland,
parenchyma of liver and pancreas, reticular stroma
of tonsils and thymus, lining epithelium of gall
bladder, urinary bladder, urethra, epithelial lining
of tympanic cavity and auditory tube.
Derivatives of Endoderm Epithelium
1. Derivatives of fore gut
a. Epithelium and lining cells of glands and their
ducts of the pharynx, oesophagus, stomach and
duodenum.
b. Epithelium and lining cells of glands and their
C H A P T E R-55
ducts of the trachea, bronchi, bronchioles and
alveolar sacs
c. Glandular and duct-lining cells and the main
follicular cells of the thyroid.
d. Epithelium of the auditory tube, tympanic cavity,
tympanic antrum, internal lamina of the
tympanic membrane.
e. Hepatocytes of liver, lining of biliary tract,
exocrine and endocrine cells of the pancreas.
2. Derivatives of midgut: Epithelium and lining cells
of glands and their ducts of the duodenum, jejunum,
appendix, caecum, part of transverse colon.
3. Derivatives of Hindgut: Epithelium and lining cells
of glands and their ducts of the part of the transverse,
decending and sigmoid colon, rectum and upper
part of anal canal.
4. Derivatives of allantois: Epithelium of urinary
bladder, vagina, urethra, secretory cells of the
prostate and urethral glands.
Development of External Features of Growing
Embryo and Fetus
External features of embryo during 2nd month of
intrauterine life
Somites and pharyngeal arches are prominent
features of embryo at the end of 4th week of
intrauterine life. Age of embryo at this stage can be
estimated with the help of no. of somites as given in
table on page no. 669.
 672 Human Anatomy For Dental Students
During 2nd month of development there is increase
in head size appearance of forelimbs and hind limbs,
formation of face, ear, nose and eyes. Forelimb and
hind limb buds appear in the 5th week of intrauterine
life.
Changes in fetus from 3rd month till birth
The period from 9th week till birth is known as fetal period.
It is characterized by growth and development of tissues
and organs. There is increase in length during 3rd, 4th
and 5th month while in increase in weight is seen in last
two months of intrauterine life.
Features during 3rd month
In 3rd month face shows human features
Eyes lie ventrally
Ears occupy position close to their definite position
on the side of the head.
Proportional increase in length in limbs in
comparison to body.
External genitalia are well developed and can be
detected by ultrasound examination.
S E C T I O N-5
Features during 4th and 5th month
1. CR length is between 15 to 19 cm and weight is about
450 to 500 gm.
2. The fetus is covered with fine lanugo hair
3. Eyebrows and head hair are also visible
4. During 5th month the movement of fetus is felt by
mother known as quickening
Features during 6th month
Skin is fetus is reddish and wrinkled
Features during 7th month
CR length during 7th month is 24 to 27 cm. and weight
approximately 1100 gm.
Features during last two months of intrauterine life
1. Presence of subcutaneous fat which gives rounded
shape to the fetus
2. Skin of the fetus is covered by whitish fatty substance
called caseosa by the end of intrauterine life.
Fig. 55.44A to C: Development of intraembryonic coelom
3. Skull has the larger circumference in comparison to
all parts of body by the end of 9th month.
4. Weight is about 3200 gm (average weight of a new
born in India at term pregnancy is 2800 gm
approximately).
5. CR lengh is about 36 cm and CHL (crown heel
length) is about 50 cm.
DEVELOPMENT OF BODY CAVITIES (Figs 55.44 and
55.45)
The intraembryonic mesoderm differentiates into
paraxial, intermediate and lateral plate mesoderm by the
end of 3rd week of development. Towards the end of 5th
week, before the formation of head fold, intracellular clefts
or spaces appear in the mesenchyme cranial to the
buccopharyngeal membrane and in the lateral plate
mesoderm which coalesce to form intraembryonic coelom
(cavity). It is in the shape of a horse shoe and extends
craniocaudally from the level of buccopharyngeal
membrane to the first somite. At this point it does not
communicate with the extraembryonic coelom. This
cavity divides the lateral plate mesoderm into
somatopleuric mesoderm subjacent to ectoderm and
splanchnopleuric mesoderm next to endoderm.
As the embryo undergoes folding at head end, then
tail end and laterally the cranial part of intraembryonic
coelom extends on to the ventral aspect of the developing
foregut. This midline ventral portion of the intraembryonic
coelom, caudal to buccopharyngeal membrane gives rise
to pericardial cavity.
The portion of intraembryonic coelom on the lateral
aspect of developing foregut extends caudally and gives
rise to pericardioperitoneal canals on each side. The
intraembryonic coelom extends laterally and later
ventrally (after the lateral folding of embryo) and
communicates with the extraembryonic coelom. The
pericardioperitoneal canals in the region of foregut give
rise to pleural cavities and upper part of peritoneal cavity.
The rest of the pericardioperitoneal canals give rise to
peritoneal cavity proper.
 General Embryology 673

The lung bud develops from the ventral aspect of

foregut at the level of septum transversum and
bifurcates to form bronchial buds which give rise to
the lung. Each developing bud grows dorsally
passing lateral to the foregut and projects into the
pericardioperitoneal canal of that side forming the
primary pleural coelom around it.
An elevated tissue named pulmonary ridge develops
on the lateral wall of pleural coelom and encircle the
pleuropericardial canal giving rise to pleuro-
pericardial folds.
Further growth of heart with development of great
vessels and expansion of enlarging lungs ventrally,
dorsally and laterally leads to fusion of pleuro-
pericardial folds with each other and the root of lung
leading to formation of pericardial cavity and pleural
cavities.
Septum transversum, development of mesenchyme
Fig. 55.45: Development of pericardioperitoneal canal, from lateral walls of pleuroperitoneal epithelium
peritoneal cavity, pericardial cavity giving rise to pleuroperitoneal folds and the dorsal
mesentery of esophagus together form the
diaphragm which separates the pleural cavity from

C H A P T E R-55
Formation of Pericardial, Pleural and Peritoneal
Cavities peritoneal cavity.
The cavities assume their final shape and loose
The cranial part of initial intraembryonic coelom
communication with extraembryonic coelom and
which comes to lie ventral to the developing foregut
each other due to differential growth of the body and
forms the pericardial cavity.
complex interactions between them and the
The heart tubes develop in the splanchnopleuric
developing mesenchyme.
mesoderm ventral to the developing foregut and with
Somatopleuric mesoderm gives rise to the parietal
further growth and fusion are enveloped by the
layer of pericardial, pleural and peritoneal cavities
intraembryonic coelom.
while the splanchnic mesoderm forms the visceral
Septum transversum: The mesenchyme present
layer covering the abdomino thoracic viscera.
rostral to the buccopharyngeal membrane in the
embryonic disc develops the cranial end of
intraembryonic coelom. With appearance of head DEVELOPMENT OF DIAPHRAGM
fold, the mesenchyme comes to lie ventral to the It is mesodermal in origin. It has a composite origin:
developing foregut between the thoracic region and 1. Septum transversum: It is a mesodermal partition
the yolk sac. below the pericardial sac and extends from the
The visceral part close to the developing heart tube
ventral body wall to ventral surface of the esophagus.
gives rise to the visceral pericardium and
This give rise to the anteromedian part including
myocardium of heart. The parietal part develops
central tendon, vena caval and esophageal openings.
caudally and forms a ventral mass, caudal to the
2. Dorsal mesenetry of esophagus: Gives rise to
heart which further forms a separation between the
posterior part between esophageal and aortic
foregut and pericardial coelom. The mesenchyme is
openings.
now named septum transversum. This septum
3. Body wall: It forms the peripheral part of diaphragm.
extends dorsally on each side of the foregut. Initially
4. Pleuro-peritoneal membrane: It covers the pleuro-
the pericardial coelom communicates with the
peritoneal opening, a triangular gap on each side of
pericardioperitoneal canals on each side dorsal to
dorsal mesentery and septum transversum. The
this septum transversum. Septum transversum does
muscles of septum transversum migrate over the
not separates thoracic cavity completely from
membrane and convert it into a muscular partition.
abdominal cavity.
 674 Human Anatomy For Dental Students

Fetal Circulation (Fig. 55.46)
The placenta provides oxygen and nutrients to the
fetus and is the site of excretion of toxic substances
from fetus to mother.
A pair of umbilical veins carry oxygenated blood
from placenta to fetus. The right umbilical vein
disappears very early in fetal life and only one
umbilical vein is left.
The umbilical vein passes into fetus at the umbilicus
and runs along the anterior abdominal wall in the
S E C T I O N-5
falciform ligament towards liver. It drains into left
branch of portal vein. Left branch of parital vein gives
rise to a larger branch, ductus venosus.
The ductus venosus is connected directly with the
inferior vena cava delivering a large part of
oxygenated blood to it.
Part of blood draining into portal vein supplies the
liver. Blood from liver is drained by the hepatic veins
into inferior vena cava.
The inferior vena cava also receives deoxygenated
blood from lower half of body. Thus the blood in

Fig. 55.46: Fetal circulation (Diagrammatic representation)


inferior vena cava is mixed and is less oxygenated
than the blood in umbilical vein.
The inferior vena cava drains into right atrium of
heart and this blood is directed to the left atrium of
heart via foramen ovale and hence to the left
ventricle. Blood from left ventricle passes into
ascending aorta and coronary arteries to supply
heart. It further flows to arch of aorta and its branches
namely common carotid arteries to supply the head
(brain) and neck.
The right atrium also receives deoxygenated blood
from superior vena cava returning from upper half
of body that flows into right ventricle, hence
pulmonary artery. A very small percentage of blood
enters pulmonary circulation while the majority
drains into aorta directly via ductus arteriosus, a
channel connecting pulmonary trunk (left
pulmonary artery) to arch of aorta.
This pattern of blood flow ensures well oxygenated
blood to brain and heart while less oxygenated blood
flows to the extremities.
The mixed blood (oxygenated + deoxygenated)
courses down from arch of aorta supplying rest of
the body via its branches. It passes back to the
placenta via right and left umbilical arteries,
branches of anterior trunk of internal iliac arteries.
At birth when umbilical cord is clamped and cut,
umbilical circulation is obliterated. The pressure in
inferior vena cava and right atrium falls closing
foramen ovale. The high pulmonary vascular
pressure also falls due to first breath of baby leading
to expansion of lungs thus further closing foramen
ovale and causing closure of ductus arteriosus also.
Adult circulation is thus established.
The umbilical arteries and veins, ductus venosus,
ductus arteriosus undergo gradual atrophy and
obliteration and result in formation of fibrous cords,
seen as remnants in adults.
Fetal vessel Remnants in adult
Left umbilical vein Ligamentum teres
Umbilical arteries Medial umbilical ligaments
Ductus venosus Ligamentum venosum
Ductus arteriosus Ligamentum arteriosum
CLINICAL CORRELATION WITH
DEVELOPMENT
Ectopic implantation (Fig. 55.47): The normal site
of implantation of fertilized ovum is the upper
posterior wall of uterus. Implantation of fertilized
ovum at any other site is called ectopic implantation.
General Embryology 675
Fig. 55.47: Sites of ectopic implantation
The most common site of abnormal implantation is
uterine tube though it may occur even in the ovary
or in the abdominal cavity. The common causes of
tubal pregnancy is pelvic inflammatory disease
especially tuberculosis leading to damage of the
tubes or use of intrauterine contraceptive devices.
C H A P T E R-55
Twinning: It is the formation of two embryos. It is
of two types:
Dizygotic twinning which is the more common
variety of twinning. It arises from fertilization
of two ova by two separate sperms.
Monozygotic twinning occurs from a single
fertilized ovum which separates into two in the
early embryonic development. If the separation
occurs before eight cell stage, it leads to
formation of diamniotic, monochorionic twins.
If separation occurs in the 8th to 12th day of
fertilization, before formation of primitive streak,
it leads to formation of monoamniotic,
monochorionic twins. If the separation occurs
at or beyond 13th day of fertilization there is
incomplete splitting of the germinal disc leading
to formation of conjoint twins.
Caudal dysgenesis: There is defective development
of caudal mesoderm leading to hypoplastic or fused
lower limbs, vertebral abnormalities, imperforate
anus and abnormalities in development of external
genitalia.
Sacrococcygeal teratoma: It is a pleuripotent germ
cell tumor arising from the remnant of primitive
streak.
Holoprosencephaly: This condition refers to a
spectrum of abnormalities in the development of
craniofacial structures. There is loss of formation
of midline structures which results in severe
malformations of the brain and face. In most cases
the two lateral ventricles merge into a single
telencephalic vesicle, the eyes are fused and there
is a single nasal chamber along with other midline
facial defects. Holoprosencephaly is believed to
occur as a result of defective gastrulation.
 Chapter
56 Development of
Musculoskeletal System
INTRODUCTION
The skeleton system develops from paraxial mesoderm,
somatopleuric layer of lateral plate mesoderm and neural
crest (ectoderm). The muscular system almost entirely
develops from the mesoderm.
DEVELOPMENT OF SKULL
Development of skull can be studied in two parts namely,
development of neurocranium which gives rise to bones
enclosing the brain and cranial cavity and the
development of viscerocranium which gives rise to bones
of facial skeleton.
Development of Neurocranium
Neurocranium or cranial cavity is derived from neural
crest mesenchyme and mesoderm. It develops in
membrane as well as in cartilage. Part of neurocranium
Fig. 56.1: Development of membranous neurocranium showing spicules of bone spreading from primary ossification centre
which develops in membrane is called as membranous
neurocranium and it gives rise to vault of skull. The part
which develops in cartilage is called as chondrocranium
and it gives rise to base of skull.
1. Development of membranous neurocranium (Fig.
56.1): Skull vault is membranous neurocranium and
it is derived from neural crest cells and also paraxial
mesoderm.
Mesenchyme from neural crest and paraxial
C H A P T E R-56
mesoderm invests the developing brain and
undergoes membranous ossification. It forms the
parietal, frontal, squamous part of temporal and
superior part of occipital bones. The ossification
is characterized by appearance of needle shaped
bone spicules. These spicules radiate towards
periphery from the primary ossification centre.
The membranous bones enlarge by appositional
growth during fetal and postnatal life.
Simultaneous osteoclastic resorption provides for
definite shape of each bone.
 678 Human Anatomy For Dental Students
Fig. 56.2: Development of chondrocranium
S E C T I O N-5
Fig. 56.3: Newborn skull (superior aspect)
2. Development of chondrocranium (Fig. 56.2):
Chondrocranium or base of skull initially is made
up of a number of separate cartilages.
Cartilages which lie in front of the rostral limit of
notochord or centre of sella turcica are derived
from neural crest. These form prechordal
chondrocranium.
The cartilages which lie posterior to centre of sella
turcica are derived from occipital sclerotomes
formed by paraxial mesoderm. This part of
chondrocranium is known as chordal chondro-
cranium.
All cartilages eventually fuse and ossify by endo-
chondral ossification.
New Born Skull (Figs 56.3 and 56.4)
At birth, bones of skull vault are separated from each
other by connective tissue known as sutures. Sagittal
suture is derived from neural crest and coronal suture is
derived from paraxial mesoderm. Fontanella are also
present.
The striking feature of a newborn skull is the relatively
large size of the cranium as compared to the facial skeleton
which is small and consists of a collection of tiny bones
clustered on the anterior end of the cranium. The
mandible and maxilla are not fully developed as there
are no teeth. The sinuses are also underdeveloped. The
bony part of external ear is not developed. It is important
to remember that the tympanic membrane is nearer to the

Fig. 56.4: New born skull (lateral aspect)
surface. Mastoid process is also absent and thus the facial
nerve behind styloid process is also superficial.
Fontanelles
The skull at birth is partly ossified and gaps or fontanelles
exist between the various bones. These are filled in by a
membranous structure.The fontanelles serve two
important purposes:
1. Permit some overlapping of the skull bones
(moulding) during child birth
2. Permit growth of brain in infancy.
Number of fontanelles: There are six fontanelles, one
situated at each angle of the parietal bone.
1. Median fontanelle: These are two in number
namely,
a. Anterior fontanelle: It is rhomboid in shape and
is present at the meeting point of sagittal, coronal
and metopic sutures. It closes by 18 to 24 months
of age.
b. Posterior fontanelle: It is triangular in shape and
lies at junction of sagittal and lamboid sutures. It
closes by 4 to 6 months of age.
2. Lateral fontanelles: These are 4 in number
a. Two anterolateral fontanelles or sphenoidal
fontanelles. These are situated at sphenoidal
angle of parietal bone, where coronal suture meets
the greater wing of sphenoid bone.
Development of Musculoskeletal System 679
C H A P T E R-56
b. Two posterolateral fontanelles or mastoid
fontanelles.These are situated at mastoid angle
of parietal bone where it meets the mastoid part
of temporal bone.
Development of Viscerocranium
Viscerocranium or bones of face are formed from
mesenchyme derived from neural crest present in
1st and 2nd pharyngeal arches.
1st pharyngeal arch gives rise to a dorsal part and a
ventral part. Dorsal part is known as maxillary
process which gives rise to maxilla, zygomatic bone
and part of temporal bone. Ventral part is known as
mandibular process which gives rise to Meckels
cartilage. Mesenchyme around Meckels cartilage
forms the mandible by membranous ossification.
Meckels cartilage later disappears except in the
sphenomandibular ligament.
The dorsal tip of mandibular process along with 2nd
pharyngeal arch gives rise to incus, malleus and
stapes. Ossification of these three ossicles starts in
4th month of development.
Initially face is small in comparison with
neurocranium. This is due to absence or small size
of paranasal air sinuses and small size of bones.
 680 Human Anatomy For Dental Students

Skull Bones Developing in Membrane membrane while the rest of the bone ossifies in
cartilage.
Frontal, parietal, maxilla, zygomatic, palatine, nasal,
2. Sphenoid bone: Body of sphenoid, lesser wing of
lacrimal, vomer, squamous part of temporal and
sphenoid and medial part of greater wing of
upper part of occipital bones develop in membrane.
sphenoid ossifies in cartilage and rest of the bone is
Frontal and parietal bones are formed from
formed in membrane.
mesenchyme covering the developing brain.
3. Temporal bone: Petrous part, mastoid part and
Mesenchyme of maxillary process gives rise to the
styloid process undergo endochondral ossification.
maxillae (excluding premaxilla), zygomatic bone,
Styloid process is derived from cartilage of second
palatine bone, and part of temporal bone.
branchial arch. Petrous and mastoid parts are
Nasal, lacrimal and vomer are ossified from the
derived from cartilage of otic capsule. Squamous and
mesenchyme of olfactory capsule.
tympanic parts are formed in membrane.
4. Mandible: Most of the mandible is formed in
Skull Bones Developing in Cartilage
membrane from the mesenchyme of the mandibular
The nasal capsule becomes well developed by 3rd process. Condylar and coronoid processes are
month. It gives rise to ethmoid bone and inferior ossified from secondary cartilages. Meckels cartilage
nasal conchae. gets incorporated in the bone.
Cartilages of nose are also derived from this nasal
capsule.
DEVELOPMENT OF VERTEBRAE AND VERTEBRAL
Skull Bones Developing in Both Membrane and Cartilage COLUMN (Figs 56.5 to 56.8)
S E C T I O N-5

1. Occipital bone: Part of occipital bone above superior Vertebrae develop from sclerotome part of somites. Somites
nuchal line, the interparietal part, develops in are derived from paraxial mesoderm.

Fig. 56.5: Formation of paraxial mesoderm Fig. 56.6: Formation of somites from paraxial mesoderm

Fig. 56.7: Formation of sclerotome and dermomyotome from somites


Fig. 56.8: Development of vertebrae and vertebral column
Formation of Vertebrae
During 4th week of development sclerotome cells
migrate around spinal cord and notochord. The
mesenchyme of one side merges with the cells of the
sclerotome of opposing somite on the other side of
neural tube to form the body and vertebral arches
which enclose a foramen containing the spinal cord.
With further development sclerotome part of each
somite undergoes resegmentation. Caudal half of
each sclerotome fuses with cephalic half of subjacent
sclerotome. Thus, each vertebra is formed from
caudal half of one sclerotome and cephalic half of
subjacent sclerotome.
Mesenchyme between cephalic and caudal part of
original sclerotome segment does not proliferate but
fills the space between the precartilagenous vertebral
bodies. They contribute to formation of intervertebral
discs.
Notochord persists within the intervertebral discs
as nucleus pulposus which is later surrounded by
circular fibers known as fibrous annulosus.
Intersegmental arteries lying between sclerotome
now pass midway over the vertebral bodies. Spinal
nerves now leave through intervertebral foramen.
DEVELOPMENT OF RIBS AND STERNUM
Development of Ribs
Ribs develop from costal processes of thoracic vertebrae.
Vertebrae are derived from sclerotome part of somites.
Somites develop from paraxial mesoderm. Thus ribs are
derived from paraxial mesoderm.
Development of Musculoskeletal System 681
Development of Sternum
Sternum develops in the somatopleuric mesoderm in the
ventral body wall. It has a bilateral origin and arises in
C H A P T E R-56
the form of a sternal band on either side of midline. Later,
these bands fuse to form manubrium, sternebrae and
xiphoid process.
DEVELOPMENT OF MUSCULAR SYSTEM
The entire muscular system develops from mesodermal
germ layer except muscles of iris, mammary gland and
sweat gland which develop from ectoderm. Muscular
system consists of:
1. Skeletal muscle
2. Smooth muscle
3. Cardiac muscle
Skeletal muscles develop from paraxial mesoderm,
smooth muscles differentiate from splanchnopleuric
(splanchnic) mesoderm surrounding gut and its
derivatives. Cardiac muscle develops from splanchnic
mesoderm surrounding heart tube.
Development of Skeletal Muscles
Somitomeres and somites form musculature of axial
skeleton, body wall, limbs and head.
Seven pairs of somitomeres located rostral to
occipital somites give rise to skeletal musculature of
the head and neck
Somites caudal to occipital region differentiate to
form sclerotome, dermatome and myotome of the
corresponding region.
 682 Human Anatomy For Dental Students

Myotome presents with two muscle forming regions, Development of Musculature of Head region
a ventrolateral edge (lip) and a dorsomedial edge
All skeletal muscles of head are derived from paraxial
(lip) (Fig. 56.9).
mesoderm (seven pairs of somitomeres) except muscles
Ventrolateral lip contributes to progenitor cells for
of iris.
the musculature of limbs and body wall which is
called hypomeric musculature.
Development of Craniofacial Muscles
Dorsomedial region contributes to progenitor cells
for the musculture of back and is known as epimeric Origin Muscles
musculature.
Somitomeres 1 and 2 Superior rectus, medial
Further differentiation of precursor cells or
rectus, inferior rectus
myoblasts results in fusion of cells and formation of
multinucleated cells. Myofibrils appear in Somitomere 3 Superior oblique
cytoplasm. Cross striations appear by the end of 3rd Somitomere 4 Masseter, medial
month. pterygoid and temporalis
Tendons are derived from corresponding
Somitomere 5 Lateral rectus
sclerotomes.
Somitomere 6 Lateral pterygoid and
facial muscles
Somitomere 7 Stylopharyngeus
Somites 1 and 2 Intrinsic muscles of larynx
S E C T I O N-5

Somites 2 to 5 (constitute
the occipital group) Muscles of tongue

Development of Musculature of Limbs

In the 7th week of developing embryo, a condensation
of mesenchyme is observed near the base of limb
Fig. 56.9: Development of somite showing ventrolateral buds. This mesenchyme is derived from the
region of myotome and dorsomedial region of myotome dorsolateral cells of somites.

Various Muscles of Body Wall which arise from Hypomeric Musculature

Region Muscles
Cervical region Scalene, geniohyoid and prevertebral muscles

Thoracic region External intercostal, internal and inner intercostal muscles,

transverse thoracic muscle

Abdomen External oblique muscle, internal oblique muscle, transverse

abdominus muscle

Lumbar region Quadratus lumbar

Sacral and coccygeal region Pelvic diaphragm, striated muscles of anus

Ventral column and abdomen Rectus abdominus

Ventral column of cervical region Infrahyoid muscles


These cells migrate into limb buds to form muscles.
Therefore the limb muscles are derived from paraxial
mesoderm.
Upper limb buds lie opposite lower five cervical and
upper two thoracic segments while lower limb buds
lie opposite lower four lumbar and upper two sacral
segments. Upper limb is thus, supplied by C4 to C8
and T 1 and T 2 spinal segements. Lower limb is
supplied by L2 to L5 and S1 and S2 spinal segments.
Development of Smooth Muscle
Smooth muscles in the wall of gut and gut derivatives
are derived from the splanchnopleuric (splanchnic)
mesoderm that surrounds these structures.
Smooth muscles of aorta and large arteries is derived
from lateral plate mesoderm and neural crest cells.
In coronary artery, smooth muscle originates from
proepicardial cells and neural crest cells.
Development of Cardiac Muscle
Cardiac muscles are derived from splanchnic mesoderm
surrounding the heart tube.
CLINICAL CORRELATION WITH
DEVELOPMENT
DEVELOPMENTAL DEFECTS OF SKULL
Craniorachischisis: It is a condition in which the
cranial vault fails to form and brain tissue is
exposed to the amniotic fluid and degenerates. This
leads to anencephaly. Smaller defects in formation
of cranial vault result in herniation of cranial
meninges with or without brain tissue and are named
as cranial meningocele and meningoencephalocele
respectively.
Craniosynostosis: In this condition there is
premature closure of one or more cranial sutures.
This leads to deformation of skull and malformation
of the brain.
Development of Musculoskeletal System 683
Micorcephaly: Microcephaly means small skull. It
is associated with poor brain development and
mental retardation.
DEVELOPMENTAL DEFECTS OF LIMBS
Meromelia: Condition characterized by partial
absence of one or more limbs.
Amelia: Condition characterized by complete
absence of one or more limbs.
Phocomelia: It is a form of meromelia in which
proximal part of the limb bones are absent and
rudimentary hands and feet are seen attached to
the trunk.
The above three conditions can be caused by genetic
defects or drug intake by mother during developmental
phase.
Polydactyly: Condition characterized by presence
of extra fingers or toes.
Syndactyly: It is a condition characterized by
abnormal fusion of digits of hands or feet.
C H A P T E R-56
Congenital absence of radius may be associated with
certain genetic defects.
Achondroplasia: It is an autosomal dominant
inherited genetic disorder and is the most common
form of dwarfism. It primarily affects the long bones
which remain under developed.
DEVELOPMENTAL DEFECTS OF VERTEBRA
Scoliosis: It is a condition where there is lateral
curving of one segment of spine. It usually happens
due to failure of formation of a vertebra or
asymmetrical fusion of adjacent vertebra.
Spina bifida: It is a defect in fusion of vertebral arches
and usually involves one or more vertebra specially
in the lumbar or sacral region. This results in small
gaps between the vertebral laminae through which
protrusion of meninges (meningocele) or meninges
and spinal cord (meningomyelocele) can occur. In
severe cases the newborn suffers from variable
neurological defects.
 Chapter
57 Development of
Head and Neck
INTRODUCTION
The development of skull and musculature of head is
discussed in chapter no. 56. The face and neck region
develops from the mesenchyme in the region of embryonic
pharynx covered externally with ectoderm and lined
internally by the endoderm.
DEVELOPMENT OF BRANCHIAL ARCHES
(PHARYNGEAL ARCHES) (Fig. 57.1)
A primitive tubular gut develops from the endoderm due
to folding of the developing embryo in the 4th week of
intra-uterine life. This is divided into foregut, midgut and
hindgut. Foregut is that part of the gut which lies in the
head fold of the embryo. Foregut is divided into cephalic
and caudal parts with the help of laryngotracheal groove.
The cephalic part or the prelaryngeal part of foregut
develops into pharynx and floor of the definitive mouth
cavity. It presents a funnel shaped expansion having a
ventral wall, a dorsal wall and two lateral walls. Each
lateral wall of this expansion is separated from the surface
Fig. 57.1: Schematic diagram showing position of branchial arches in an embryo
ectoderm by splanchnic mesoderm. Development of
pharynx is complex and is interrelated with the formation
of the viscerocranium, i.e., facial skeleton and formation
of larynx.
The splanchnic mesoderm gets condensed to form 6
mesodermal bars on either side of the mid line and these
give rise to the branchial arches and branchial apparatus.
Branchial Apparatus
Branchial apparatus is made up of 5 (initially there are 6
C H A P T E R-57
but the 5th arch is soon lost) branchial or pharyngeal
arches and the intervening pharyngeal grooves or
ectodermal cleft and the pharyngeal pouches (Figs 57.2
to 57.4).
Branchial Arches (Pharyngeal Arches)
Pharyngeal arches consist of six pairs of mesodermal
bars which lie in the region of the cephalic expansion
of embryonic foregut. Mesenchyme is derived from
neural crest (for 1st arch), paraxial mesoderm and
 686 Human Anatomy For Dental Students

Fig. 57.2: Branchial arches (pharyngeal arches)

cS E C T I O N-5

Fig. 57.3: Nerves of branchial arches

angiogenic mesenchyme. Neural crest mesenchyme
gives rise to skeletal element, striated muscles are
from paraxial mesenchyme. Angiogenic mesench-
yme gives rise to blood vessels.
Each arch is covered externally by the ectoderm and
lined on inner aspect by endoderm.
Each arch produces round ridge like prominences
of ectoderm on surface and of underlying endoderm
on the lateral walls of pharynx (see Fig. 57.2).
Each branchial arch is traversed by a nerve derived
from the hind brain vesicle
Each arch gives rise to ectodermal, mesodermal and
endodermal derivatives. The branchial apparatus
gives rise to face, neck, definitive mouth, pharynx,
larynx.

Fig. 57.4: Branchial arch, clefts and pouches
Ectodermal Clefts
These are grooves seen on the external surface
between adjacent branchial arches.
As the 5th arch is lost, there are 4 ectodermal
branchial clefts identified on each side of midline.
Due to growth of underlying mesenchyme the
ectodermal grooves are obliterated and only the 1st
cleft persists as the cervical sinus.
Cervical Sinus (Fig. 57.4): 1st and 2nd arches are more
prominent than the other arches. The 2nd arch overhangs
the other arches and the corresponding ectodermal clefts.
This forms a depression known as the cervical sinus. With
further development of 2nd arch the cervical sinus gets
obliterated and concavity of the neck is restored.
Endodermal Pouches (Pharyngeal Pouches) (Fig. 57.4)
Endoderm on the inner side of arches extends in
between the adjacent arches into the mesoderm and
forms pouches.
There are 5 pairs of endodermal pouches seen on
each side of midline which come in close apposition
to the overlying ectoderm. Increasing proliferation
of mesenchyme of the branchial arches separates the
pouches from clefts. The clefts are obliterated while
the endodermal pouches present local proliferations
and evaginates to form certain organs associated
with pharyx.
Development of Head and Neck 687
C H A P T E R-57
Mesodermal Derivatives of Branchial Apparatus
1. They form the basic structure of face and neck.
2. Various derivatives are tabulated below.
3. Epibranchial placodes appear at the dorsal ends of
the 1st, 2nd and 4th clefts by proliferation of
ectodermal cells. These give rise to ganglia of facial,
glossopharyngeal and vagus nerves.
Arteries and Nerves of the Arches
Tubular structures develop within the mesoberm of each
arch which are interconnected. These form 6 pairs of
arterial arches which get connected with the
corresponding dorsal aortae.
Endodermal Derivatives of the Arches
1. The epithelium over the sides of the floor of the
mouth and body of the tongue is derived from the
endodermal lining of 1st arch.
2. Endoderm of the 2nd and 3rd arches gives rise to the
epithelium of root of tongue and pharynx.
3. Endoderm of the 4th arch gives rise to the epithelium
of root of tongue, pharynx and epiglottis.
4. Other endodermal derivatives of the branchial
arches are
a. Rudiments of tongue
b. Thyroid diverticulum
c. Laryngo-tracheal groove
 688 Human Anatomy For Dental Students

Skeletal and Muscular Derivatives of Branchial Arches (Fig 57.5)

Arch Skeleton Muscles
1st Arch Maxillary process gives rise to 1. Temporalis
It is divided into maxillary 1. Upper jaw 2. Masseter
and mandibular processes 2. Palate 3. Lateral pterygoid
3. Dentine 4. Medial pterygoid
Mandibular process gives rise to Meckels 5. Tensor veli palatini
cartilage which forms the following 6. Tensor tympani
structures 7. Anterior belly of digastric
1. Malleus 8. Mylohyoid muscle
2. Incus
3. Anterior ligament of malleus
4. Sphenomandibular ligament
5. Body of mandible between the mandibular
and mental foramen
6. Symphysis menti, as an ossified remanant of
the cartilage
2nd arch or hyoid arch This give rise to Reicherts cartilage which forms 1. Stapedius
1. Stapes 2. Stylohyoid
2. Styloid process 3. Posterior belly of digastric
3. Stylohyoid ligament 4. Auricular muscles
4. Lesser cornu of hyoid bone 5. Occipitofrontalis
5. Upper part of body of hyoid bone 6. Muscles of facial expression
cS E C T I O N-5

7. Platysma
3rd arch Its dorsal part disappears and the ventral part 1. Stylopharyngeus
gives rise to 2. Superior constrictor
1. Greater cornu of hyoid bone
2. Lower part of body of hyoid bone
4th arch It gives rise to 1. Cricothyroid muscle
1. Thyroid cartilage 2. Middle and inferior
2. Cuneiform cartilage constrictors of pharynx
5th arch It disappears, however some authors consider None as the arch disappears
the thyroid cartilage to develop from it.
6th arch 1. Cricoid cartilage Intrinsic muscles of the larynx
2. Corniculate cartilage except cricothyroid
3. Arytenoid cartilage

Ectodermal Derivatives of Branchial Apparatus

Arch Ectodermal covering Derivatives
1st arch Maxillary process 1. Epidermis of upper lip and cheek
2. Enamel of teeth
3. Parotid gland
Mandibular process 1. Epidermis of lower lip and jaw
2. Epithelium of vestibule and palate
1st branchial cleft 1. Epithelial lining of external auditory meatus
2. Cuticle of the tympanic membrane
2nd arch Auricle and neck Epidermis over the posterior part of the
auricle and neck
3rd arch Middle of neck Epidermis over middle of neck
4th , 5th, and 6th arches Obliterated by the cervical sinus
 Development of Head and Neck 689

C H A P T E R-57
Fig. 57.6: Arterial arches and their fate
Fig. 57.5: Skeletal derivatives of branchial arches

Arteries (Fig. 57.6) and Nerves of the Arches

Arch Arterial arches and their fate Nerve of the arch
1st (Mandibular arch) 1st arterial arch mostly disappears. Mandibular nerve (post trematic)
It may give rise to a small part of Chorda tympani (pre trematic)
the maxillary artery
2nd (Hyoid arch) It gives rise to the dorsal part of Facial nerve
stapedial artery. Rest of the arch
disappears
3rd Arch Ventral part forms common carotid Glossopharyngeal nerve
artery
Dorsal part forms internal carotid artery
4th Arch On right side, it forms the right Superior laryngeal nerve
subclavian artery
On left side, it remains as
the arch of aorta
5th Arch Disappears completely on both the sides Not known
6th Arch On right side: Ventral part Recurrent laryngeal nerve
persists as right the pulmonary artery
On left side: Ventral part forms
left pulmonary artery and the dorsal
part forms the ductus arteriosus
 690 Human Anatomy For Dental Students

Endodermal derivatives from the pharyngeal pouches and These invasions form the tonsillar crypts. Lymphoid
floor of the pharynx. cells collect around these crypts and arranged
themselves into follicles.
Pharyngeal pouch Derivatives
Stroma of tonsil is derived from mesenchyme of 2nd
1st pouch 1. Auditory tube arch.
2. Epithelium of tympanic
cavity and mastoid antrum
3. Mastoid air cells DEVELOPMENT OF TONGUE (Fig. 57.7A and B)
4. Mucous (inner) layer of
Tongue develops from three sources namely, endoderm,
tympanic membrane
5. Submandibular and occipital somites and mesoderm of the branchial arches.
sublingual salivary glands Its development is described below:
1. Development of mucous membrane: Mucous
2nd pouch Tonsils with tonsillar pits, membrane of tongue is derived from the endoderm
tonsillar crypts and intratonsillar
of the foregut and arises in 3 parts:
cleft
a. Lingual swellings: These are a pair of endodermal
3rd pouch 1. Inferior parathyroid gland elevations which make their appearance at the
2. Reticular fibres and ventral (mandibular) ends of the 1st branchial
corpuscles of thymus arches. They later unite to form a single mass
4th pouch Superior parathyroid gland and fuse caudally with tuberculum impar. They
4th and 5th pouch 1. Thymic element increase in size ventrally and a sulcus is formed
2. Lateral thyroid along the ventral and lateral margins of the
3. Ultimo-branchial body elevation formed by the swellings. This forms the
cS E C T I O N-5

(parafollicular cells of linguogingival groove.

thyroid) b. Tuberculum impar: It is a small, single median
elevation seen in the floor of pharynx which lies
DEVELOPMENT OF PALATINE TONSIL between the 1st and 2nd arches caudal to the
Palatine tonsils develop from ventral parts of the lingual swellings. The lingual swellings fuse
2nd pharyngeal pouches. with tuberculum impar and give rise to the
The endodermal lining of the 2nd pharyngeal pouch mucous membrane of anterior 2/3rd of the
on each side divides and invades the underlying tongue.
mesenchyme of the 2nd arch.

Fig. 57.7A: Ventral part of phyrangeal arches showing development of tongue


Fig. 57.7B: Development of tongue
c. Hypobranchial eminence: This appears as a
median elevation caudal to the tuberculum
impar. It is formed at the ventral ends of 2nd, 3rd
and 4th arches which converge into it. The
eminence is divided into a caudal and a cranial
part by a transverse sulcus. The cranial part gives
rise to the mucus membrane of posterior 1/3rd
of tongue. It later fuses with the anterior 2/3rd of
the tongue. The line of fusion is known as sulcus
terminalis.
2. Development of musculature of the tongue: It is
derived from the occipital myotomes present along
the epipericardial ridges.
3. Development of fibro-areolar stroma: It is derived
from the mesenchyme of branchial arches. It binds
together the musculature of the tongue.
DEVELOPMENT OF THYROID GLAND (Fig. 57.8)
Thyroid gland develops from the following three sources
1. Thyroglossal duct, which gives rise to isthmus and
the lateral lobes of thyroid.
2. Caudalpart of 4th pouch of pharyngeal complex:
This is considered to be the inducer for the
differentiation of the lateral lobes.
Development of Head and Neck 691
C H A P T E R-57
3. Ultimobranchial body: Gives rise to parafollicular
cells of the thyroid gland.
Process of Development
The gland appear as the median thickening caudal
to the tuberculum impar by the proliferation of
endodermal cells in the region between 1st and 2nd
pharyngeal pouch. It is known as median rudiment.
The cells then invaginate caudally through the
substance of tongue and form the median
diverticulum or the thyroglossal duct.
Thyroglossal duct then grows caudally, ventral to
the hyoid bone and in front of laryngeal cartilages.
At the level of the prominent part of trachea the
thyroglossal duct divides into a series of double
cellular plates which give rise to isthmus and lateral
lobes of the gland.
The plates get converted into primary follicles.
Further budding form these primary follicles give
rise to secondary or definitive follicles. Colloid can
be seen in the follicle as early as 3rd month of
development.
Thyroglossal duct disappears and leaves only a trace
of its cephalic attachment, seen as the foramen
caecum of the tongue.
 692 Human Anatomy For Dental Students
Fig. 57.8: Development of thyroid and parathyroid glands
cS E C T I O N-5
Lateral thyroid rudiments which are derived from
the caudal pharyngeal complex fuse with the bilobed
mass.
Parafollicular cells are derived from the
ultimobranchial body and also form part of the
thyroid gland.
The connective tissue (capsule, septae) of thyroid
gland is derived from the associated cardiac neural
crest mesenchyme.
DEVELOPMENT OF SALIVARY GLANDS
Development of Parotid Glands
Each parotid gland is developed from the ectodermal
furrow between the maxillary and mandibular
prominences. Growth of mesenchyme of these
prominences leads to conversion of the furrow into a tube
during 5th week of intra-uterine life. The tube
subsequently looses its connection with the epithelium
of mouth. It forms the parotid duct. The lateral end of this
duct proliferates and gives rise to cords of ectodermal
cells which project into the surrounding mesoderm and
give rise to acini and ductules of the gland.
Development of Submandibular Glands
Each submandibular gland develops as an endodermal
outgrowth from the floor of the alveolo-lingual groove in
the 6th week of intra-uterine life. The outgrowth
subsequently is canalized and gives rise to acini and
ductules.
Development of Sublingual Glands
These glands develop as epithelial outgrowths from the
lateral side of the submandibular ducts in the 7th week of
intra-uterine life.
DEVELOPMENT OF PITUITARY GLAND (Figs 57.9
and 57.10)
Pituitary gland or hypophysis cerebri develops from the
ectoderm of stomodeum and the neuroectoderm of
diencephalon in two parts.
1. Development of anterior lobe of pituitary
Anterior pituitary develops from a diverticulum
that evaginates from the roof of the stomodeum
in front of the buccopharyngeal membrane.
This diverticulum is known as the Rathkes
pouch.
Rathkes pouch extends up to the floor of the fore
brain vesicle. The Rathkes pouch separates from
the stomodium by the second month due to
growth of the surrounding mesenchyme.
The cells covering the anterior wall of the pouch
gives rise to anterior lobe of pituitary. The
posterior wall of the pouch forms the pars
intermedia. Cavity of the pouch persists as the
intraglandular cleft.
The cephalic part of anterior lobe persists as the
pars tuberalis.
Sometimes the stomodeal end of the pouch
invades the roof of the naso-pharynx and
persists as the pharyngeal hypophysis.
 Development of Head and Neck 693

Fig. 57.9: Development of pituitary gland, formation of diverticulum from diencephalon and Rathkes pouch

C H A P T E R-57
Fig. 57.10: Development of pituitary gland

2. Development of the posterior lobe DEVELOPMENT OF FACE (Fig. 57.11)

Posterior lobe develops from a funnel-shaped
diverticulum which extends from the floor of
the diencephalon, in the 6th week of intrauterine
life. The lower end of this diverticulum
proliferates and forms the posterior lobe. The
upper end of the diverticulum forms the
infundibulum.
Most of the cells in posterior lobe are neuroglial
cells. The posterior lobe is invaded by nerve fibres
of hypothalamus.
Face develops from five processes which centre around
the stomodeum consisting of frontonasal process, a pair
of maxillary processes and a pair of mandibular
processes.
Frontonasal process gives rise to philtrum of upper
lip, alae of the nose, nasal septum and primitive
palate.
Maxillary processes gives rise to the lateral parts of
the upper lip, upper jaw, palatine process of maxilla
and cheek.
 694 Human Anatomy For Dental Students

Mandibular arches form the lower lip and lower
jaw.
Process of Development of Face
The development of face starts by the end of 4th week
of intra-uterine life. There is proliferation of
cS E C T I O N-5
mesenchyme which covers the ventral surface of the
forebrain vesicle along with its surface ectoderm.
This forms the frontonasal process.
The frontonasal process, presents with an ecto-
dermal thickening on both sides of the midline,
known as the olfactory (nasal) placode. Over growth

Fig. 57.11: Development of face

 Development of Head and Neck 695

of surrounding mesenchyme converts these placodes DEVELOPMENT OF PALATE (Figs 57.12 and 57.13)
into olfactory pits which gives rise to a medial and a
Palate is derived from two sources
lateral nasal prominence around the pit on each side.
1. Primitive palate: It is formed by fusion of the two
The two lateral nasal processes form the alae of nose.
medial nasal processes (part of frontonasal process).
A pair of maxillary processes develop from the
2. Permanent palate: It is formed by the fusion of the
cephalic side of the dorsal part of the mandibular
horizontal palatine processes of the maxillary
arches.
processes from each side.
In the subsequent 6th and 7th weeks the maxillary
processes of each side grow in size and move more Process of Deveopment of Palate
medially compressing the medial nasal processes
Primitive nasal cavity opens into the roof of
towards each other. Eventually the two medial nasal
stomodeum. These openings are known as primitive
processes fuse to form the philtrum of upper lip and
posterior nares.
primitive palate.
The partition present between the primitive nasal
Rest of the median part of frontonasal process thins
and oral cavities, ventral to posterior nares is formed
out forms the nasal septum.
by fusion of the two medial nasal processes which
The maxillary process on each side meets the
form the primitive palate. It is wedge shaped and
corresponding lateral and medial nasal process and
carries the 4 incisor teeth in adult. Dorsally the
gives rise to the cheek, palatine process of maxilla,
partition forms nasal septum that separates the
upper jaw and lateral parts of the upper lip.
nasal cavities.
Along the line of fusion of lateral nasal process and
During 6th week of intrauterine life, a shelf like
the corresponding maxillary process, an ectodermal
projection grows medially from each maxillary
solid cellular cord gets buried in the deep part of the

C H A P T E R-57
process. These processes are known as palatine
mesenchyme between the two processes. This gives
processes. Each palatine process grows caudally
rise to the nasolacrimal duct as the maxillary process
along the side of the tongue.
fuses with the lateral nasal process.
During 7th week of intrauterine life the palatine
The mandibular arches (1st branchial arches) grow
processes assume a horizontal position and fuse
towards each other and subsequently, there is fusion
with each other and form the permanent palate. This
of mandibular arches which gives rise to lower lip
is facilitated by the ventral and caudal growth of
and lower jaw.
mandibular arches and the ventral shift of tongue.
Initially, the angle of the mouth lies at the level of the
Permanent palate further fuses with primitive palate
auricle. Later, due to fusion of maxillary processes
in a y-shaped manner, ventrally.
and mandibular processes and their growth, there
The junction between permanent palate and
is shifting of the lateral angle of mouth to its adult
primitive palate is represented by incisive fossa in
position.
adults.

Fig. 57.12 : Development of palate

 696 Human Anatomy For Dental Students
DEVELOPMENT OF NASAL CAVITIES
DEVELOPMENT OF SKULL
See musculoskeletal system, chapter no. 56.
DEVELOPMENT OF TEETH (Fig. 57.14)
cS E C T I O N-5
Fig. 57.13A to C: Frontal section through head showing
development of palate A. Palatine processes are vertical in
position B. Palatine process become horizontal and tongue
moved downward C. Two palatine processes are fused and
with nasal septum
The ventral 3/4th of permanent palate is formed by
fusion of palatine processes with each other and
with nasal septum. This part persists as hard palate.
Dorsal 1/4th of permanent palate is formed by fusion
of palatine processes which fail to fuse with nasal
septum. This persists as soft palate which is seen in
the form of a curtain falling behind the hard palate.
The soft palate is invaded by mesenchyme of 3rd
pharyngeal arch to give rise to muscles of soft palate.
The fusion of palatine processes with each other and
with primitive palate starts from before backwards
and completed by 8th week of intrauterine life.
During 6th week of development, when the facial
rudiments are in the process of fusion, the nasal
cavities are fromed by deepening of the nasal pits to
become two primitive nasal cavities, on each side of
fused medial nasal process by extending into the
mesenchyme present dorsally.
The caudal surface of primitive nasal cavities comes
in close contact with roof of stomodeum.
The fusion of palatine processes of the maxillary
processes forms floor of nasal cavity which separates
it from the oral cavity.
Nasal septum separating the two nasal cavities is
formed by the fusion of medial nasal processes and
dorsal extension of median part of frontonasal
process.
Ectoderm present on the alveolar border of
mandibular and maxillary prominences thickens to
form two parallel arches of cells. The external arch
is known as labiogingivular-vestibular lamina and
internal arch is known as dental lamina.
Labiogingival lamina invades the mesenchyme and
breaks down to form vestibule (a sulcus) which
separates upper and lower lips from their adjacent
gums. Dental lamina gives rise to enamel organ.
Teeth develop from the interaction of ectodermal
epithelium on the mandibular and maxillary
prominences and the mesenchyme derived from
neural crest.
Epithelium overlying the arched alveolar border of
both mandible and maxilla thickens to form dental
lamina. The dental lamina then presents with local
thickenings which are formed by proliferation of
ectodermal cells. These give rise to enamel organs.
One enamel organ is formed for each milk tooth. Each
milk tooth organ gives off a local thickening medial
to it. These thickenings are the buds for permanent
teeth and give rise to enamel organ for permanent
incisors, canines and premolars. Buds for permanent
molars arise from dental lamina posterior to the last
milk teeth.
The dental lamina is established by the 6th week of
intrauterine life. At birth, tooth germ of all temporary
and permanent teeth are present except the 3rd
molars. Germs of permanent premolars and 2nd
molars are rudimentary. Germs of 3rd molars are
formed after birth. Permanent lower 1st molar and
all temporary teeth begin to calcify before birth.
 Development of Head and Neck 697

C H A P T E R-57

Fig. 57.14: Development of teeth

 698 Human Anatomy For Dental Students
Development of Tooth can be divided into following
stages (Fig. 57.14)
1. Bud stage: Enamel organ is seen as a small bud. It
consists of polygonal cells in the centre surrounded
by columnar cells. The surrounding mesenchyme
gives rise to dental papilla and dental sac. These
two are not well defined during this bud stage.
Dental papilla and bud are together called as tooth
bud or germ.
2. Cap stage: The enamel organ grows downwards and
the bud is invaginated by the mesenchyme from its
under surface. Thus, the organ forms a cap like
structure over the dental papilla. The cells lining the
concavity of the cap become tall columnar and are
called as inner enamel epithelium. Outer cells
covering the concavity of the cap become cuboidal
are called as outer enamel epithelium. Outer and
inner enamel epithelium get separated by a
intercellular substance. Dental papilla and dental
sac become more prominent.
3. Bell stage
There is a continuous and uneven growth of
enamel organ by which it acquires a bell shape.
Further invagination by mesenchyme causes
cS E C T I O N-5
deepening of under surface of enamel.
The inner enamel epithelium is tightly adherent
to the dental papilla and give rise to ameloblasts.
Ameloblasts lay down enamel.
Mesenchymal cells of dental papilla adjacent to
ameloblasts arrange them as a continuous
epithelium. These cells differentiate into
odontoblasts. Odontoblast lay down dentine.
Ameloblasts and odontoblasts are separated by
a basement membrane. Ameloblasts lay down
enamel on the outer surface of basement
membrane and odontoblasts lay down dentine
on the inner surface of basement membrane.
As layer by layer enamel and dentine are laid
down, ameloblasts and odontoblasts move away
from each other. Ameloblasts move towards the
outer enamel epithelium and they disappear
when the enamel is fully-formed, leaving a thin
membrane, the dental cuticle, over the enamel.
As dentine is laid down by odontoblasts, they
start moving towards the center of the dental
papilla leaving behind a cytoplasmic extension
which forms dentinal tubules. Odontoblasts
persist through out life of teeth as a layer
separating dentine from the pulp.
Remaining cells of the dental papilla form pulp
of the tooth.
Formation of Root of Tooth
Odontoblasts in the deeper regions proliferate and
invade the mesenchyme laying down dentine. As
laying down of dentine progresses, it leads to
narrowing of pulp space. Pulp space gets converted
into a canal. This root canal carries the neuro-
vascular bundle of tooth.
In the region of root, dentine is covered by
mesenchymal cells that differentiate into
cementoblasts. These cells lay down a thin layer of
bone called cementum over the dentine. Outside the
cementum, the mesenchymal cells from periodontal
ligament.
The wide open apical foramen is gradually reduced
by apposition of dentine and cementum at the root
apex.
Cementum and periodontal ligaments are formed
from mesenchymal cells of dental sac.
CLINICAL CORRELATION WITH
DEVELOPMENT
Branchial cyst: It occurs due to the failure of
obliteration of cervical sinus.
Branchial fistula: It occurs due to failure of growth
of second pharyngeal arch over the 3rd and 4th
arches. This leaves remnants of the 2nd, 3rd and
4th clefts in contact with the surface by a narrow
canal, known as branchial fistula. The fistula is
usually seen on the lateral aspect of neck directly
anterior to the sternocleidomastoid muscle.
Cleft lip: It occurs due to fusion defects in the
development of the lips. It can affect either the upper
or the lower lips. It is further divided into two types
a. Lateral cleft lip: It is caused by the failure of the
fusion of the maxillary process with the
globular swelling of the median nasal process.
b. Central cleft lip: It is caused by the failure of
fusion of the globular swellings with each other.
Cleft palate: It occurs due to failure of fusion of
palatine process of maxillary process with the
primitive palate (median nasal process). It can be
present on one side (unilateral) or can may be
bilateral, i.e., on both sides. It has a multifactorial
cause, can be hereditary or influenced by
environmental factors, e.g., intake of drugs during
pregnancy.
Tongue tie: It occurs due to incomplete
development of the anterior part of alveolo-lingual
sulcus which separates the tongue from the floor of
the oral cavity. There is incomplete separation of
dorsal part of the tongue from floor of the oral cavity.
This causes tongue tie or ankyloglossia. It presents
as a shortening of the frenulum of tongue.
Bifid tongue: This condition occurs due to the
failure of fusion of two lingual swellings.
Aglossia: Complete agenesis of tongue is known as
aglossia.
Thyroglossal cyst: The cyst is formed due to
persistance of thyroglossal duct.
The thyroid gland starts secreting thyroid
hormones by the 4th month of intra-uterine life.
Chapter
58 Development of
Nervous System
INTRODUCTION
The first event in the formation of the future central
nervous system is the appearance of a thickened
neural plate in the epiblast along the mid sagittal
axis, cranial to the primitive pit, by 4th week of
intrauterine life.
It is likely that neural plate develops in response to
inducing substances secreted by the underlying axial
mesodermal structures, i.e., by prechordal plate and
cranial portions of notochordal plate. These
substances diffuse into the overlying epiblast cells
in which they activate specific genes that cause the
cells to differentiate into a thick plate of columnar,
pseudostratified neuroepithelial cells (neuro-
ectoderm). The neural plate first appears at the
cranial end of the embryo and then differentiates
cranio-caudally.
By the beginning of the 4th week the neural plate
consists of a broad cranial portion that will give rise
to the brain and a narrow caudal portion that will
give rise to the spinal cord (Fig. 58.1).
Fig. 58.1: Formation of neural plate
In the beginning of 6th week the narrow caudal
portions of the neural plate (future spinal cord)
represents 25% of the length of the neural plate and
by the end of 6th week it occupies about 60% of neural
plate. The rapid lengthening of the neural plate
during this period is thought to depend on the
elongation of the underlying notochord.
In the 4th week, neural plate converts into neural
tube by a process of folding called neurulation.
During the somite period, the lateral margins of the
neural plate are elevated dorsally to form neural folds.
Due to growth of underlying mesoderm, a
longitudinal gutter is produced between the folds
and is known as the neural groove. This neural
groove extends from the Hensons node upto the
C H A P T E R-58
buccopharyngeal membrane.
Neural folds formed on each side of the groove
become concave and as they rotate the lateral lips of
the folds meet dorsally to form a tube enclosing a
space called the neural canal. As the lips of the neural
tube fuse, the junction between the neuroepithelium
and the adjacent surface ectoderm is pulled dorsally.
The opposing margins of surface ectoderm also meet
and fuse. As soon as the surface ectoderm fuses, the
neural tube separates from it and sinks into the
posterior body wall (Fig. 58.2A to D).
The neural folds gradually fuse to form the neural
tube. Fusion first takes place in the region of the 5th
somites and then extends cranially and caudally.
The cranial and caudal ends presents with an
opening, the anterior neuropore and the posterior
neuropore which communicate with the amniotic
cavity (Fig. 58.3). The anterior neuropore closes in
the beginning of 5th week while the posterior
neuropore closes by end of 5th week of development.
The caudal most portion of the neural tube is formed
by secondary neurulation of the caudal eminence.
Gastrulation through the regressing primitive streak
produces the mesodermal caudal eminence by day
20. The caudal eminence gives rise to caudal neural
tube and to the caudal entrance of spinal cord and
coverings. Caudal eminence also produces the
somites of the most inferior levels of the embryo.
The tips of the neural folds are lined by special cells
known as neural crest cells. They lie between the
neural zone and the surface ectoderm. These cells
migrate from the neural folds and pass cranio
caudally before the closure of neural tube.
cS E C T I O N-5 700 Human Anatomy For Dental Students

Fig. 58.2A to D: Transversections of emrbryo showing formation of neural tube A. Formation of neural groove B. Formation
of neural fold and neural crest C. Formation of neural tube D. Migration of Neural crest cells

Fig. 58.3: Formation of neural tube and its relation with somites
 Development of Nervous System 701

Ectodermal placodes: These are groups of

neuroepithelial cells that get incorporated into the
surface epithelium as the neural tube closes. These
placodes later invaginate and form vesicles beneath
the surface ectoderm. Example are hypophyseal
placode, future Rathkes pouch; olfactory placodes;
epibranchial placodes, located on dorsal aspect of
developing pharyngeal arches give rise to sensory
ganglia of VII, IX, X cranial nerves.
Later, due to differential growth of the body with
respect to the neural tube, it presents with a large
cranial part and a smaller caudal part. It develops
three vesicles in the cephalic part. These vesicles are
forebrain, midbrain and hind brain vesicles
separated by constrictions (Fig. 58.4).
The cavities of these vesicles form the various
ventricles and the cerebral aqueduct (Fig. 58.5).
The caudal part of the neural tube retains its simple
tubular structure and gives rise to the spinal cord.

C H A P T E R-58
Fig. 58.4: Development of brain vesicles

Fig. 58.5: Development of ventricles of brain

Cytodifferentiation of neural tube commences in the
rhombencephalic region just after the
occipitocervical neural folds fuse, at the end of 4th
week and proceeds cranially and caudally as the
tube zippers up. Precursors of most of the cell types
of the future central nervous system, the neurons,
some types of glial cells and ependymal cells that
line the central canal of the spinal cord and the
cerebral ventricles of the brain are produced by
proliferation in the layers of neuroepithelial cells that
immediately surround the neural canal. This layer
is called as the ventricular layer of differentiating
neural tube (Fig. 58.6).
cS E C T I O N-5 702 Human Anatomy For Dental Students

Fig. 58.6: Cytodifferentiation of neural tube

Histogenesis of Neural Tube (Fig. 58.7) 3. Outer or marginal zone: This zone is made up of
nerve fibres of neuroblasts. Initially this layer is
Proliferation of neuroepithelial cells lining the neural
formed by the cytoplasmic processes of the
tube make the wall of the neural tube multilayered and
neuroepithelial cells. This layer does not contain any
thick. The cells are arranged in 3 zones.
neuronal cell bodies and it later becomes the white
1. Inner ventricular (ependymal zone): It consists of a
matter of CNS.
single layer of columnar cells. These cells are
germinative in function. The first wave of cells Alar and basal lamina: There is marked proliferation of
produced in the ventricular layer consists of cells in the dorsolateral and ventrolateral aspect of the
neuroblasts which will give rise to the neurons of neural tube. This proliferation occurs mainly in the mantle
the central nervous system. These neuroblasts zone and forms the dorsal alar lamina and the ventral
migrate peripherally to establish a second layer, the basal lamina. Basal lamina gives rise to neurons which
mantle layer, external to the ventricular layer.
Remaining cells of ependymal zone line the cavity
of ventricles and the central canal of spinal cord and
these cells are non migratory.
2. Mantle or middle layer: This layer is highly cellular.
It contains neuroblasts and spongioblasts. This
neuron containing layer develops into the gray
matter of the CNS. The neuronal processes that
sprout from the mantle layer neurons grow
peripherally to establish a third layer, the marginal
layer. In addition immune cells migrate from blood
to this zone to form microglia. Fig. 58.7: Histogenesis of neural tube
 Development of Nervous System 703

are motor in function while the alar lamina gives rise to ependymal cells that line the cerebral ventricles and
sensory neurons. Also, the sensory nuclei of cranial nerves central canal of spinal cord.
are derived from alar lamina and the motor nuclei ar
derived from basal lamina. DEVELOPMENT OF BRAIN (Fig. 58.8)
Roof plate and floor plate: There is no thickening seen in
The cephalic portion of the neural tube forms the
the dorsal and ventral walls of the neural tube and they
brain. Even before neurulation begins, the primordial
form the roof plate and the floor plate respectively. They
of the three primary brain vesicles: the
remain thin and do not contain nerve cells.
prosencephalon, mesencephalon, and rhomben-
As soon as the neuroepithelial layer lining the neural
cephalon are visible as broadenings in the neural
canal ceases to produce neuroblasts, it begins to
plate.
produce a new cell type, the glioblasts. These cells
In the 5th week of intrauterine life, before the closure
differentiate into a variety of glial cells.
of neural tube, there is enlargement and ballooning
Neuroepithelium also differentiates to produce

C H A P T E R-58

Fig. 58.8: Development of different parts of brain

 704 Human Anatomy For Dental Students
of the cephalic part of the neural tube with formation
of regional expansions leading to formation of three
primary cerebral vesicles. These are:
1. Forebrain vesicle (Prosencephalon)
2. Midbrain vesicle (Mesencephalon)
3. Hindbrain vesicle (Rhombencephalon)
The prosencephalon and rhombencephalon enlarge
more than the mesencephalon. During the fifth week,
the prosencephalon subdivides into telencephalon
and diencephalon and the rhombencephalon
subdivides into metencephalon and myelence-
phalon. Thus, along with the mesencephalon, this
creates five secondary brain vesicles. During this
period the brain is also transiently divided into
smaller segments called neruomeres.
Forebrain vesicle further gives rise to following
diverticula.
a. Right and left telencephalic vesicles
b. Right and left optic diverticula which give rise to
optic cups
c. Ventral median diverticulum which forms the
neurohypophysis
cS E C T I O N-5
d. Dorsal median diverticulum for pineal gland.
The midline portion of the forebrain gives rise to the
diencephalon.
Mesencephalon remains as it is and is separated
from the rhombencephalon or hind brain vesicle by
the rhombencephalic isthmus.
Rhombencephalon is further divided into two parts
a. Metencephalon: It forms the pons and
cerebellum.
b. Myelencephalon: It give rises to medulla
oblongata.
Formation of flexures: Three flexures appear during
the development of brain, produced due to the
excessive growth of brain vesicles and the limited
space available for their expansion. These are
a. Cephalic (mesencephalic) flexure: It develops
during the formation of head fold of the embryo
and is concave ventrally.
b. Pontine flexure: It is convex ventrally and
appears in the 6th week of intrauterine life in the
region of future pons, at the metencephalic part
of the hind brain.
c. Cervical flexure: It is seen at the junction of hind
brain and spinal cord. It is concave ventrally. It
gets reduced when the neck begins to extend
during development in the 8th week.
Development of Telencephalon
Telencephalon consists of two telencephalic vesicles
which arise as diverticulae from the procencephalon.
The two cerebral hemispheres arise as lateral
outpouchings of the telencephalon and grow rapidly
to cover the diencephalons and mesencephalon. The
hemispheres are joined by the cranial lamina
terminalis (representing the zone of closure of the
cranial neuropore) and by fiber tracts called
commissures, particularly the massive corpus
callosum. The layered cellular architecture of the
cerebral cortex arises by a complex mechanism.
The wall of the telencephalic vesicles is made up of
all three zones, ependymal, mantle and marginal
zones.
The migration of cells from mantle zone to the
marginal zone gives rise to cerebral cortex.
Proliferation of mantle zone gives rise to striatal
elevations. These striatal elevations give rise to
caudate nucleus, lentiform nucleus.
The growth along the free margin of the medial wall
of the vesicle gives rise to the limbic lobe.
The forebrain has no basal plates.
Development of commissures: The posterior commissure
and habenular commissure develop in the epithalamus.
Corpus callosum, anterior commissure and fornix
develop in lamina terminalis.
Development of Diencephalon
It develops from the central part of prosencephalon
and consists of a stretched roof plate and two alar
laminae. The floor palate and basal lamina are
absent.
The alar plates of the diencephalon are divided into
a dorsal portion and a ventral portion by a deep
groove called the hypothalamic sulcus. The
hypothalamic swelling ventral to this groove
differentiates into the nuclei collectively known as
the hypothalamus, the most prominent function of
which is to control visceral activities such as heart
rate and pituitary secretion. Dorsal to the
hypothalamic sulcus, the large thalamic swelling
gives rise to the thalamus which serves as a relay
center, processing information from subcortical
structures before passing it to the cerebral cortex.
Finally, a dorsal swelling, the epithalamus, gives
rise to a few diminutive structures, including the
pineal gland.
A ventral outpouching of the diencephalic floor
plate, called the infundibulum, differentiates to form
the posterior pituitary. A corresponding
diverticulum from the roof of stomodeum, called
Rathkes pouch, grows cranially to meet this
infundibulum and becomes the anterior pituitary.
Diencephalic outpouchings also form the eyes.
From the floor of the diencephalon arise the
mamillary bodies.

Development of Mesencephalon
It develops from both the basal and alar plates of the
midbrain vesicle.
The basal plate gives rise to motor nuclei that supply
the intrinsic and extrinsic muscles of the eye.
The alar lamina gives rise to two cephalo-caudal
swellings which then split to form a pair of superior
and a pair of inferior colliculi. The superior colliculi
control ocular reflexes while the inferior colliculi
serve as relays in the auditory pathway.
The cells from alar lamina migrate ventrally to give
rise to red nucleus, substantia nigra and reticular
formation of midbrain.
The cavity of mesencephalon persists as the
aqueduct of Sylvius or cerebral aqueduct.
Development of Myelencephalon
The myelencephalon gives rise to the medulla
oblongata, which is the portion of the brain most
similar in organization to the spinal cord.
The basal lamina forms all the cranial nerve nuclei
present in the medulla.
Alar lamina is placed dorsolaterally due to the
stretching of the roof plate and gives rise to sensory
nuclei.
Olivary nuclei are formed by the ventral migration
of mantle zone cells of alar lamina.
Cavity of the myelencephalon forms the caudal part
of the IV ventricle.
Fig. 58.9: Development of cerebellum and attachment of cranial nerves
Development of Nervous System 705
Development of Metencephalon
Metencephalon gives rise to pons and cerebellum. Pons
develops ventrally and cerebellum dorsally.
Development of Pons
Pons arises as an expansion from the metencephalon
that consists mainly of the massive white matter
tracts serving the cerebellum, to and fro from the
cerebellum.
The basal lamina forms the motor and the alar
lamina forms the sensory nuclei.
The pontine nuclei are formed by the extension of
alar lamina within the substance of pons.
Development of Cerebellum (Fig. 58.9)
The cerebellum arises from the dorsal rhombic lips
of the metencephalic alar plates which flank the
expanded roof plate in this region. It is formed by
the migration of cells of alar lamina to the roof which
initially consists of the right and left rhombic lips.
C H A P T E R-58
These lips fuse dorsally to form the cerebellar plate.
Two lateral swellings and a midline portion appear
in 12th week of intrauterine life to give rise to future
cerebellar hemispheres and the vermin respectively.
The posterior lateral fissure appears first followed
by the primary fissure.
A specialized process of cytodifferentiation in the
cerebellum gives rise to the gray matter of the
cerebellar cortex, as well as to internal basal nuclei.
Cells migrate from the mantle layer to form the
cerebellar cortex. Some of the cells of the mantle zone
 706 Human Anatomy For Dental Students
remain close to the roof and give rise to the deep
cerebellar nuclei.
The cerebellum controls posture, balance and the
smooth execution of movements.
DEVELOPMENT OF SPINAL CORD (Fig. 58.10)
The definitive spinal cord develops from the caudal
part of the neural tube.
The alar and basal lamina bulge into the cavity and
give rise to characteristic changes which result in
the formation of definitive spinal cord.
There is closure of the dorsal portion of the neural
cavity by fusion of right and left alar lamina. This
leads to the formation of posterior median septum.
The growth of the ventral basal lamina from both
side leads to formation of an anterior median sulcus.
The large central cavity reduces in size and forms
the central canal of spinal cord.
Alar lamina forms the posterior horn cells and basal
lamina forms the anterior horn cells of the grey
matter of spinal cord.
There is appearance of cervical and lumbar
cS E C T I O N-5
enlargements opposite the site of limb buds.
Initially, upto 3rd month of intrauterine life, the
spinal cord extends throughout the vertebral column.
However, at birth it lies at the level of L3 and in adults
it ends at the level of lower border of L1 vertebra.
This occurs due to the differential growth of vertebral
column with respect to spinal cord.
Fig. 58.10A and B: Development of spinal cord and formation
of ventral and dorsal horns of gray matter
DEVELOPMENT OF BRAIN MATTER, CRANIAL
NERVES, DORSAL AND VENTRAL COLUMNS OF
SPINAL CORD
Development of Brain Matter and Cranial Nerves
Cytodifferentiation of the neural tube begins in the
rhombencephalon at the end of the fourth week. The
neural tube neuroepithelium proliferates to produce
in succession, the neuroblasts, glioblasts, and
ependyma of the central nervous system. The
neuroblast migrate peripherally to establish a mantle
zone, the precursor of the gray matter.
In the regions of spinal cord and brain stem, the
mantle zone immediately overlies the ventricular
zone of proliferating neuroepithelium, and the
growing neuronal fibers establish a marginal zone
(the future white matter) peripheral to the mantle
zone. In the higher centres of the brain, including
the cerebellum and cerebral hemispheres, the pattern
of cytodifferentiation is more complex.
The mantle zone of the brainstem, like that of the
spinal cord, is organized into a pair of ventral (basal)
columns (or plates) and a pair of dorsal (alar)
columns (or plates). Laterally the two columns are
separated by a groove called the sulcus limitans;
dorsally and ventrally they are sepatated by
thinnings of the neural tissue called respectively,
the roof plate and the floor plate (Fig. 58.11).
Fig. 58.11: Cytodifferentiation of brain at the level of
mylencephalon
Cranial nerves (Figs 58.9 and 58.12): Nuclei of all
cranial nerves appear by the 5th week of
development. Olfactory nerve nucleus is present in
telencephalon, optic nerve nucleus is present in
diencephalon and the nuclei of 3rd to 12th cranial
nerves are located in the brain stem. Occulomotor
nerve nucleus is present in mesencephalon while
the nuclei of rest of the cranial nerves arise in the
various parts of metencephalon.
Cranial nerves are motor, sensory or mixed and
therefore, some of the cranial nerves arise from more
than one nucleus. The cranial nerve motor nuclei
develop from the brain stem basal plates and the

Fig. 58.12: Functional columns of cranial nerves in brain stem
associational nuclei develop from the brain stem alar
plates. The brain stem cranial nerve nuclei are
organized into seven columns which correspond to
the types of function they subserve. From
ventromedial to dorsolateral, the three basal columns
contain somatic efferent, branchial efferent and
visceral efferent motor neurons and the four alar
columns contain visceral afferent, special visceral
afferent (subserving the special sense of taste),
general afferent and special somatic afferent
(subserving the special senses of hearing and
balance) associational neurons.
The peripheral neurons of the sensory and
autonomic (parasympathetic) cranial nerve
pathways reside in ganglia located outside the
central nervous system. Cranial nerve parasympa-
thetic ganglia are derived from neural crest cells.
Sensory ganglia of cranial nerves develop from
neural crest cells (III, VII, IX and X) and from
ectodermal placodes (I, V, VII, IX and X).
Development of Dorsal and Ventral Columns of
Spinal Cord
Starting at the end of fourth week, the neuroblasts in
the mantle layer of spinal cord become organized
into four columns that run the length of the cord: a
pair of dorsal or alar columns and a pair of ventral
or basal columns. Laterally, the alar and basal
columns are separated by a groove called the sulcus
limitans. Dorsally and ventrally they are separated
by acute thinnings of the neural tissue called,
respectively, the roof plate and the floor plate.
The cells of the ventral columns become the somatic
motor neurons of the spinal cord and innervate
somatic motor structures such as the voluntary
(striated) muscles of the body wall and extremities.
The cells of the dorsal columns develop into
association neurons, which will interconnect the
motor neurons of the ventral columns with neuronal
processes that soon grow into the cord from the
Development of Nervous System 707
sensory neurons of the dorsal root ganglia. In most
regions of the cord including all 12 thoracic levels,
lumbar levels L1 and L2 and at sacral levels S2
through S4 , the neuroblasts in the more dorsal
regions of the basal columns segregate to form
distinct intermediolateral cell columns.
The thoracic and lumbar intermediolateral cell
columns contain autonomic motor neurons of the
C H A P T E R-58
sympathetic system while the intermediolateral cell
columns in the sacral region contain central
autonomic motor neurons of the parasympathetic
system.
In general, at any given level of the brain or spinal
cord the motor neurons form before the sensory
elements appear.
Development of Autonomic Nervous System
Autonomic nervous system consists of sympathetic and
parasympathetic components.
Neural crest cells in the thoracic region migrate
towards the developing spinal cord during the 5th
week of development . They get arranged on each
side of the spinal cord in the form of a chain of
sympathetic ganglia interconnected by nerve fibres .
Neuroblasts from these ganglia migrate to form the
future regional ganglia like celiac and mesenteric
ganglia and regional plexuses like cardiac and
pleural plexuses.
Nerve fibres from the intermediate columns of the
thoracodorsal segments of developing spinal cord
establish connections with these ganglia forming the
preganglionic and postganglionic fibres.
Parasympathetic ganglia are also derived from
migating neural crest crells which localize in the
brainstem (parasympathetic cranial nerve nuclei III,
VII, IX and X) and in the sacral part of spinal cord.
Preganglionic nerve fibres are derived from the
neuroblasts in the corresponding regions and
postganglionic fibres are derived from these ganglia.
 708 Human Anatomy For Dental Students
SUPRARENAL GLAND
Suprarenal gland is made up of cortex and medulla. The
suprarenal glands in fetus and newborn are relatively
larger in size than in adult.
Development of Suprarenal Gland
Cortex is derived from coelomic epithelium
(mesoderm), the cells of which pass between the
dorsal mesogastrium and the mesonephros to reach
their destination.
Medulla is derived from neural crest cells (ectoderm).
The neural crest cells from somite level 18 to 24
invade this proliferating coelomic epithelial tissue
from the medial aspect to form medulla.
The mesonephric arteries penetrate medulla to form
venus sinusoids.
The mesenchyme of mesonephros forms the capsule.
The subcapsular nests of proliferating epithelium
arrange themselves into radially arranged cords of
cells that form the fetal cortex (zona glomerulosa).
This zone is present till birth and rapidly involutes
cS E C T I O N-5
after birth and it is only in the first year of life that
the characteristic three zones of adult cortex are
formed.
CLINICAL CORRELATION WITH
DEVELOPMENT
Spina bifida: Neural tube defects originate
generally in the 3rd week of development. Failure
of the neural tube to close disrupts the induction of
the overlying vertebral arches, so that the arches
remain underdeveloped and fail to fuse along the
dorsal midline to enclose the vertebral canal. The
resulting open vertebral canal leads to the condition
called spinabifida. In some cases of spinabifida the
contents of the vertebral canal bulge into a
membranous sac (cele) that is continuous with the
surrounding skin. The fact that spinabifida is quite
common in the lower lumbar and upper sacral
region suggests that neuropore closure or secondary
neurulation may be involved in the etiology of these
malformations.
Anencephaly: The most severe defects of neural
tube development are those in which the neural
folds not only fail to fuse but also fail to differentiate,
invaginate and separate from the surface ectoderm.
Failure of the entire neural tube to close results in
an anomaly called craniorachischisis totalis. If the
defect involves only the cranial neural tube, a defect
results in which the brain is represented by an
exposed dorsal mass of undifferentiated neural
tissue. This condition is called exencephaly,
anencephaly or craniorachischisis.
Congenital adrenal hyperplasia: It is the most
common abnormality of adrenal development. It is
due to an autosomal recessive genetic disorder
which leads to deficiency of various enzymes
involved in the path of synthesis of cortisol.
Deficiency of cortisol stimulates anterior pituitary
to secrete excess amounts of ACTH. ACTH
stimulates growth and hyperplasia of adrenals.
Alternate pathways of enzymes are stimulated
leading to excess production of androgens. Excess
androgens lead to virilization of female fetuses and
is the most common cause of ambiguous genitalia
in them. In male fetuses the effects are less visible
at birth.
 Chapter
59 Molecular Regulation
of Development
The embryo and fetus are derived from a single cell, i.e.,
the fertilized ovum. There is a definite pattern in the
proliferation of the cells, the cleavage divisions leading
to formation of morula, blastocyst stage and forming of
trilaminar disc of embryo with establishment of embryonal
axis. The growth (increase in number of cells) and
differentiation (induction of new cell lines to form various
tissues) is a complex process and the overall development
of any organism is controlled by genes (genetic material
in chromosomes). Genes are units of DNA (deoxyribose
nucleic acid) which are responsible for protein synthesis.
The proteins subsequently are responsible for inducing
or inhibiting various intercellular and intra-cellular
interactions that regulate development.
Proteins are made up of chains of amino acids, the
nature of which is determined by variations in type of
amino acids and sequence of amino acids in the chain.
Amino acids are synthesized from genes present in DNA
of chromosome by process of transcription to translation.
The genes which code for amino acids are known as
exons while genes which do not code for any amino acid
as known as introns.
There are about 35,000 genes known till date in the
human genome. However, the number of proteins are
more than three times (more than 1 lac) the number of
genes. This means that one gene can synthesize more
than one type of protein molecule. This is possible by
process of alternative splicing which means differential
removal of the introns present in the transcribed mRNA
that gives rise to variations in mRNA sequence from same
gene and hence variable type of protein. Variations in
protein synthesis are also achieved by process of
posttranslational modifications. After formation of a
protein molecule, it further undergoes some form of
modification in the structure in order to gain the ability to
perform an action, e.g., cleaving of pro hormone to active
hormone, phosphorylation of kinase enzymes. This is
known as posttranslational modification
Regulation of gene expression is an important process
in the development. Despite same genetic material in all
cells, protein production by one group of cells varies from
another group. This regulation is the foundation for
differentiation of cells into variable cell lines and
formation of different tissues and organ. Gene regulation
is achieved by presence of gene promotion regions,
transcription initiation sites, translation initiation sites,
translation termination codons, transcription factors,
presence of enhancers (regulatory factors that increase
rate of particular transcription), silencers (regulatory
factors that inhibit transcription).
The development of a particular cell line and tissue is
thus dependant on variations in formation of growth
C H A P T E R-59
factors, cell surface proteins, transcription regulatory
factors derived from variable activation of certain gene
regions and inhibition of other gene regions.
Examples of genes controlling development of various
parts of developing embryo.
Hox genes: These are responsible for formation and
segmentation of neural tube, development and
differentiation of neural crest and pharyngeal arches.
Pax genes: These are responsible for development of alar
lamina of neural tube, neural crest differentiation,
development of eye.
Examples of growth and differentiation factors affecting
development
Epidermal growth factor (EGF): Control growth and
proliferation of cells of ectodermal and mesodermal
origin.
Transforming growth factors (TGF): Control
formation of extracellular matrix, epithelial
branching in formation of lung kidney etc.
Mullerian inhibiting factor (MIF): Causes regression
of paramesonephric duct
Hedgehog proteins: Control neural tube formation,
somite differentiation, limb development.
WNT proteins: Control development of somites,
urogenital differentiation, limb patterning
Fibroblast growth factors (FGFs): Responsible for
mesoderm differentiation, angiogenesis, limb
development.
The various cell populations within developing
embryo further undergo complex interactions and help
in the differentiation and development of various organs
 710 Human Anatomy For Dental Students
of the body. Interactions between adjacent cell lines
continue throughout embryonic, fetal and even early
postnatal development. The process of interaction leading
to development of another tissue is known as induction
and the tissue exerting the influence is known as
organiser. The ability of cell population to develop in
response to the organizer is known as competence.
Examples of cell to cell interactions leading to induction
of formaton of tissues are:
Epithelialmesenchymal interactions
Induction of development of limb is controlled
by the presence of apical ectodermal ridge and
its interaction with underlying mesenchyme, the
later acting as inducer.
Development of ureteric bud and formation of
collecting tubules by interaction with metane-
phric mesenchyme.
cS E C T I O N-5
Epithelialepithelial interaction: Presence of optic
vesicle induces the overlying ectoderm to form lens
vesicle.
The cell to cell interaction is achieved by direct cell to
cell contact via gap junctions, presence of cell adhesion
molecules and their receptors, ligands in extracellular
matrix interact with surrounding cells, growth factor and
their receptors which act by paracrine manner i.e. diffuse
to surrounding cell and either activate or block the activity
of a pathway of development.
The overall process of differentiation and
development of embryonic axis, formation of embryonal
cell populations, fetal growth and development thus
occurs in response to the ability of cells to produce certain
proteins which is primarily regulated by genes which is
the molecular or genetic control of development.
Chapter

60 Review of
Embryology
Q. What is reproduction? 3. There is an increase in sulphide cross linking
Ans. Reproduction is essential for survival of species. between proteins, in epididymis
Reproduction includes following three phases
Q. How do sperm travel in genital tract?
in human life:
Ans. 1. Spermatozoa are largely transported in
1. Embryogenesis
genital tract by ciliary action, fluid currents
2. Growth and muscular contractions.
3. Sexual maturity 2. On ejaculation the spermatozoa display their
Q. What is male gemete? pattern of motility.
3. Rate of travel of human spermatozoa is 1.5-

Ans. It is also known as sperm, spermatozoon,
spermatoid, spermium. A single ejaculate
contains about 300 million spermatozoa.
Q. What is morphology of sperm?
Ans. It consists of the following (Fig. 55.1A):
1. Head or caput
2. Neck
3. Tail or cauda
a. It is 45-50 in length.
b. It is divided into three parts
i. Middle piece/part
ii. Principal part or tail
iii. End part or piece
Q. What is spermatogenesis?
Ans. It is an orderly sequential process which gives
rise to spermatozoa from primordial germ cells.
The entire process is divided into the following
three phases.
1. Spermatocytosis
2. Meiosis
3. Spermiogenesis
Q. What is maturation of spermatozoa?
Ans. 1. It is a complex process by which the
spermatozoon attains a specific pattern of
independent motility.
2. Epididymis is essential for spermatozoon
motility.
C H A P T E R-60
3mm / minute and they reach tubal ostia of
uterus in 70 minutes following ejaculation.
4. Constituents of semen derived from
epididymis, testes, seminal vesicles and
prostate may exert influence in achieving
their motility.
Q. What is capacitation ?
Ans. It is the terminal event in the maturation of
spermatozoa by which it attains the capacity to
fertilize ova. The exact mechanism of
capacitation is still uncertain.
Q. What is the effect of temperature on spermato-
genesis?
Ans. The testes are present in scrotal sacs which have
a counter current mechanism of heat exchange
from arteries to veins. The interior of scrotum is
thus kept at 4-5C below body temperature,
around 32C. This temperature favours
development of sperms. The spermatogenesis
is hampered in cases of abnormal position of
testes eg. if it is lying in abdomen or in males
exposed to high temperatures due to tight
clothes or hot baths.
Q. What is the function of seminal vesicle?
Ans. 1. They contribute about 60% of total semen
volume.
 712 Human Anatomy For Dental Students
2. They secrete thick, sticky fluid which is
rich in.
a. Potassium, fructose, phosphorylcholine,
citric acid and ascorbic acid which are
energy sources to spermatozoa.
b. Hyaluronidase that lyses mucopoly-
saccharides and help in penetration of
cervical mucus.
c. Prostaglandins: These produce contrac-
tions in uterine musculature leading to
movement of sperm inside.
Q. What is the contribution of prostate gland?
Ans. It contributes to 20% of total semen volume. It
secretes a thin, opalescent fluid which is acidic
and gives semen its characteristic fishy order.
The fluid contains: calcium, ions like Na+, zinc,
citric acid, fibrinolysin, acid phosphatase.
Q. What is the role of bulbourethral (Cowpers)
glands?
cS E C T I O N-5
Ans. They produce a mucoid alkaline secretion which
helps in lubrication during coitus.
Q. What is semen?
Ans. 1. It is the fluid ejaculated from penile urethra
during coitus.
2. It contains sperms and secretions from the
accessory glands.
3. The volume of an ejaculate usually varies
from 2.0-3.5 ml but decreases with frequent
ejaculations.
4. The normal pH of semen is alkaline which
favours sperm motility.
5. Fructose is an important constituent of semen
and provides the metabolic fuel to sperms.
6. Sperm count varies from 60-120 million/ml
of ejaculate.
7. Sperms remain viable for upto 24-48 hours
in the female genital tract.
Q. What is Oogenesis?
Ans. The process of formation of mature oocyte from
primordial germ cells is known as oogenesis.
Development of mature oocytes is divided into
three phases
1. Establishing germ cell pop ulation
2. Oocyte growth and meiotic maturation
3. Development of ovarian follicle.
Q. What is establishing germ cell population?
Ans. 1. After migration of germ cells from yolk sac
to the gonadal ridges at 6th week post
conception they proliferate and by 8 10
weeks about 6,00,000 oogonia are present in
the ovary.
2. At 12 weeks of gestation the oogonia start
differentiating to primary oocytes.
3. By 5th month of gestation, continuous
proliferation leads to presence of 70,00,000
primary oocytes in ovary.
4. At birth, only 1,000,000 remain and by
puberty there are about 40,000 primary
oocytes in ovary.
5. Meiotic anomalies are considered responsible
for large rate of atrision of fetal cells.
6. In the reproductive span of a woman, only
400 oocytes finally ovulate.
Q. What is oocyte growth and meiotic maturation?
Ans. 1. In the fetus itself the primary oocyte is
surrounded by a single layer of squamous
cells and this unit is called primordial follicle.
2. Primary oocyte is about 35 micron in
diameter with a large vesicular nucleus with
an eccentric nucleolus.
3. The first signs of growth is enlargement of
oocyte. The surrounding cells also assume
cuboidal shape and proliferate to form
granulosa cells. Growth is stimulated by
gonadotrophins produced at puberty.
4. The final diameter of oocyte is 120-140
microns.
5. Zona pellucida, an amorphous material
surrounding the oocyte, inner to granulosa
cells is formed.
6. Granulosa cells also increase and are
surrounded by flat elongated cells derived
from ovarian stroma, these are called theca
cells.
Q. What are functions of zona pellucida?
Ans. 1. Forms a barrier between oocyte and
granulosa cells
2. Helps in triggering acrosomal reaction
3. Responsible for species specific recognition
of spermatozoa.
4. Helps in providing nutrition to oocyte
through diffusion.
5. Prevent ectopic implantation.

Q. What changes occur during meiotic division
of oocyte?
Ans. 1. The primary oocytes, seen as early as 12
weeks of gestation, undergo DNA replication
and enter 1st phase of meiotic division.
2. The primary oocyte gets arrested in the
diplotene stage of meiotic prophase from 20
weeks of gestation till further stimulation.
3. Thus a fully grown primary oocyte contains
double stranded diploid number of
chromosomes at birth.
4. The further stimulus to resume meiosis
occurs after puberty in the developing follicle
at the time of LH surge. The primary oocyte
completes the first meiotic division and gives
rise to a large secondary oocyte and a smaller
polar body.
5. Secondary oocyte now has double stranded
n haploid number of chromosomes.
6. It straight away enters the 2nd meiotic
division. It gets arrested in the metaphase of
2nd meiotic division prior to ovulation
7. The secondary oocyte completes its second
meiotic division only when it is fertilized.
Q. Enumerate the different stages of development
of ovarian follicle?
Ans. 1. Primordial follicle
2. Primary follicle
3. Secondary (antral or vesicular follicle)
4. Tertiary follicle (also called Graffian follicle)
Q. What is primordial follicle?
Ans. Primary oocyte in fetal stage is enveloped by
single layer of squamous cells and this unit is
called as primordial follicle (Fig. 55.5).
Q. What is primary follicle?
Ans. After puberty, as the oocyte grows, the
enveloping cells called granulosa cells become
cuboidal and also proliferate. It is now called
primary follicle (Fig. 55.7).
Q. What is secondary follicle?
Ans. The antrum is surrounded by thin layer of
granulosa cells except at one pole where the
granulosa layer is thick enclosing the oocyte.
Theca cells proliferate and form two layers,
theca interna and theca externa. This structure
is called as secondary oocyte (Fig. 55.8).
Review of Embryology 713
Q. What is tertiary follicle?
Ans. Only one follicle out of the many secondary
follicles matures to tertiary stage. The antrum
enlarges, oocyte is surrounded by clusters of
cells known as cumulus oophorous and outer
cells are called granulosa cells. Cell immediately
surrounding the oocyte are called corona
radiata. A perivetalline space is created beneath
the zona pellucida after extrusion of 1st polar
body (Fig. 55.9).
The mature fully grown oocyte breaks away and
floats in follicular fluid. It completes its 1st
meiotic division.
Q. What is menstrual cycle?
Ans. The cyclical changes in the endometrium of
uterus in response to ovarian hormones
constitute the menstrual cycle.
Q. Enumerate the various phases of menstrual
cycle?
C H A P T E R-60
Ans. (Fig. 55.12)
1. Proliferative phase
2. Secretory phase
3. Menstrual phase
Q. Enumerate the layers of endometrium?
Ans. 1. Stratum compactum: It is the superficial
compact layer
2. Stratum spongiosum: It is the
intermediate spongy layer
3. Stratum basale: It is the deep or basal layer
Q. What is fertilization?
Ans. It is the fusion of mature spermatozoon and
mature ovum to form zygote.
Q. What are the effects of fertilization?
Ans. 1. Completion of second meiotic division of
secondary oocyte.
2. Restoration of diploid number of chromo-
somes.
3. Determination of chromosomal sex.
4. Initiation of cleavage division of zygote.
Q. What is morula?
Ans. At about 12 to 16 cell stage, the mass is called as
morula. All the cells are approximately of same
size. Here, the distinction of inner and outer cell
mass occurs. Inner cell mass gives rise to embryo
 714 Human Anatomy For Dental Students
in future and outer cell mass is destined to form
the fetal membranes (Fig. 55.22).
Q. What is blastocyst?
Ans. Cells in morula continue to divide and
intercellular spaces appear between the inner
cell mass and outer cell mass. Fluid from uterine
cavity reaches intercellular spaces and give rise
to a fluid filled cavity which is known as
blastocele. This stage is known as blastocyst. It
occurs at the 32 to 64 cell stage (Fig. 55.22).
In the 107 cell blastocyst, it is seen that 69 cells
give rise to mural trophoblast, 30 cells give rise
to polar trophoblast and 8 cells form inner cell
mass.
Q. What is implantation?
Ans. Zygote enters uterine cavity on 3rd to 4th day
of fertilization. It is in the stage of morula. At
blastocyst stage zona pellucida disappears and
implantation occurs on 6th to 7th day (Fig. 55.23).
cS E C T I O N-5
Q. What is the commonest site of implantation?
Ans. Site of implantation is posterior uterine wall
near fundus of uterus (Fig. 55.24).
Q. What is decidua?
Ans. During secretory phase of menstrual cycle
endometrial cells become vacuolated and store
glycogen and lipid. This is known as decidual
reaction. This reaction is intensified after
implantation and endometrium is now known
as decidua. The decidua is named according to
its position in respect of developing embryo
(Fig. 55.25A).
Q. What are primary, secondary and tertiary villi?
Ans. Placenta is made up of finger like projections
known as villi and intervillous spaces
(Fig. 55.30).
1. Primary villus: It is made up of cytotro-
phoblast and is covered by syncytiotropho-
blast from outside.
2. Secondary villus: When this primary villus
is invaded by the extraembryonic mesoderm
in the core, it is known as secondary villus.
3. Tertiary villus: When blood capillary of fetus
enters the secondary villus in the extra-
embryonic mesodermal inner layer it
becomes tertiary villus.
Q. What are morphological features of placenta?
Ans. There are 15 to 20 lobes present in human
placenta. Placenta is disc shaped and weighs
around 500 gms at term. Each lobe contains a
number of cotyledons. There are 60 to 100
cotyledons in mature placenta. Each cotyledon
consists of an anchoring villus and its branches.
After birth of child the placenta is shed off along
with decidua. Fetal side of placenta is the
chorionic plate and is covered with amnion
(Figs 55.31 and 55.32)
Q. Name the structures forming placental barrier?
Ans. 1. Endothelium of fetal capillary present in villi.
2. Basement membrane of fetal capillary
present in villi.
3. Extramembranous mesoderm of villi.
4. Cytotrophoblast and its basement membrane
in villi.
5. Syncytotrophoblast of villi.
Q. What are functions of placenta?
Ans. 1. Exchange of oxygen, from maternal to fetal
blood.
2. Excretion of carbon dioxide, urea and other
waste products from fetal blood to maternal
blood.
3. Exchange of nutrients, electrolytes and
vitamins from maternal blood to fetal blood.
4. Placenta helps in providing passive
immunity to fetus by facilitating transmission
of IgG from maternal blood to fetal blood.
5. Synthesis of human chorionic gonado-
trophins (HCG) takes place in placenta.
6. Placenta acts as a selective barrier and
prevents many bacteria and harmful
substances from reaching the fetus.
Q. Which viruses can cross placental barrier?
Ans. Viruses like poliomyelitis, rubella, CMV and
measles virus.
Q. Which drugs can cause congenital malforma-
tions?
Ans. Some drugs like aminoglycosides (gentamycin
and amikacin) and anticonvulsants (sodium
valproate) can cause congenital malformations.
Q. What is gastrulation?
Ans. Formation of primitive streak is the beginning
of gastrulation. Gastrulation is the process
 Review of Embryology 715

where epiblast gives rise to a trilaminar
structure with a defined cranio-caudal axis and
formation of the embryonic shape.
Q. What is ingression?
Ans. The process by which cells become part of the
streak and then migrate away from it, is termed
as ingression.
Q. What is primitive node?
Ans. It is the most rostral region of the primitive
streak. It appears as a curved ridge of cells. Cells
ingress from node pass into the primitive pit,
and migrate rostally beneath the epiblast
(Fig. 55.35).
and sigmoid colon, rectum and upper part of
anal canal.
Q. Enumerate the derivatives of allantois?
Ans. Epithelium of urinary bladder, vagina, urethra,
secretory cells of the prostate and urethral
glands.
Q. Enumerate the nervous tissue derivatives of
neural crest?
Ans. 1. Dorsal root ganglia
2. Sympathetic and parasympathetic ganglia
3. Ganglia related to V, VII, VIII, IX and X
4. Meisseners and Auerbachs plexuses
5. Enteric neurons

Q. What is notochord? Q. Enumerate the connective tissue derivatives of

Ans. The earliest cells migrating through primitive neural crest?
node and streak give rise to endoderm and Ans. 1. Schwann cells
notochord. Notochordal cells become epithelial 2. Satellite cells of sensory and autonomic
after ingression through primitive node. Noto- ganglia

C H A P T E R-60
chordal cells form epithelial rod between the 3. Glial cells in enteric plexuses
epiblast and endoderm extending from caudal 4. Satellite cells in carotid body
part of prechordal plate to primitive streak. Most
Q. Name the mesenchymal derivatives of neural
of notochord disappears but part of it persists
crest?
as nucleus pulposus in intervertebral disc
Ans. 1. Pia and arachnoid mater (meninges)
(Fig. 55.36).
2. Sclera of eye
Q. Enumerate the derivatives of fore gut? 3. Choroid of eye
Ans. Epithelium and lining cells of glands and their 4. Vomer, maxilla, mandible nasal, palatine,
ducts of the pharynx, oesophagus, stomach and frontal, parietal and temporal bones
duodenum. 5. Cartilage, ligaments and tendons of head
1. Epithelium and lining cells of glands and region.
their ducts of the trachea, bronchi, 6. Lacrimal, nasal, palatine, labial, oral and
bronchioles and alveolar sacs salivary glands
2. Glandular and duct-lining cells and the main 7. Suprarenal medulla
follicular cells of the thyroid. 8. Dentine of tooth
3. Epithelium of the auditory tube, tympanic 9. Tunica media of aorta and pulmonary
cavity, tympanic antrum, internal lamina of
Q. Enumerate the epithelial tissue derivatives of
the tympanic membrane.
4. Hepatocytes of liver, lining of biliary tract, neural crest?
exocrine and endocrine cells of the pancreas. Ans. 1. Peripheral sensory receptors
2. Parafollicular cells of thyroid
Q. Enumerate the derivatives of mid gut? 3. Melanocytes
Ans. Epithelium and lining cells of glands and their 4. Carotid body, type I and type II cells
ducts of the duodenum, jejunum, appendix, 5. Chromaffin cells
caecum, part of transverse colon.
Q. What are branchial arches?
Q. Enumerate the derivatives of hind gut? Ans. They are made up of six pairs of mesodermal
Ans. Epithelium and lining cells of glands and their bars which lie in the region of the cephalic
ducts of the part of the transverse, decending expansion of foregut (Figs 57.1 to 57.3).
 716 Human Anatomy For Dental Students

Each bar is covered externally by the ectoderm Q. Enumerate the muscular derivatives of Ist
and lined on inner aspect by endoderm. arch?
Ans. 1. Temporalis
Q. What is cervical sinus?
2. Masseter
Ans. 1st and 2nd arches are more prominent than the 3. Lateral pterygoid
other arches. The 2nd arch overhangs the other 4. Medial pterygoid
arches and the corresponding ectodermal clefts. 5. Tensor veli palatini
This forms a depression known as the cervical 6. Tensor tympani
sinus. With further development of 2nd arch the 7. Anterior belly of digastric
cervical sinus gets obliterated and concavity of 8. Mylohyoid muscle
the neck is restored (Fig. 57.4).
Q. Enumerate the muscular derivatives of 2nd
Q. Enumerate the skeletal derivatives of Ist arch? arch?
Ans. Maxillary process gives rise to Ans. 1. Stapedius
1. Upper jaw 2. Stylohyoid
2. Palate 3. Posterior belly of digastric
3. Dentine 4. Auricular muscles
Mandibular process gives rise to Meckels 5. Occipitofrontalis
cartilage which forms the following structures: 6. Muscles of facial expression
1. Malleus 7. Platysma
2. Incus
cS E C T I O N-5

3. Anterior ligament of malleus Q. Enumerate the muscular derivatives of 3rd

4. Sphenomandibular ligament arch?
5. Body of mandible between the mandibular Ans. 1. Stylopharyngeus
and mental foramen 2. Superior constrictor
6. Symphysis menti, as an ossified remanant of
Q. Enumerate the muscular derivatives of 4th
the cartilage
arch?
Q. Enumerate the skeletal derivatives of 2nd Ans. 1. Cricothyroid muscle
arch? 2. Middle and inferior constrictors of pharynx
Ans. This give rise to Reicherts cartilage which forms Q. Enumerate the muscular derivatives of 6th
1. Stapes arch?
2. Styloid process
Ans. Intrinsic muscles of the larynx except crico-
3. Stylohyoid ligament
thyroid.
4. Lesser cornu of hyoid bone
5. Upper part of body of hyoid bone Q. Enumerate the derivatives of 1st pouch?
Ans. 1. Auditory tube
Q. Enumerate the skeletal derivatives of 3rd arch?
2. Epithelium of tympanic cavity and mastoid
Ans. Its dorsal part disappears and the ventral part
antrum
gives rise to
3. Mastoid air cells
1. Greater cornu of hyoid bone
4. Mucous layer of tympanic membrane
2. Lower part of body of hyoid bone
5. Submandibular and sublingual salivary
Q. Enumerate the skeletal derivatives of 4th arch? glands
Ans. It gives rise to Q. Enumerate the derivatives of 2nd pouch?
1. Thyroid cartilage Ans. 1. Tonsillar pits
2. Cuneiform cartilage 2. Tonsillar crypts
Q. Enumerate the skeletal derivatives of 6th arch? 3. Intratonsillar cleft
Ans. 1. Cricoid cartilage Q. Enumerate the derivatives of 3rd pouch?
2. Corniculate cartilage Ans. 1. Inferior parathyroid gland
3. Arytenoid cartilage 2. Reticular fibres and corpuscles of thymus

Q. Enumerate the derivatives of 4th pouch?
Ans. Superior parathyroid gland
Q. Enumerate the derivatives of 4th and 5th
pouch?
Ans. 1. Thymic element
2. Lateral thyroid
3. Ultimo-branchial body (parafollicular cells of
thyroid)
Q. Name the structures giving rise to mucous
membrane of tongue.
Ans. It is derived from the endoderm of the foregut
and arises in three parts.
The lingual swellings along with tuberculum
impar give rise to the mucous membrane of
anterior 2/3rd of the tongue. Ventral part of
hypobranchial eminence gives rise to the mucus
membrane of posterior 1/3rd of tongue. It later
fuses with the anterior 2/3rd of the tongue. The
line of fusion is known as sulcus terminalis.
Q. Where does the musculature of tongue develop
from?
Ans. Muscles of tongue are derived from the occipital
myotomes present along the epipericardial
ridges.
Q. Where does the fibroalveolar stroma of tongue
develop from?
Ans. Stroma is derived from the mesenchyme of
branchial arches. It binds together the
musculature of the tongue.
Q. What is the development of thyroid gland?
Ans. Thyroid gland develops from the following
three sources
1. Thyroglossal duct, which gives rise to
isthmus and the lateral lobes of thyroid.
2. Caudal pharyngeal complex of the fourth
pouch: This is considered to be the inducer
for the differentiation of the lateral lobes.
3. Ultimobranchial body: Gives rise to
parafollicular cells of the thyroid gland.
Q. What is the development of pituitary gland?
Ans. Pituitary gland or hypophysis cerebri develops
from the ectoderm of stomodeum and the
neuroectoderm of diencephalon in two parts.
Review of Embryology 717
Q. What is Rathkes pouch?
Ans. Anterior pituitary develops from a diverticulum
that evaginates from the roof of the stomodeum
in front of the bucco-pharyngeal membrane.
This diverticulum is known as the Rathkes
pouch (Fig. 57.9).
Q. Which processes give rise to development of
face?
Ans. Face develops from five processes which centre
around the stomodeum (Fig. 57.11).
1. Frontonasal process: This gives rise to
philtrum of upper lip, alae of the nose, nasal
septum and primitive palate.
2. A pair of maxillary processes: These contri-
bute to the formation of lateral parts of the
upper lip, upper jaw, palatine process of
maxilla and cheek.
3. A pair of mandibular arches: They form the
lower lip and lower jaw.
C H A P T E R-60
Q. What is the source of development of palate?
Ans. It is derived from two sources (Fig. 57.12)
1. Primitive palate: It is formed by fusion of
globular processes of the median nasal
process.
2. Permanent palate: It is formed by the fusion
of the horizontal palatine processes of the
maxillary processes of each side.
Q. Which bones of skull develop in membrane?
Ans. Skull bones developing in membrane
1. Frontal, parietal, maxilla, zygomatic,
palatine, nasal, lacrimal, vomer and part of
temporal bones develop in membrane.
2. Frontal and parietal bones are formed from
mesenchyme covering the developing brain.
3. Mesenchyme of maxillary process gives rise
to the maxillae (excluding premaxilla),
zygomatic bone, palatine bone, and part of
temporal bone.
4. Nasal, lacrimal and vomer are ossified from
the mesenchyme of olfactory capsule.
Q. Which bones of skull develop in cartilage?
Ans. The nasal capsule becomes well developed by
3rd month. It gives rise to ethmoid bone and
inferior nasal conchae. Cartilages of nose are
also derived from this nasal capsule.
 718 Human Anatomy For Dental Students
Q. Which bones of skull develop in cartilage and
membrane both?
Ans. Skull bones developing in both membrane
and cartilage
1. Occipital bone: Part of occipital bone above
superior nuchal line, the interparietal part,
develops in membrane while the rest of the
bone ossifies in cartilage.
2. Sphenoid bone: Body of sphenoid, lesser
wing of sphenoid and medial part of greater
wing of sphenoid ossifies in cartilage and rest
of the bone is formed in membrane.
3. Temporal bone: Petrous part, mastoid part
and styloid process undergo endochondral
ossification. Styloid process is derived from
cartilage of second branchial arch. Petrous
and mastoid parts are derived from cartilage
of otic capsule. Squamous and tympanic
parts are formed in membrane.
4. Mandible: Most of the mandible is formed
cS E C T I O N-5
in membrane from the mesenchyme of the
mandibular process. Condylar and coronoid
processes are ossified from secondary
cartilages. Meckels cartilage gets incor-
porated in the bone.
Q. What are sources of development of teeth?
Ans. Teeth develop from the interface of ectodermal
epithelium on the mandibular and maxillary
prominences. The mesenchyme of teeth is
derived from neural crest.
Q. What are stages of development of teeth?
Ans. (Fig. 57.14)
1. Bud stage
2. Cap stage
3. Bell stage
Q. What are ameloblasts?
Ans. The inner enamel epithelium is tightly adherent
to the dental papilla and give rise to ameloblasts.
Ameloblasts lay down enamel.
Q. What are odontoblasts?
Ans. Mesenchymal cells of dental papilla adjacent to
ameloblasts arrange them as a continuous
epithelium. These cells differentiate into
odontoblasts. Odontoblasts lay down dentine.
Q. How many enamel organ are formed for milk
teeth?
Ans. One enamel organ is formed for each milk tooth.
Section-6: Radiological Anatomy and Anatomical
Basis of Clinical Examination

61. Radiological Anatomy .......................................... 721-730

62. Anatomical Basis of Clinical Examination ......... 731-742
 Chapter

61
Radiological Anatomy
RADIOLOGICAL ANATOMY Wavelength of different rays of electromagnetic
Human anatomy can be studied by using various spectrum (Fig. 61.1):
imaging techniques like X-rays, ultrasound and Type of rays Wavelength
magnetic resonance imaging. Radiological anatomy
1. Cosmic rays 4 105 nm
deals with the study of human anatomy using X-ray
2. Electronic rays 2.7 104 nm
imaging.
3. Gamma rays 6 103 nm to 0.14 nm
Techniques of imaging human body can be classified 4. X-rays 0.14 to 13.6 nm
into the following categories: 5. Ultraviolet rays 13.6 to 379 nm
1. Techniques using ionizing radiations: 6. Visible rays 397 to 723 nm

C H A P T E R-61
a. Simple X-ray. a. Violet 397 to 424 nm
b. Computed X-ray tomography (CT). b. Indigo 424 to 455 nm
c. Radioisotope or radionuclide scanning. c. Blue 455 to 492 nm
2. Ultrasound: It utilizes the principle of high fre- d. Green 492 to 575 nm
quency or ultra-sonic sound waves. e. Yellow 575 to 585 nm
3. Magnetic resonance imaging: It is based on the f. Orange 585 to 647 nm
principle of variations in radiofrequencies of g. Red 647 to 723 nm
protons (hydrogen atoms, H) in an electromagnetic 7. Infrared rays 723 to 1 103 nm
field. 8. Wireless rays (Hertzian rays) 1 105 to 3 1013 nm
a. Short 1 105 to 1 1010 nm
X-ray Techniques b. Long 1 1010 to 3 1013 nm
9. Electromagnetic oscillations Over 3 1013 nm
X-rays were discovered in 1895 by a German
physicist named Conrad Roentgen.
X-rays are a part of the electromagnetic spectrum. Features of X-ray Examination
The wireless radiofrequency waves are at one end X-rays can easily pass through various substances
of spectrum having long wavelengths while X-rays due to their short wavelength. The image of a sub-
and cosmic rays are at the other end of the spectrum stance fundamentally depends on two factors
having very short wavelengths. namely,
X-rays have a very short wavelength of 1/10,000 1. Penetrating power of X-rays.
of visible light. This characteristic permits X-rays 2. Atomic weight of the substance. Higher the
to penetrate materials which otherwise do not atomic weight of a substance, greater is the
transmit visible light. absorption of X-rays.
When an X-ray beam is passed through the body ,
the beam gets partly scattered and partly absorbed.
The amount of energy absorbed depends on the
atomic weight of the structure.
Higher the atomic weight, greater will be the
absorption of the rays which cannot pass through
the structure. As little or no rays will pass through,
the structure is projected as a white or radio-opaque
area on the developed film. Example, bone and
Fig. 61.1: Different rays of electromagnetic spectrum teeth.
 722 Human Anatomy For Dental Students

Also in our body, calcium absorbs X-rays and since

the concentration of calcium in bones is highest it
absorbs more X-rays than skin, muscle, fascia.
Structure with lower atomic weights allow passage
of X-rays and appear as radiolucent or black to grey
on the film. The rest of structures will appear in
various shades of grey on the image. Examples of
radiolucent structures which are readily penetrated
by X-rays are cartilage, muscle and fascia (Figs 61.2,
61.3).
The X-rays image is obtained on a silver impre-
gnated plastic film known as the photographic
plate. Hence, this type of image is actually a
negative imprint of the X-rays. Thus a radiograph
is also known as skiagram (skia shadow, gram
a writing).

DIFFERENT METHODS OF X-RAY EXAMINATION

Simple Radiography
The X-ray beam is passed through the patient on to the
photography plate (Fig. 61.2).
S E C T I O N-6

1. Different views of radiography
a. Anteroposterior view: X-rays are projected from
anterior aspect of the subject and photographic
plate is placed posteriorly to the subject.
Posterior structures are better visualized in this
view. Examples, Xrays of limbs, spine.
b. Posteroanterior view: X-rays are projected from
2. Screening and image intensifier: In this method
behind and photography plate is placed anterior
to the subject. Anterior structures are better
visualized in this view. The most common
example is chest X-ray (Fig. 61.4) in which this
view best delineates the lungs.
3. Video-radiography: As described above the same
4. Xeroradiography: The X-ray beam is passed
Fig. 61.2: Simple radiography
c. Lateral view: It is done to assess depth of the
structure (Fig. 61.3). It is of two types:
Right lateral view: Photographic plate is place
to the right side of the subject.
Fig. 61.3: X-ray of knee joint (lateral view)
Left lateral view: Photographic plate is placed
to the left side of the subject.
d. Oblique view: It is done to asses a particular
structure, e.g., minimal fluid in pleural cavity.
the beam of X rays is made to pass across the part
of body on to a fluorescent screen to allow for
instant view of the image. This image is captured
via an electronic image intensifier on a closed circuit
television monitor and can be seen simultaneously
by the operator at a different place than the X ray
dark room.
fluorescent image produced by an image intensifier
can be utilized for video recording of multiple
images. This is video-radiography.
through the subject onto an aluminum plate coated
with a thin layer of selenium which is charged
electrically. The X-ray beam causes an alteration of
the electrostatic charges in correspondence with the
structure being evaluated and an image is
produced. The image is obtained by blowing a thin
powder on to the plate receiving the rays. The
powder adheres in proportion to local charge on
the plate. This method is especially useful to
delineate anatomy of soft tissues.

Fig. 61.4: X-ray of chestPA view
5. Digital vascular imaging digital subtraction
angiography: This method is useful in the imaging
of blood vessels. The area to be studied is imaged
by an image intensifier screening and the picture
stored in the computer. A second film is taken after
injecting a bolus of contrast medium into the vessel.
The first image is then electronically subtracted
from the second and a clearer picture of the vessel
minus soft tissue shadow, especially of the
surrounding bones is obtained.
6. Special radiography procedures using X-rays:
These include barium meal, contrast angiography,
intravenous pyelography.
7. Tomography: This is the variation of simple X-ray
radiography. In this method during X-ray exposure,
X-ray tube and X-ray film are moved in opposite
direction and image of a section of tissue is obtained.
Computed Tomography (CT) (Fig. 61.5)
This method was introduced by Godfrey Hounsfield in
1972 and is also known as computerized axial
tomography. Computed tomography involves multi-
directional X-ray scanning of the body. Multiple X-ray
beams are received on special detectors which produce
scintillations. These scintillations are quantified digitally
and this digital data is passed to the computer. The
computer analyzes the data and gives output in the form
of two dimensional image display of the scanned area.
Radiological Anatomy 723
Spiral computed topography: In this method patient
C H A P T E R-61
is moved longitudinally and X-ray tube moves circum-
ferentially. Net result are according to the data from
spiral path of X-ray beams which are studied.
Radioisotope Scanning
Radioisotopes are radioactive labeled isotopes of various
substances. When injected they are taken up by specific
areas of the body. The intensity of radio-activity after
injection of these substances is evaluated by gamma
cameras. Few examples where they are used are:
1. In detecting tumors, example thyroid tumors which
take up radioactive iodine in large amounts during
study.
2. Study of myocardial perfusion which is performed
using thallium isotope scan.
Ultrasound
Ultrasonic waves are sounds waves of very high
frequency which is inaudible to human ear. They have
a frequency of over 20,000 Hz. They are produced from
a piezoelectric transducer which is capable of changing
electrical signals to mechanical energy of sound waves
and changing sound waves back to mechanical and
electrical energy. The sound waves travel through
human tissue at a velocity of 1500 meters / second. These
waves are reflected back from various interfaces of body
tissues depending on their density and are received by
the same transducer and changed into electric currents.
This is amplified and displayed on the cathode ray tube
or screen of computer monitor as two dimensional
S E C T I O N-6 724 Human Anatomy For Dental Students
Fig. 61.5: CT scan of head
images. The images are also in varying shade of grey.
Several forms of ultrasound display are available.
These are:
a. A-scan
b. B-scan
c. M-mode
d. Real time two dimensional scanning
e. Doppler
f. Duplex scanner
g. Continous wave doppler
h. Three dimensional ultrasound
MRI or Magnetic Resonance Imaging
Nuclei with unpaired electrons behave as magnets.
Hydrogen atom nuclei are present in abundance in the
body, mostly as water (H 2O) in extracellular and
intracellular compartments. On application of an intense
magnetic field these protons get excited and alter their
alignment. This alteration is reversed with the cessation
of the magnetic pulse and realignment results in the
release of energy as radiofrequency waves. The energy
changes per unit substance vary according to the proton
content of the tissue which are quantified and converted
to electrical wave forms. These are analyzed by a
computer which then displays a two dimensional image
of the scanned area in varying shades of grey and white.
Magnetic field used in MRI is usually of the strength of
0.15 to 1.5 Tesla.
PACS
It stands for picture archiving and communications
system. The X-ray images are computed digitally and
stored as images on the hard disk of computer. This
enables the storage of large number of images which
can be easily retrieved when required at a later date
without the dependency on paper or films. However
this needs a high cost input and maintainance.
Use of Contrast Media in Radiology
Contrast media are substances that are injected into the
lumen of various hollow organs, veins and arteries in
order to facilitate better X-ray visualization of various
structures like the interior of an organ (e.g., GIT, urinary
tract) or blood vessels (e.g., Angiography).
Contrast media that are generally used are:
a. Salts of heavy metals: Barium as barium sulphate
has long been used for barium enema, barium meal
for evaluation of gastrointestinal tract.

b. Organic iodide preparations: These are used for
urinary tract, gall bladder, angiocardiography,
arteriography, phlebography, mylography.
c. Gas: Air and other gases are seen as black on X-ray
exposure. Air is used to identify lung, pharynx,
paranasal sinuses.
THORAX
Radiological anatomy of thorax is studied with the help
of following methods:
1. Plain X-ray (skiagram) radiograph of chest
2. CT scan of thorax
3. Bronchography
Radiograph of Chest
A postero-anterior (PA) view is generally obtained for
X-ray chest. It is the most common radiograph done for
routine medical examination and to diagnose numerous
disease conditions.
Chest X-RayPA View (Fig. 61.6)
The X-ray plate is kept in front of the chest of the patient
in standing or sitting position. The patient is asked to
place his hands on the waist such that the elbows are
pointing anterolaterally. It shows the following
characteristic features:
Following bones can be identified:
1. Clavicle is seen as a horizontal bone on each
side. Position of both clavicle indicates the
position of patient at the time of X-ray exposure
2. Medial border of scapula may be identified.
Fig. 61.6: Radiograph of chest (PA view)
Radiological Anatomy 725
3. Ribs are seen as flat curved bones on each side
overlapping the lung fields. Anterior ends and
costal cartilages of ribs are not seen clearly.
Posterior parts of shafts of the ribs are clearly
visible. The outline of anterior parts of shafts of
the ribs are also seen, though they are lighter
than posterior parts. The anterior part of the
shaft of a rib is seen at a lower level than the
posterior part of the corresponding rib.
Soft tissue shadow of breasts may be seen.
Mediastinal shadow is a dense radioopaque
shadow seen in the midline. It is formed by
superimposition of great vessels and other
structures of mediastinum in upper part and the
heart in lower part.
Right border of mediastinal shadow is formed by
the following structures, from above downwards.
a. Right brachiocephalic vein
b. Superior vena cava
c. Right atrium of heart
d. Inferior vena cava. It lies at the junction of heart
shadow with the diaphragm.
C H A P T E R-61
Left border of mediastinal shadow is formed by the
following structures, from above downwards
a. Left subclavian artery
b. Arch of aorta: It is also known as aortic knuckle
c. Pulmonary trunk
d. Auricle of left atrium
e. Left ventricle
Lung shadows or field: Shadows of both lungs are
seen as dark structures on either side of mediastinal
shadow. Lung shadows are translucent due to the
 726 Human Anatomy For Dental Students
presence of air in the alveoli. Each lung field can be
divided into three zones:
a. Upper zone: It extends from apex of lung to the
lower border of the second costal cartilage.
Upper end of this zone (shadow of apex of lung)
extends above the clavicle.
b. Middle zone: It extends from lower border of
2nd costal cartilage to lower border of 4th costal
cartilage. It corresponds to the hilum of the lung.
Fine radio-opaque lines are seen in this region.
These are caused by branches of pulmonary
vessels and lymphatics.
c. Lower zone: It extends from lower border of 4th
costal cartilage to base of lung.
Upper part of trachea is seen as a translucent
shadow in the medial plane above the level of
medial ends of clavicles. The lower cervical and
upper thoracic vertebrae can be seen through it..
Diaphragm is seen as a dome shaped shadow on
either side related to each of the base of lung with a
central flat part related to lower end of mediastinal
shadow (base of heart). The right dome of
diaphragm is placed higher than the left because is
S E C T I O N-6
is related to the liver below.
Costophrenic angle is the angle between lateral end
of dome of diaphragm and the corresponding lower
end of thoracic wall. The angle presents with
radiolucent shadow of lung base. Radio opaque
appearance of the angle occurs in pleural effusion.
This is called obliteration of angle.
Fig. 61.7: Radiograph of chest (Lateral view)
Subdiaphragmatic area on left side, under the left
dome of diaphragm presents with a dark
radiolucent shadow. This represents gas in the
fundus of stomach.
X-ray ChestLateral View (Fig. 61.7)
The X-ray plate is kept on the right or left side of the
chest of the patient and the arms are raised above.
Both domes of diaphragm overlap.
Cardiac shadow lies in relation to the anterior half
of diaphragm.
Lung fields of each side overlap. This view helps to
asses the postero inferior parts of the lungs.
Sternum is seen anteriorly and thoracic vertebrae
are seen posteriorly.
Bronchography: It is the procedure performed with the
help of injection of contrast media into the tracheo-
bronchial tree. X-ray films obtained help delineate the
opacified bronchial tree.
ABDOMEN AND PELVIS
Radiological anatomy of abdomen and pelvis is studied
with the help of plain X-ray abdomen and special
radiography techniques.
Plain X-ray Abdomen
Before obtaining plane X-ray abdomen the patient is
asked to use a laxative a day prior to the procedure. This
preparation helps to eliminate excess intestinal air and

Fig. 61.8: Radiograph of abdomen (AP view)
avoids presence of gas shadows. The gas shadows often
obscure the anatomical details of the region.
This radiograph is useful to visualize any stone in
the kidneys, ureters and urinary bladder. It is also useful
to diagnose intestinal obstruction.
X-Ray AbdomenAP View (Fig. 61.8)
Following features are identified:
Bony shadows of lower ribs, lumbar vertebrae,
sacrum, sacroiliac joints, iliac crest, pubic symphysis
are identified clearly.
Gas shadow under the left dome of diaphragm is
seen. It represents air in fundus of stomach.
Faint shadow of kidneys may be seen on each side
of vertebral column.
A well defined soft tissue shadow is seen along the
lateral margin of vertebral column extending
downwards and outwards. It is formed by psoas
major muscle.
HEAD AND NECK
Radiological anatomy of head and neck is studied, with
the help of angterior posterior and lateral view of plain
radiograph. Paranasal sinuses are demarcated well in
Caldwell (posterioanterior view) of head and neck.
Anterior posterior view of head and neck (Figs 61.9
and 61.10): Following features are identified for superior
to inferior direction:
1. Outer and inner plates of skull vault bone
2. Sagittal suture seen in the midline
3. Coronal suture meets the sagittal suture near the
vertex
Radiological Anatomy 727
4. Lambdoid suture is seen more anteriorly to the
coronal suture
C H A P T E R-61
5. Frontal air sinuses are seen on both sides above and
between two orbits
6. Orbits are distinctly visible on the face below and
lateral to frontal air sinus
7. Nasal cavity is seen between two orbits separated
by nasal septum: sphenoidal and ethmoidal air
sinuses are superoinferioly.
8. Two maxillary air sinuses are seen as translucent
area are of each side of nasal cavity below each orbit.
9. Two mandibular rami are seen extended upwards
leading to mandibular condyles.
10. Mastoid process and air cells are visible laterally
and inferiorly to mandibular condyle.
11. Anteriorly and inferiorly teeth of upper and lower
jaw a visible with body of mandible forming the
lower most part of the face.
12. Lesser wing of sphenoid, greater wing of sphenoid
are seen in orbit as white lines. Petrous temporal
bone forms a white dense shadow running directly
medially across the orbit and maxillary air sinus.
Lateral view of head and neck (Figs 61.11 and 61.12):
In the lateral view following features are identified:
1. Outer and inner table of Vault of skull are identified
as two white lines.
2. Sutures are seen as translucent lines. The lambdoid
suture extends downwards for posterior part of
Vault of skull to the base behind the shadow of
petrous temporal bone.
3. In the anterior most part near the base of the skull
a translucent triangle area seen is frontal air sinus.
It lies in the frontal bone.
S E C T I O N-6 728 Human Anatomy For Dental Students

Fig. 61.9: Radiograph of skull (AP view)

Fig. 61.10: Radiograph of skull (Cald Wells view)

 Radiological Anatomy 729

C H A P T E R-61
Fig. 61.11: Radiograph of skull (lateral view)

Fig. 61.12: Radiograph of skull and neck (lateral view)

 730 Human Anatomy For Dental Students
4. A white line extends from the frontal air sinus to
the anterior clenoid process at the base of skull is
the anterior cranial fossa.
5. Anterior clenoid process forms the anterior
boundary of pituitary fossa
6. Pituitary fossa is seen as a round or oval depression
lies superior to the sphenoidal air sinus.
7. Posterior clenoid process is seen projecting from the
posterior part of pituitary fossa from dorsum sella.
8. Sphenoidal air sinus are seen below the pituitary
fossa.
9. A triangle white dense shadow is seen behind
posterior clenoid process is the petrous temporal
bone.
S E C T I O N-6
10. At the level of thin shadow a circular translucent
area is present is the external acustic meatus
11. Behind shadow of petrous temporal bone a shadow
of vestibular process and air cell is seen
12. Coronal suture form a zig-zag translucent line
passing from vertex to a variable distance
13. Groove for middle meningeal vessels seen behind
thin coronal suture extend to the Vault of the skull.
14. Orbits casts shadow inferior to frontal air sinus and
anterior to ethmoid air sinus.
15. Maxillary air sinuses are seen a translucent are
below orbits.
16. Hard palate and teeth are seen below maxillary air
sinuses.
17. Body and rami of mandible is seen.
 Chapter

62 Anatomical Basis
of Clinical Examination
PALPATION OF ARTERIES IN BODY Facial Artery
Arteries of Head and Neck Pulsations of facial artery (Fig. 62.1) can be felt against
the angle of mandible at the infero-medial border of
Superficial Temporal Artery masseter muscle. Ask the patient to clench his teeth and
Pulsations of superficial temporal artery can be felt feel for the masseter muscle, follow it inferiorly and feel
in front of the tragus of the ear. Here it crosses the for the pulse at its anterior end, against the border of
root of zygoma. They can also be felt at the temple mandible.
(Fig. 62.1).
The course of anterior terminal branch of superficial Common Carotid Artery

temporal artery can clearly be seen on the forehead
especially in bald men, during outbursts of anger.
It also becomes noticeably more tortuous with
increasing age.
C H A P T E R-62
Pulsations of common carotid artery (Fig. 62.1) can be felt
at the level of superior border of thyroid cartilage, just in
front of anterior border of sternocleidomastoid muscle.

Fig. 62.1: Peripheral pulses felt in head and neck

 732 Human Anatomy For Dental Students

Arteries of Upper Limb (Fig. 62.2 and 62.3) Brachial Artery

Axillary Artery Pulsations of brachial artery are felt in the cubital fossa,
Pulsations of axillary artery are felt in relation to lateral just medial to tendon of biceps brachii muscle. The biceps
wall of axilla, at the junction of anterior 1/3rd and tendon can be easily felt in cubital fossa when the
posterior 2/3rd. forearm is flexed against resistance (Fig. 62.2).

Fig. 62.2: Landmark tendons for palpation of brachial and radial arteries
S E C T I O N-6

Fig. 62.3: Palpation of arterial pulses in upper limb


Fig. 62.4: Palpation of abdominal aorta
Radial Artery (Fig. 62.3)
Pulsations of radial artery are felt against the anterior
surface of lower 1/3rd of shaft of radius in forearm, just
lateral to tendon of flexor carpi radialis muscle.
Radial Artery in Anatomical Snuff Box (Fig. 62.3)
Pulsations of radial artery can be felt in the anatomical
snuff box, on the lateral aspect dorsum of hand.
Anatomical snuff box is a triangular depression present
between tendon of extensor pollicis longus laterally and
tendons of abductor pollicis and extensor pollicis brevis
medially. It becomes visible when the thumb is extended.
Arteries of Abdomen (Fig. 62.4)
Abdominal Aorta
In a thin built person pulsations of abdominal aorta can
be felt on deep palpation in the umbilical region.
Arteries of Lower Limb (Fig. 62.5)
Femoral Artery
Pulsations of femoral artery can be felt at the mid
inguinal point, against the capsule of hip joint.
Anatomical Basis of Clinical Examination 733
C H A P T E R-62
Fig. 62.5: Palpation of peripheral pulses in lower limb
Popliteal Artery
Pulsations of popliteal artery can be felt in the
popliteal fossa in semiflexed position of knee joint.
This artery is also used for measuring blood
pressure in lower limb.
Dorsalis Pedis Artery
Pulsations of dorsalis pedis artery can be felt on the
dorsum of the foot in front of ankle joint, between the
tendon of extensor hallucis longus and first tendon of
extensor digitorum longus. This point is about 5 cm
distal to medial and lateral malleoli, over the inter-
mediate cuneiform bone.
Posterior Tibial Artery
Pulsations of posterior tibial artery are felt behind the
medial malleolus and in front of tendocalcaneus.
Lumbar Puncture (Lumbar Tap) (Fig. 62.6)
It is a procedure to obtain a sample of cerebrospinal fluid
from subarachnoid space for examination. It is done to
introduce drugs for spinal anesthesia, antibiotics, etc. in
subarachnoid space.
Lumbar puncture is done in lumbar region. Spinal
cord ends at the level of L 1 or L 2 vertebra and
 734 Human Anatomy For Dental Students
S E C T I O N-6

Fig. 62.6: Lumbar puncture

subarachnoid space extends upto lower border of S1 Right Border

vertebra. Following structures are pierced from without Put a point 1.2 cm. lateral to the margin of sternum
inwards in lumbar puncture (Fig. 62.6). on the upper border of the right 3rd costal cartilage.
1. Skin Put a point in the right fourth intercostal space
2. Superficial fascia 3.7 cm. lateral to the median plane.
3. Supraspinous ligament Mark the sternal end of the right sixth costal cartilage.
Draw a line joining these points with a gentle
4. Interspinous ligament
convexity to the right.
5. Ligamentum flavum
6. Extra dural space
7. Duramater Lower Border
8. Arachnoid mater Put a point on the sternal end of the right sixth costal
cartilage.
SURFACE ANATOMY OF HEART (FIG. 62.7) Mark the xiphisternal junction.
Locate the apex beat.
It is the surface projection of the sternocostal surface of Draw a line joining these points.
the heart.
Left Border
Mark the apex beat.
Put a point 1.2 cm. lateral to the sternal margin on
the lower border of the left second costal cartilage.
Join these points by a line with a gentle upward
convexity.

Upper Border
Join the upper ends of the right and left borders.

SITES OF AUSCULTATION OF HEART SOUNDS

(FIG. 62.8)
The heart sounds are produced by closure of the various
Fig. 62.7: Surface anatomy of heart valves of the heart.

Fig. 62.8: Sites of auscultation of valve sounds
1. Aortic valve sound: It is heard in the right 2nd
intercostal space, just next to the lateral margin of
sternum.
2. Pulmonary valve sound: It is heard in the left 2nd
intercostal space, just next to the lateral margin of
sternum.
3. Tricuspid valve sound: It is heard in the left 5th
intercostal space, just next to the lateral margin of
sternum.
4. Mitral valve sound: It is heard at the apex of heart in
the left 5th intercostal space, in midclavicular line.
On auscultation of heart, primarly two heart sound
are heard namely, LUB (S1) followed by DUB (S2). First
heart sound (S1) occurs due to simultaneous closure of
atrioventricular valves and second heart sound (S2)
occurs due to simultaneous closure of aortic and
pulmonary valves.
SURFACE LANDMARKS OF ANTERIOR CHEST
WALL AND ABDOMINAL WALL
Bony Landmarks of Anterior Chest Wall
Suprasternal notch: As a finger is slipped down along
midline of neck, a depression is felt over superior aspect
of manubrium. This is the suprasternal notch.
Sternal angle: As a finger is slipped down from
suprasternal notch over manubrium sterni, a bony
prominence is felt about 2.5 cm below it which is the
sternal angle. This corresponds to lower border of T4
vertebra posteriorly.
The second costal cartilage is at level of sternal angle
and lower ribs can be counted from this point.
Xiphisternum: As a finger is slipped downwards along
the midline of sternum, the lowest bony point beyond
which there is a depression is xiphisternum.
Anatomical Basis of Clinical Examination 735
Costal margin: The costal margin can be traced as a bony
margin from each side of xiphisternum passing the finger
downwards and laterally.
C H A P T E R-62
Bony Landmarks of Abdomen and Pelvis
The upper limit of abdomen anteriorly is costal margin.
The lower limit of abdomen presents the following bony
landmarks:
1. Pubic symphysis: As a finger is passed downwards
along the midline of anterior abdominal wall, the
first bony prominence felt is the pubic symphysis.
2. Pubic crest: It may be felt as a small bony margin
just lateral to pubic symphysis on each side.
3. Pubic tubercle: As the finger is passed laterally from
pubic symphysis, a bony projection is felt about 2.5
cm lateral to it which is pubic tubercle. This rounded
projection at the lateral end of pubic crest can be felt
in obese individuals also.
4. Anterior superior iliac spine: Place your hand on
the waist and slide the finger down, the bony
prominence felt in front above the groin, is anterior
superior iliac spine.
5. Iliac crest: It is a curved bony margin felt passing
backwards from anterior superior iliac spine when
the hand is kept on the waist.
6. Posterior superior iliac spine: A dimple is seen on
back, on each side of vertebral spine, just above
the buttocks. The posterior superior iliac spine lies
underneath this dimple.
7. Spine of S2 vertebrae: The line joining the two
dimples passes through the spine of S2 vertebra.
Soft Tissue Landmarks on Anterior Abdominal Wall
1. Umbilicus: It is the midline depression or defect in
anterior abdominal wall, usually at the midpoint of
 736 Human Anatomy For Dental Students
a line joining xiphisternum and pubic symphysis.
This corresponds to level of intervertebral disc of L3
and L4 vertebrae. It is lower in children and in obese
individuals.
2. Linea alba: It is a midline raphe passing from
xiphisternum to pubic symphysis which may be felt
as a slight depression, more prominent above the
level of umbilicus. The linea alba is seen better in
muscular individuals.
3. Linea semilunaris: It corresponds to the lateral
border of rectus abdominis muscle. It is marked as a
line joining the tip of ninth costal cartilage to the
pubic tubercle with a gentle convexity facing
laterally. It is also better visible in muscular
individuals.
4. Midpoint of inguinal ligament: It is the midpoint of
a line joining the anterior superior iliac spine and
the pubic tubercle. It corresponds to the deep
inguinal ring.
5. Mid inguinal point: It is the midpoint of a line joining
anterior superior iliac spine and the pubic
symphysis. It corresponds to the site of origin of
S E C T I O N-6
femoral artery.
6. Mc Burneys Point (Fig. 62.9): This point correspond
to the junction of upper 2/3rd and lower
1/3rd of a line drawn from the right anterior superior
iliac spine to the umbilicus. It is the usual site of
referred pain of appendicitis.
Fig. 62.9: Mc Burneys point
QUADRANTS AND PLANES OF ABDOMEN
For descriptive purposes the anterior abdominal wall is
divided into four quadrants by a vertical midline and a
horizontal line perpendicular to midline which passes
through the umbilicus. The four quadrants are:
1. Upper right quadrant
2. Upper left quadrant
3. Lower right quadrant
4. Lower left quadrant
The anterior abdominal wall is also divided into nine
regions for purpose of clinical description by two
horizontal lines and two verticals lines.
Horizontal lines are:
1. Line joining the lowest point on costal margin on
each side: corresponds to 10th costal cartilages.
2. Line joining the tubercles of iliac crest on each side,
intertubercular line. Each tubercle of iliac crest may
be felt or marked, as a bony point on iliac crest, 5 cm
posterior to anterior superior iliac spine.
Vertical lines are lines passing vertically down from
midpoint of clavicle on each side.
The nine regions of abdomen are:
1. Right hypochondrium
2. Epigastric region
3. Left hypochondrium
4. Right lumbar region
5. Umbilical region
6. Left lumbar region
7. Right iliac fossa
8. Hypogastric region
9. Left iliac fossa
Planes of Abdomen (Fig. 62.10)
The abdomen can be studied by the following horizontal
and vertical planes.
Horizontal Planes
1. Subcostal plane: It is a horizontal plane passing
anteroposteriorly from a line joining the lowest points
of costal margins of each side. This corresponds to
the 10th costal cartilage. The plane passes
posteriorly through the lower border of L2 vertebra.
Clinical significance: It passes through the origin of
inferior mesenteric artery and third part of
duodenum.
2. Trans-tubercular plane: It is a horizontal plane
passing antero-posteriorly from a line joining the
two tubercles of iliac crest. Posteriorly, the plane
passes through upper border of L5 vertebra.
Clinical significance: It passes the origin of inferior
vena cava, joining of common iliac crest.
3. Transpyloric plane: It is a horizontal plane passing
antero-posteriorly midway between suprasternal
notch of manubrium and upper border of pubic
symphysis. Anteriorly it passes through the tips of
9th costal cartilages while posteriorly, it passes at
the lower border of L1 vertebra.
Clinical significance: This plane passes through:
a. Pylorus of stomach
 Anatomical Basis of Clinical Examination 737

C H A P T E R-62
Fig. 62.10: Planes and quadrants of abdomen

b. Origin of superior mesenterior artery DISPOSITION OF INTRA-ABDOMINAL VISCERA

c. Formation of portal vein (FIGs 62.11 to 62.16)
d. Hilum of kidneys Stomach (Fig. 62.11)
e. Head and neck of pancreas
f. Termination of spinal cord It is placed on left upper quadrant of abdomen. It
extends between epigastrium, left hypochondrium
Vertical Planes and umbilical regions.
The upper or cardiac and is located 2.5 cm to left of
1. Midsagittal plane: It is a midline vertical plane median plane, at the level of 7th costal cartilage.
passing through a line joining midpoint of sternal The lower or pyloric is located 1.2 cm to right of
notch of manubrium sterni and pubic symphysis. median plane, on the transpyloric plane.
2. Paramedian or right and left lateral vertical plane
These are vertical planes on either side, passing
Duodenum (Fig. 62.12)
anteroposteriorly from a line joining midpoint of
clavicle, and midinguinal point (midpoint of a line It lies in the upper half of umbilical region.
joining anterior superior iliac spine and pubic 1st part starts from pyloric end of stomach and
symphysis). It passes just lateral to tip of 9th costal extends along the tranpyloric plane for 2.5 cm to
cartilage. right.
 738 Human Anatomy For Dental Students
S E C T I O N-6
Fig. 62.11: Disposition of abdominal viscera
2nd part curves downwards, vertically to end 7.5 cm
below the right end of the 1st part.
3rd part lies on the subcostal plane and extends from
lower end of 2nd part crossing the midline to the left
just above umblicus.
4th part curves upto 1 cm below the transpyloric
plane from the 3rd part.
Liver (Figs 62.11, 62.12)
It mostly lies in the right hypochondrium and is
present behind the lower five ribs and the
corresponding costal cartilages. The left lobe extends
to the epigastrium and a little part lies in the left
hypochondrium also.
The lower edge may be just palpable below the left
costal margin normally, especially in children.
Spleen (Figs 62.11, 62.12)
It lies the left hypochondrium with the posterior end
extending into the epigastric region.
It lies horizontally at the level of spine of T10 vertebra,
behind the 9th, 10th and 11th ribs on left side.
Caecum (Figs 62.11 and 62.12)
It lies in the rigth iliac fossa.
Appendix (Fig. 62.12)
It lies in the right iliac fossa.
The base of appendix usually lies at the point of
junction of upper 2/3rd and lower 1/3rd of a line
joining umbilicus to right anterior superior iliac
spine.
Ascending Colon (Fig. 62.15)
It extends up from the right iliac fossa at the level of
transtubercular plane and passes vertically up in right
lumbar region to right hypochondrium till the tip of 9th
costal cartilage. The upper end correspondes to the
hepatic flexure of colon.
Transverse Colon (Fig. 62.12)
It extends from the right hypochondrium to the left
hypochondrium and hangs down as a loop. The lowest
end of loop may reach upto the umbilicus.
 Anatomical Basis of Clinical Examination 739

C H A P T E R-62
Fig. 62.12: Disposition of abdominal viscera

Fig. 62.13: Disposition of abdominal viscera

 740 Human Anatomy For Dental Students
S E C T I O N-6

Fig. 62.14: Disposition of abdominal viscera

Fig. 62.15: Disposition of abdominal and pelvic viscera


Fig. 62.16: Disposition of female reproductive organs
Descending Colon (Fig. 62.12)
It extends vertically down from the left end of transverse
colon (splenic flexure) in left hypochondrium at level of
8th costal cartilage. It passes along left lumbar region
till left iliac fossa.
Pancreas (Fig. 62.14)
It lies in the C-shaped curve of duodenum. It extends from
the epigastrium to the left hypochondrium, at the level of
transpyloric plane.
Kidneys (Figs 62.13, 62.14)
The right kidney lies slightly lower than the left due to
presence of liver in the right hypochondrium.
a. Right kidney: It lies in the right hypochondrium
and right lumbar regions and extends medially into
epigastric and umbilical regions. The transpyloric
plane passes through upper end of its hilum.
b. Left kidney: It lies in the left hypochondrium and
left lumbar regions and extends medially into the
epigastric and umbilical regions. The transpyloric
plane passes through lower end of its hilum.
Anatomical Basis of Clinical Examination 741
C H A P T E R-62
Urinary Bladder (Figs 62.13 and 62.15)
It lies in true pelvis behind pubic symphysis. When
distended it extends into the hypogastric region of
abdomen.
Uterus (Fig. 62.16)
It lies in the pelvic cavity between urinary bladder and
rectum. During pregnancy it enlarges to become an
abdominal organ.
Ovary (Fig. 62.16)
Ovaries lie in ovarian fossa one on each side of uterus in
lesser pelvis.
SITES OF INTRAMUSCULAR INJECTION
Deltoid Muscle
Intramuscular injection is given in the lower half of deltoid
muscle to prevent damage to axillary nerve (Fig. 62.17).
Gluteus Medius Muscle
Intramuscular injection is given in the outer and upper
quadrant of gluteal region, in gluteus medius muscle. This
minimizes any risk to sciatic nerve (Fig. 62.18).
 742 Human Anatomy For Dental Students

Fig. 62.17: Site of intramuscular injection

S E C T I O N-6

Fig. 62.18: Site of intramuscular injection in gluteal region

does not slip away when intravenous injections are given.

It acts as lifeline in emergency conditions to give
intravenous injections and fluids. It is the most common
site used for cardiac catheterization.

Fig. 62.19: Site of intramuscular injection in thigh

Vastus Lateralis Muscle

Intramuscular injection is given in vastus lateralis muscle
in thigh. This is the preferred site in children (Fig. 62.19).

SITE OF INTRAVENOUS INJECTION (Fig. 62.20)

Median Cubital Vein
Median cubital vein is connected to the deep veins of the
upper limb through a perforator which fixes it. Hence, it
Fig. 62.20: Site of intravenous injection in median cubital vein
 INDEX
A Anterior cranial fossa 222 Ball and socket joint 79
A cells 571 Anterior ethmoidal foramen 226 Barr bodies 18
Abdomen 35 Anterior ethmoidal nerve 317 Bartholin cyst 193
Abdominal aorta 733 Anterior fontanelle 678 Bartholins gland 187
Abdominal cavity 38 Anterior jugular vein 340 Basal ganglia 98
Abducent nerve 285 Anterior spinal artery 363 Basal lamina 489
Abduction 10 Anterior superior iliac spine 735 Base of skull 222
Abductor digiti minimi muscle 52 Anterior triangle of neck 344 Basilar sinus 307
Abductor pollicis brevis muscle 52 Anterior vagal trunk 422 Basilic vein 131
Abductor pollicis longus muscle 51 Antibodies 152 Basophilic structures 485
Absorption 168 Aorta 124 Basophils 138
Accessory azygos vein 132 Aortic orifice 118 Bell stage 698
Accessory nerve 358 Aortic valve sound 121 Bells palsy 269
Accessory parotid gland 331 Aortic vestibule 118 Biceps brachii 49
Accessory phrenic nerve 361 Apical ligament of Dens 447 Bifid tongue 381, 698
Accessory thyroid arteries 437 Apnea 166 Bile canaliculi 569
Accommodation 296 Apocrine glands 21, 197, 500 Bile duct 175
Acetabulum 56 Apocrine glands 500 Binocular vision 300
Acid fuchsin 485 Appendicular skeleton 67 Bipennate muscle 81
Acidophilic structures 485 Appendix 171, 738 Black eye 259
Acquired immunity 150 Aqueduct of vestibule 225 Blastocyst 657
Acquired immunity 151 Arcuate eminence 224 Blood 135
Acromegaly 185 Arm 42 Blood groups 137
Active acquired immunity 151 Arrector pili muscle 197 Blood supply of bones 71
Active transport 14 Arterial pulse 122 Blood vessels 122
Adduction 10 Arteries 124 B-lymphocytes 151
Adductor brevis muscle 61 Arterioles 122, 124, 536 Body cavities 672
Adductor longus muscle 61 Arteriovenous anastomosis 123 Bones 509
Adductor mangus muscle 61 Arthrography 80 Bones 68
Adductor pollicis muscle 52 Articular capsule 79 Bones of the hand 46
Adenohypophysis 310 Articular cartilage 78 Bony labyrinth 430
Adipocytes 23 Articular disc or meniscus 79 Bony pelvis 37
Adipocytes 501 Articular genu 60 Bowmans capsule 574
Adipose tissue 25 Articular surfaces 78 Bowmans glands 546
Adipose tissue 504 Aryepiglottis 416 Bowmans membrane 290
Adrenal glands 184 Arytenoid cartilages 412 Brachial artery 125, 732
Adventitious bursa 26 Ascending colon 172, 738 Brachial plexus 91
Aglossia 381 Ascending pharyngeal artery 351 Brachialis muscle 49
Aglossia 698 Association fibres 98 Brachiocephalic vein 129
Agnor staining 625 Asterion 217, 452 Brachioradialis 51
Alar ligament 447 Astigmatism 296 Bradyapnea 166
Alleles 632 Astrocytes 89, 524 Branchial apparatus 685
Alveolar arch 217 Atlanto-axial joints 446 Branchial arches 685
Alveolar process of maxilla 449 Atlanto-occipital joints 445 Branchial cyst 698
Alveolar process of mandible 449 Atrio-ventricular bundle 121 Branchial fistula 698
Alveoli 551 Atrio-ventricular node 121 Bregma 212
Ameloblast 698 Atrium 116 Bregma 452
Amniocentesis 635 Atypical ribs 31 Bright-field type microscope 488
Amnion 661 Auditory pathway 433 Brodmanns classification 98
Amniotic cavity 659 Auriculotemporal nerve 320 Bronchial tree 156
Anal canal 172 Autonomic ganglia 528 Broncho-pulmonary segments 159
Anaphase 619, 620 Autonomic nervous system (ans) 108 Buccal nerve 320
Anastomoses 123 Autoradiography 486 Buccal nodes 444
Anatomical basis of respiration 164 Axial skeleton 67 Buccinator muscle 262, 325
Anatomical planes 7 Axilla 42 Buccopharyngeal fascia 343
Anatomical position 6 Axillary artery 124, 732 Bucket handle movement 165
Anatomy 3 Axillary group of lymph nodes 148 Bud stage 698
Anconeus 51 Axillary vein 131 Bulb of the vestibule 187
Anemia 141 Axons 86, 524 Buttock 53
Azoospermia 194
Anencephaly 708
Azygos system of veins 132
C
Aneuploidy 628 Caecum 171, 738
Angiogenesis 670 B Caldwell luc operation 397
Angle of mandible 233, 450 B cells 571 Canaliculi 274
Ankyloglossia 698 B lymphocytes 540 Cancellous bones 69
Ansa cervicalis 356 Babinskis sign 108 Canines 375
Anterior cervical nodes 445
 744 Human Anatomy For Dental Students
Cap stage 698 Classification of chromosomes 627 Cricopharyngeus muscle 404
Capacitance vessels 122 Classification of connective tissue 25 Cricothyroid muscle 416
Capacitation 646 Clavicle 42 Cricothyroid membrane 413
Capillaries 123, 124, 536 Cleft lip 698 Crico-tracheal ligament 413
Cardiac muscle 82 Cleft lower lip 387 Cri-du-chat or cat cry syndrome 630
Cardiac plexus 120 Cleft palate 387, 698 Cruciate muscle 82
Cardiovascular system 3, 113, 533 Cleft upper lip 387 Cruciform ligament 447
Carotid body 350 Clinical anatomy 5 Crus cerebri 102
Carotid canal 227 Clitoris 187 Crux of the heart 118
Carotid sheath 343 Clivus 224 Cryptorchidism 194
Carotid sinus 349 Clotting factors 140 Cuneiform cartilages 413
Carotid triangle 346 Clotting mechanism 140 Cushings syndrome 186
Carotid tubercle 452 Clotting of blood 140 Cutaneous receptors 93
Carpal bones 46 Coccyx 37 Cystic duct 175
Carrier gene 632 Cochlea 430 Cystitis 180
Carrier proteins 15 Cochlear duct 431 Cystoscopy 180
Cartilage 75, 505 Coeliac trunk 127 Cytochemistry 486
Cartilages of larynx 411 Collagen fibres 25, 503 Cytogenetics 623
Cartilaginous joints 76 Collateral circulation 123 Cytokines 152
Cataract 295 Collecting tubules 575 Cytoplasm 16
Cavernous sinus 306 Colour vision 300 Cytoskeleton 17
Cavernous sinus thrombosis 307 Columella 390
Cavity of the larynx 414 Columnar epithelium 19
D
C-banding 625 Commissural fibres 98 Dangerous area of face 264
Cell 13 Common carotid artery 124, 349, 731 Decidua 658
Cell cycle 617 Common iliac artery 128 Decidual reaction 652
Cell division 617 Common iliac vein 132 Deciduous teeth 375
Cell mediated immunity 151 Compact bone 69, 72, 509 Deep cervical artery 364
Cell membrane 13 Comparative anatomy 5 Deep cervical lymph nodes 443
INDEX

Central nervous system (CNS) 83, 95 Complement system 152 Deep fascia 26
Centromere 627 Complete cleft palate 387 Deep fascia of neck 341
Cephalhaematoma 259 Components of connective tissue 23 Deep inguinal lymph nodes 149
Cephalic flexure 704 Composition of body 27 Deep palmar arch 127
Cephalic vein 131 Compound glands 21, 500 Deep temporal nerves 320
Cerebellum 104 Computed tomography 723 Deep vein of tongue 380
Cerebral cortex 96 Conducting vessels 122 Deglutition 409
Cerebral hemispheres 96 Condylar emissary vein 308 Deltoid muscle 47
Cerebrospinal fluid 95 Condylar joint 79 Dendrites 86, 524
Cerebrum 530 Condylar process of mandible 450 Dendritic cells 540
Cervical pleura 160 Conjugate movements 281 Dense irregular connective tissue 25
Cervical plexus 91, 360 Conjunctiva 272 Dense irregular connective tissue 503
Cervical vertebrae 250 Conjunctival sac 274 Dental caries 374
Cheeks 372 Connecting stalk 659 Depression 11
Chemoreceptors 92 Connective tissue 22, 501 Depressor anguli oris muscle 262
Chest X-raypa view 725 Constipation 176 Depressor labii inferioris muscle 262
Chin 450 Constrictor muscles of the pharynx 403 Depressor septi muscle 261
Cholecystectomy 176 Coracobrachialis muscle 49 Derivatives of branchial apparatus 687
Chondroblasts 75, 505 Cornea 290 Dermis 196
Chondrocranium 677 Corneal and conjunctival reflex Dermomyotome 669
Chondrocytes 75, 505 pathway 299 Descemets membrane 290
Chorda tympani nerve 268, 321 Corneal endothelium 290 Descending colon 172, 741
Chorion 661 Corniculate cartilages 413 Development of autonomic nervous
Chorionic cavity 659 Coronal or frontal plane 7 system 707
Chorionic villi 662 Coronary arteries 118 Development of cerebellum 705
Chorionic villus biopsy or sampling 635 Coronary sinus 120 Development of diaphragm 673
Choroid 291 Corrugator supercilli 261 Development of diencephalon 704
Chromatin fibre 626 Corticotropes 310 Development of face 693
Chromatin threads 18 Costal cartilages 32 Development of mesencephalon 705
Chromosomes 18, 623 Costal pleura 160 Development of metencephalon 705
Chylothorax 152 Costocervical trunk 362, 364 Development of muscular system 681
Ciliary body 291 Cranial cavity 27 Development of myelencephalon 705
Circulating plasma 27 Cranial nerves 83, 91 Development of nasal cavities 696
Circumduction 11 Craniorachischisis 708 Development of palate 695
Circumpennate muscle 81 Cranio-sacral outflow 110 Development of palatine tonsil 690
Circumvallate papillae 554 Crenitism 185 Development of pituitary gland 692
Cisterna chyli 144 Cricoid cartilage 412, 452 Development of pons 705

Development of ribs and sternum 681
Development of salivary glands 692
Development of skull 677
Development of spinal cord 706
Development of teeth 696
Development of telencephalon 704
Development of thyroid gland 691
Development of tongue 690
Development of vertebrae 680
Developmental anatomy 5
Diakinesis 619
Diaphragm 163
Diaphragma sellae 303
Diaphragmatic pleura 161
Diaphysis 71
Diarrhea 176
Diencephalon 100
Differential interference contrast
microscope 488
Differentiation 27
Digastric muscle 348
Digastric triangle 344
Digestion 168
Digestive system 167, 553
Diplotene 619
Disconjugate movements 281
Distal convoluted tubule 574
Distributing vessels 122
Dna 631
Dominant gene 632
Dorsal digital expension 53
Dorsal interossei muscle 53
Dorsal root ganglia 528
Dorsal root ganglion 90
Dorsal scapular artery 362
Dorsal thalamus 100
Dorsal venous arch 131
Dorsalis pedis artery 733
Dorsomedial edge (lip) 681
Duct of Santorini 176
Duct of Wirsung 176
Duodenum 169, 170, 737
Dura mater 302
Dysphagia 438
Dysphonea 438
Dyspnoea 166, 438
E Extensor carpi radialis brevis muscle 51
Ear 423
Ear ossicles 428
Ectoderm 666
Ectodermal clefts 687
Effector organ 93
Ejaculatory ducts 192
Elastic cartilage 507
Elastic cartilage 75
Elastic fibres 25, 503
Elastic tissue 25
Electrocardiogram (ECG) 122
Electron microscope 488
Elevation 11
Ellipsoid joint 79
Emboli 142
Embryogenesis 643
Embryology 643
Emissary veins 308
Index 745
Enamel 374 External nose 389
Endochondral or cartilaginous External occipital crest 213
ossification 73, 513 External occipital protuberance 212, 450
Endocrine glands 21, 181, 500 Exteroceptors 92
Endocrine system 3, 181 Extra hepatic biliary system 174
Endocytosis 15 Extracellular fluid (ECF) 27
Endoderm 671 Extracellular matrix 23
Endodermal pouches 687 Extracellular matrix junctions 18
Endoneurium 526 Extraembryonic coelom 661
Endoplasmic reticulum 16 Extraembryonic mesoderm 659
Eosin 485 Extraocular muscles 278
Eosinophilia 142 Extrinsic group of muscles of back 365
Eosinophils 138 Eyeball 275, 289
Eosionopenia 142 Eyelids 271
Ependymal cells 89, 525
Epiblast layer 658
F
Epibranchial placodes 687 Face 259
Epidermis 195 Facial artery 352, 731
Epididymis 191 Facial nerve 265
Epiglottis 411, 547 Facial vein 264
Epineurium 526 Facilitated diffusion 14
Epiphyseal arteries 71 Fallopian tubes 189
Epiphyseal cartilage 71 False or greater pelvis 37
Epiphysis 71 False ribs 30
Episiotomy 193 Falx cerebelli 303
Epithalamus 100 Falx cerebri 302
Epithelial tissue 19 Fascia 26
Epithelial tissue 489 Fascia adherens 18
Epithelialepithelial interaction 710 Fascia bulbi 275, 289
INDEX
Epithelialmesenchymal interactions 710 Female gamete 648
Erector spinae muscle 366 Female reproductive organs 591
Eruption of teeth 375 Female urethra 180
Erythroblastosis fetalis 141 Femoral artery 128, 733
Erythrocyte sedimentation rate (esr) 136 Femoral vein 134
Erythrocytes 135 Femur 56
Erythropoesis 136 Fenestrated capillaries 123, 536
Esophagus 440 Fertilization 655
Ethmoid bone 247 Fetal circulation 674
Ethmoidal sinuses 397 Fetoscopy 636
Euchromatin 626 Fibres 23
Eversion of foot 11 Fibroblast growth factors 709
Exchange vessels 122 Fibroblasts 23, 501
Exocrine glands 21, 500 Fibrous joints 76
Exocytosis 15 Fibrous pericardium 113
Experimental anatomy 5 Fibula 59
Expiration 164 Filariasis 152
Extension 10 Filiform papillae 553
Filtration 16
Extensor carpi radialis longus muscle 51 Fingerprinting 198
Extensor carpi ulnaris muscle 51 First cervical vertebra 251
Extensor digiti minimi muscle 51 First rib 31
Extensor digitorum muscle 51 FISH technique 625
Extensor digitorum brevis muscle 62 Flat bones 70
Extensor digitorum longus muscle 62 Flexion 10
Extensor hallucis longus muscle 62 Flexor digitorum superficialis 50
Extensor indicis muscle 51 Flexor carpi radialis muscle 50
Extensor pollicis brevis muscle 51 Flexor carpi ulnaris muscle 50
Extensor pollicis longus muscle 51 Flexor digiti minimi muscle 52
External carotid artery 350 Flexor digitorum longus muscle 63
External ear 423 Flexor digitorum profundus muscle 50
External female genitalia 187 Flexor hallucis longus muscle 63
External iliac artery 128 Flexor pollicis brevis muscle 52
External iliac vein 132 Flexor pollicis longus muscle 50
External intercostal muscle 162 Flexures of colon 172
External jugular vein 131, 340 Floating ribs 31
External laryngeal nerve 421 Flow cytometry 625
 746 Human Anatomy For Dental Students
Fluorescence light microscope 488 Graffian follicle 650 Histology of ovaries 595
Foliate papillae 553 Granular foveolae 222 Histology of palatine tonsil 543
Follicular epithelial cells 602 Great auricular nerve 265, 361 Histology of pancreas 570
Fontanelles 678 Great saphenous vein 134 Histology of parathyroid glands 607
Foot 53 Greater palatine canal 228 Histology of penis 590
Foramen caecum 226 Greater palatine foramen 227 Histology of peripheral nerve trunk 527
Foramen lacerum 227 Greater petrosal nerve 268 Histology of pharynx 546
Foramen magnum 227 Grey matter 89 Histology of pineal gland 606
Foramen ovale 226 Gross anatomy 3 Histology of pituitary gland 604
Foramen rotundum 226 Growth 27 Histology of placenta 600
Foramen spinosum 226 Growth of bones 74 Histology of prostate 588
Forearm 42 Histology of salivary gland 555
Forebrain 83
H Histology of seminal vesicles 588
Forebrain vesicle 704 Haemochorial 661 Histology of skeletal muscle 516
Forehead 449 Haemoglobin 136 Histology of smooth muscle 518
Fossa of Rosenmuller 400 Haemolysis 137 Histology of spinal cord 530
Free nerve endings 93 Haemotoxylin 485 Histology of spleen 542
Frenulum linguae 377 Hair bulb 196 Histology of stomach 562
Frontal air sinuses 395 Hair follicle 196 Histology of sympathetic ganglion 529
Frontal bone 241 Hairs 196 Histology of testis 582
Frontal crest 222 Hamstring muscles 62 Histology of the cerebrum 530
Frontal nerve 317 Hand 42 Histology of thymus 542
Frontonasal process 693 Hard palate 217, 384 Histology of thyroid gland 601
Fronto-zygomatic suture 449 Haversian canals 509 Histology of tongue 553
Functional anatomy 5 Haversian system 509 Histology of trachea 548
Fungiform papillae 553 Head and neck 27 Histology of umbilical cord 600
Fusiform muscle 81 Heart 114 Histology of ureter 577
Heart sounds 121 Histology of urinary bladder 578
G Hedge hog proteins 709 Histology of uterine cervix 593
INDEX

G1 phase 617 Helix 424 Histology of uterine tubes 593

G2 phase 617 Hemiazygos vein 132 Histology of vagina 597
Gag-reflex 409 Hemidesmosomes 18 Histology of cartilage 505
Galea aponeurotica 258 Hemopoesis 136 Histology of vas deferens 586
Gall bladder 175 Hensons node 664 Histology of veins 537
Ganglia 89 Hepatic lobule 569 Histology the cerebellum 532
Ganglion cell layer 293 Heterochromatin 626 Histone proteins 625
Gap junctions 18 Heterozygous alleles 632 Holocrine glands 21, 500
Gastrocnemius muscle 63 High resolution banding 625 Homeostasis 27
Gastrointestinal or digestive system 3, 167 Hind brain 83 Homozygous alleles 632
Gastrointestinal tract 168 Hindbrain vesicle 704 Hormones 181
Gastrulation 663 Hinge joint 79 Hox genes 709
G-banding 625 Hip 53 Humerus 43
General histology of blood vessels 533 Hip bone 54 Humoral immunity 151
Genes 632 Histochemistry 486 Hyaline cartilage 75, 505
Genial tubercles 231 Histological techniques 485 Hydroxyapatite crystals 509
Genioglossus muscle 379 Histology 485 Hymen 187
Geniohyoid muscle 384 Histology and cytology 5 Hyoepiglottic ligament 413
Giemsa stain 625 Histology of small intestine 562 Hyoglossus muscle 379
Gingivitis 374 Histology of arteries 533 Hyoid bone 67, 249
Glabella 449 Histology of body of uterus 591 Hyperacusis 269
Glands 21, 499 Histology of bone 509 Hypermetropia 296
Glial cells 89 Histology of breast 599 Hypoblast layer 658
Gliosis 89 Histology of bronchi 549 Hypobranchial eminence 691
Glomera 123 Histology of cardiac muscle 521 Hypoglossal canal 227
Glomerular basement membrane 574 Histology of dorsal root ganglion 528 Hypoglossal nerve 381
Glossopharyngeal nerve 407 Histology of epididymis 584 Hypothalamo-hypophyseal portal
Glottic compartment 415 Histology of esophagus 559 system 311
Gluteus maximus muscle 61 Histology of female urethra 580 Hypothalamus 100, 182
Gluteus medius muscle 61 Histology of gall bladder 569 Hypothenar muscles 52
Gluteus minimus muscle 61 Histology of kidney 575 Hypothyroidism 185
Glycocalyx 14 Histology of large intestine 565
Golgi apparatus 16 Histology of larynx 546 I
Golgi tendon organ 94 Histology of liver 567 Ileum 169, 170
Gomphosis 77 Histology of lung 552 Iliac crest 56, 735
Gonadotropes 310 Histology of lymph node 540 Iliacus 60
Gracilis 61 Histology of male urethra 579 Iliocostalis cervicis muscle 368

Iliocostalis group of muscle 368
Iliocostalis lumborum muscle 368
Iliocostalis thoracis muscle 368
Ilium 56
Immunity 150
Immunoglobulins 152
Implantation 657
Incisive foramina 227
Incisors 375
Inclusion substances 16
Incomplete or partial cleft 387
Incus 429
Inferior alveolar nerve 320
Inferior constrictor muscle 404
Inferior gemellus muscle 62
Inferior meatus 393
Inferior mediastinum 34
Inferior mesenteric artery 127
Inferior mesenteric vein 134
Inferior nasal conchae 249, 393
Inferior nuchal lines 213
Inferior oblique muscle 278
Inferior ophthalmic vein 289
Inferior orbital fissure 228, 277
Inferior parathyroids 438
Inferior petrosal sinus 306
Inferior rectus muscle 278
Inferior sagittal sinus 305
Inferior tarsal muscle 281
Inferior thyroid artery 363, 437
Inferior vena cava 129
Infraglottic compartment 415
Infraorbital artery 288
Infraorbital foramen 228, 452
Infraorbital nerve 287
Infraspinatus muscle 47
Infratemporal fossa 314
Infratrochlear nerve 317
Infundibulum/outflow tract 117
Ingestion 168
Ingression 664
Innate immunity 150
Inner intercostal muscle 162
Inspiration 164
Integumentary system 4
Interatrial septum 116
Intercalated disks 520
Intercostal arteries 162
Intercostal muscles 33, 162
Intercostal nerves 162
Intercostal spaces 162
Intercostal veins 162
Intermediate filaments 17
Intermediate mesoderm 670
Internal acoustic meatus 225
Internal auditory meatus 227
Internal capsule 98
Internal carotid artery 353
Internal ear 430
Internal iliac artery 128
Internal iliac vein 132
Internal intercostal muscle 162
Internal jugular vein 131, 355
Internal laryngeal nerve 421
Internal thoracic artery 362
Internodal pathways 121
Index 747
Interoceptors 92 Left bronchus 157
Interstitial fluid 27 Left ventricle 117
Interventricular septum 118 Leg 53
Intervertebral disc 78 Lens 294
Intervillous space 662 Leptomeninges 301
Intracellular fluid (ICF) 27 Leptotene 619
Intramembranous or membranous Lesser occipital nerve 361
ossification 73, 513 Leucocytes 137
Intrapharyngeal space 406 Leucopoesis 139
Intrinsic or deep muscles of back 366 Levator anguli oris muscle 261
Inversion of foot 11 Levator labii superioris alaeque nasi
Investing layer of deep cervical fascia 341 muscle 261
Iris 292 Levator labii superoris muscle 261
Irregular bones 70 Levator palpebrae superioris
Irregular connective tissue 25 muscle 261, 281
Ischium 56 Levator scapulae 48, 366
Islets of Langerhans 571 Levator veli palatini muscle 385
Isochromosomes 629 Leydig cells 584
Light microscope 486
J Limbic system 101
Jejunum 169, 170 Linea alba 736
Joint cavity 79 Lingual artery 351
Joints 76 Lingual nerve 320
Joints of upper limb 46 Lingual thyroid 381
Junctional complex 18 Lingual tonsil 402
Juxta glomerular cells 574 Lingual veins 377
K Lips 371
Lithotomy position 6
Karyotyping 623 Littles area 392
Kesselbachs plexus 392
INDEX
Liver 173, 175, 738
Kidneys 177, 741
Liver acini 569
Killiens dehiscence 409
Lobar bronchi 156
Klinefelters syndrome 628
Lobes of lung 158
Kupffers cells 569 Locus 632
L Long bones 69
Labia majora 187 Long ciliary nerves 317
Labia minora 187 Long head of biceps femoris muscle 62
Labrum 79 Longissimus capitis muscle 366
Lacrimal apparatus 273 Longissimus cervicis muscle 366
Lacrimal bones 249 Longissimus group of muscle 366
Lacrimal nerve 317 Longissimus thoracis muscle 366
Lacrimal puncta 274 Longitudinal muscles of the pharynx 405
Lacrimal sac 274 Longus capitis muscle 441
Lambda 212, 453 Longus colli muscle 441
Large elastic arteries 534 Loop of Henle 574
Large intestine 171 Loose areolar connective tissue 25
Laryngopharynx 402 Loose areolar connective tissue 503
Larynx 411 Lower limb 53
Lateral cricoarytenoid muscle 416 Lower motor neuron 268
Lateral fontanelles 678 Lower respiratory tract 156
Lateral incisive foramina 227 Lumbar plexus 91
Lateral or temporomandibular Lumbar puncture 733
ligament 326 Lumbar vertebrae 36
Lateral pharyngeal space 343 Lumbricals 53
Lateral plate mesoderm 670 Lung 157
Lateral pterygoid muscle 324 Lymph 144
Lateral rectus muscle 278 Lymph capillaries 144
Lateral rotation 10 Lymph nodes 146
Lateral wall of the nasal cavity 392 Lymph vessels proper 144
Latissimus dorsi muscle 48, 366 Lymphatic system 143
Law of independent assortment 632 Lymphocytes 138, 151
Law of segregation 632 Lymphocytosis 142
Law of uniformity 632 Lymphoid tissue 145
Left atrioventricular orifice 118 Lymphopenia 142
Left atrium 117 Lyons hypothesis 632
Lysosomes 17
 748 Human Anatomy For Dental Students

M Mesenchyme 670 Myenteric plexus of Auerbach 558

M phase 617 Mesoderm 668 Mylohyoid 348, 383
Macrophages 23, 502 Metabolism 27 Mylohyoid line 231
Macrostomia 387 Metacarpals 46 Myocardial circulation 119
Macula adherens (desmosomes) 18 Metaphase 618, 620 Myoepithelial cells 555
Macula densa cells 574 Metaphyseal arteries 71 Myopia 296
Magnetic resonance imaging (MRI) 724 Metaphysis 71 Myotome 681
Male gemete 643 Metatarsals 60 Myringoplasty 427
Male reproductive organs 581 Metathalamus 100
Metencephalon 704 N
Male urethra 179
Malleus 428 Methylene blue 485 Nails 197
Mallory Azan dye stain 571 Microfilaments 17 Nasal bones 248, 449
Mammotropes 310 Microglia 89, 525 Nasal cavity 390, 545
Mandible 230 Microscopic appearance of parotid Nasal septum 390
Mandibular arches 694 gland 557 Nasal vestibule 393
Mandibular canal 233 Microscopic appearance of sublingual Nasalis muscle 261
Mandibular foramen 228 gland 558 Nasion 449
Mandibular nerve 319 Microscopic appearance of Nasociliary nerve 317
Marginal artery of Drummond 127 submandibular gland 557 Nasolabial fold 453
Masseter 325 Microtubules 17 Nasolacrimal duct 274
Masseteric nerve 320 Microvilli 18 Nasopharyngeal (pharyngeal) tonsil 400
Mast cells 23, 502 Mid brain 102 Nasopharynx 400
Masticatory mucosa 373 Mid inguinal point 736 Natural immunity 151
Mastoid canaliculus 228 Midbrain 83 Near vision reflex pathway 298
Mastoid emissary vein 308 Midbrain vesicle 704 Neck 28, 339
Mastoid process 450 Middle concha 393 Nephron 573
Mature oocyte 648 Middle constrictor muscle 404 Neruomeres 704
Maxilla 234 Middle cranial fossa 224 Nerve 87
Maxillary artery 321, 353 Middle ear 427 Nerve fiber 87
INDEX

Maxillary nerve 318 Middle meatus 393 Nerve injury 89

Maxillary processes 693 Middle meningeal artery 303 Nerve to stapedius 268
Maxillary sinus 236, 396 Middle meningeal vein 308 Nerve trunk 87
Maxillary sinusitis 397 Midsagittal or median plane 7
Nervous spinosus 320
Maxillary vein 322 Migrant cells 23
Nervous system 3, 523
McBurneys point 176, 736 Mitochondria 16
Neural crest cells 667, 699
Mechanism of respiration 164 Mitosis 617
Neural folds 666
Mechanoreceptors 92 Mitral valve sound 121
Neural plate 666
Medial cubital vein 131 Molars 375
Neurocranium 211, 677
Medial pterygoid muscle 324 Monocytes 138
Neuroglial cells 524
Medial rectus muscle 278 Monosomy 628
Monosynaptic reflexes 93 Neurohypophysis 310
Medial rotation 10 Neuromuscular junction 88
Median cubital vein 132 Mons pubis 187
Morula stage 657 Neuron 85, 523
Median incisive formina 227 Neurulation 699
Mediastinal pleura 160 Mosaicism 629
Motor pathway 93 Neutropenia 141
Mediastinal surface of lung 158 Neutrophilia 141
Mediastinum 34 Mucoid tissue 25
Mucoid tissue 504 Neutrophils 138
Medulla oblongata 104 New born skull 228, 678
Medullary rays 577 Mucosa 26
Mucosa associated lymphoid Nissl bodies 86
Meiosis 619 Nociceptors 92
Meiosis ii 621 tissue 147, 543
Mucus acini 555 Non-disjunction 628
Meisseners plexus 558
Mucus secreting or mucus glands 22, 500 Norma basalis 217
Membrana tectoria 447
Mullerian inhibiting factor 709 Norma frontalis 213
Membranous labyrinth 431
Multicellular glands 21, 499 Norma lateralis 214
Membranous neurocranium 677
Multifidus muscle 368 Norma occipitalis 212
Meninges 301
Multipennate muscle 81 Norma verticalis 211
Menstrual cycle 652
Mumps 333 Northern blot technique 636
Menstrual phase 653
Muscle 81 Notochord 664
Mental foramen 228, 452
Mental spines 231 Muscles of mastication 323 Nuclear envelope 17
Mentalis 262 Muscular arteries 535 Nuclear sap 18
Merocrine glands 21, 500 Muscular system 3 Nucleolus 18
Mesangial cells 574 Muscular tissue 515 Nucleosomes 625
Mesangial tissue 574 Muscular triangle 347 Nucleus 17
Mesencephalic nucleus 315 Musculus uvulae 385 Nucleus of tractus solitarius 266
Mesencephalon 83, 704 Myasthenia gravis 89 Nucleus pulposus 665
Mesenchymal stem cells 23, 501 Myelencephalon 704 Nutrient artery 71

O Palatopharyngeal arch 401
Oblique arytenoid muscle 416
Obliquus capitis inferior muscle 370
Obliquus capitis superior muscle 370
Obturator foramen 56
Obturator internus muscle 62
Obtutator externus muscle 61
Occipital artery 352
Occipital bone 242
Occipital emissary vein 308
Occipital nodes 444
Occipital sinus 305
Occipital triangle 357
Occipitofrontalis muscle 261
Occipitomastoid suture 212
Oculomotor nerve 282
Odontoblasts 698
Olfactory glands 546
Olfactory nerve 395
Olfactory pathway 101
Oligodendrocytes 524
Oligodendrogliocytes 89
Omohyoid muscle 349
Oogenesis 648
Ophthalmic artery 287, 355
Ophthalmic nerve 286, 317
Ophthalmic veins 289
Opponens digiti minimi muscle 52
Opponens pollicis muscle 52
Opposition 11
Optic disc 293
Optic foramen 226
Optic nerve 282
Oral cavity proper 371
Oral mucosa 372
Orange G 485
Orbicularis oculi muscle 261
Orbicularis oris muscle 262
Orbital margins 449
Orbitalis muscles 281
Organelles 16
Oropharynx 401
Osmoreceptors 93
Ossification of bone 73
Ossification of skull bones and
mandible 254
Osteoblasts 69, 509
Osteoclasts 69, 509
Osteocytes 69, 509
Osteoprogenitor cells 509
Otic ganglion 321
Ovarian cycle 651
Ovaries 189, 741
P skin biopsy 636
Pachymeninx 301
Pachytene 619
Packed cell volume (PCV) 136
PACS 724
Palate 384
Palatine aponeurosis 386
Palatine bones 248
Palatine tonsil 401
Palatoglossal arch 401
Palatoglossal fold 385
Palatoglossus 379, 385
Index 749
Peritoneum 38
Palatopharyngeal fold 385 Peritonsillar space 406
Palatopharyngeus muscle 386, 406 Permanent palate 695
Palatovaginal canal 228 Peroneus brevis muscle 63
Palmar interossei muscle 53 Peroneus longus muscle 63
Palmaris brevis muscle 52 Peroneus tertius muscle 62
Palmaris longus muscle 50 Peroxisomes 17
Pancreas 175, 184, 741 Petrosquamous sinus 308
Papillae of tongue 376 Phagosomes 17
Paracrine glands 21, 500 Phalanges 46
Parafollicular or C-cells 602 Pharyngeal arches 685
Paranasal air sinuses 395 Pharyngeal plexus of nerves 406
Parapharyngeal space 406 Pharyngeal pouches 687
Parasympathetic nervous system 110 Pharyngotympanic tube 409
Parathyroid glands 184, 438 Pharynx 399
Paratracheal nodes 445 Phase contrast microscope 488
Paravertebral muscles 441 Photoreceptors 92
Paraxial mesoderm 668 Phrenic nerve 361
Parietal bones 240 Physical anthropology 5
Parietal eminence 212 Pilosebaceous unit 196
Parietal emissary vein 308 Pineal body 182
Parietal foramen 212, 228 Piriform fossa 403
Parietal foramina 222 Piriformis 61
Parietal pleura 160 Piston movement of respiration 165
Parietomastoid suture 212 Pituitary gland 183, 309
Parotid gland 329 Pivot joint 79
Parotid/preauricular lymph nodes 444 Placenta 661
Parotid-bed 329 Placental barrier 663
Pars basalis 592 Plain X-ray abdomen 726
INDEX
Pars flaccida 426 Plane joint 79
Pars functionalis 592 Plantaris muscle 63
Pars plana 291 Plasma 135, 140
Pars plicata 291 Plasma cells 23, 502
Pars tensa 426 Plasma membrane 13
Passavants ridge 406 Plasma proteins 140
Passive acquired immunity 151 Platelets 139
Passive transport 14 Platysma 340
Patella 58 Pleura 160
Pax genes 709 Pleural cavity 161
Pectineus 60 Plica fimbriate 377
Pectoral region 42 Pneumatic bones 70
Pectoralis major muscle 47 Pneumocyte-I 551
Pectoralis minor muscle 47 Pneumocyte-II 551
Pedigree chart 633 Polyaxial joints 79
Pelvic cavity 37, 39 Polycythemia 141
Pelvic diaphragm 39 Polyploidy 628, 629
Pelvic inlet 37 Polysynaptic reflex 94
Pelvic outlet 37 Pons 103
Pelvis 39 Pontine flexure 704
Penis 190 Popliteal artery 129, 733
Peptic ulcer 176 Popliteus 63
Percutaneous ultrasound guided fetal Porta hepatis 174
blood samplin 636 Portal lobule 569
Percutaneous ultrasound guided fetal Portal triads 569
Portal vein 132
Pericardium 113 Posterior auricular artery 353
Perichondrium 506 Posterior auricular nerve 268
Perikaryon 85, 523 Posterior condylar canal 227
Perineum 40, 526 Posterior cranial fossa 224
Periodic acidschiff (PAS) reaction 486 Posterior cricoarytenoid 416
Periosteal arteries 72 Posterior ethmoidal foramen 226
Periosteum 510 Posterior ethmoidal nerve 317
Peripheral nerve trunk 525 Posterior fontanelle 678
Peripheral nerves 91 Posterior inferior cerebellar artery 363
Peripheral nervous system 83 Posterior spinal artery 363
Peritoneal cavity 39 Posterior tibial artery 733
 750 Human Anatomy For Dental Students
Posterior triangle of neck 356
Posterior vagal trunk 422
Postsynaptic membrane 88
Prader-Willi syndrome 630
Pre-auricular point 452
Prechordal plate 665
Prelaryngeal nodes 445
Premolars 375
Prenatal diagnosis 635
Presbyopia 295, 296
Presynaptic membrane 88
Pretracheal fascia 342
Pretracheal nodes 445
Prevertebral fascia 343
Prevertebral muscles 440, 441
Primary cartilaginous joint 78
Primary follicle 650
Primary immune response 152
Primary lymphoid organs 145
Primary pulmonary bronchi 156
Primary villus 661
Primary yolk sac 659
Primitive node 664
Primitive palate 695
Primitive streak 664
Primordial follicle 650
Primordial germ cells 666
Principal bronchi 156
Procerus muscle 261
INDEX
Quadrants and planes of abdomen 736
Quadrate lobe 174
Quadrate muscle 81
Quadratus femoris 62
R Sagittal sulcus 222
Radial artery 126, 733
Radiographic anatomy 5
Radioisotope scanning 723
Radiological anatomy 721
Radius 44
Rathkes pouch 605, 692
R-banding 625
Recessive gene 632
Rectum 172
Rectus capitis anterior muscle 441
Rectus capitis lateralis muscle 441
Rectus capitis posterior major muscle 370
Rectus capitis posterior minor muscle 370
Rectus femoris muscle 60
Recurrent laryngeal nerve 421
Red blood corpuscles 135
Reflex arc 93
Reflexes 93
Regional anatomy 4
Regular connective tissue 25, 504
Reids base line 452
Renal angle 180
Renal colic 180
Saccule and utricle 432
Sacral and coccygeal plexus 91
Sacrum 36
Saddle joint 79
Sagittal planes 7
Salivary glands 329
Salpingopalatine fold 400
Salpingopharyngeal fold 400
Salpingopharyngeus muscle 406
Sartorius muscle 60
Scaleno-vertebral triangle 442
Scalenus anterior muscle 442
Scalenus medius muscle 442
Scalenus posterior muscle 442
Scalp 257
Scapula 44
Scapular region 42
Sclera 290
Sclerotome 669
Scrotum 191
Sebaceous glands 197
Seborrhic dermatitis 198
Second cervical vertebra 252
Second rib 31
Secondary follicle 650
Secondary active transport 15
Secondary cartilaginous joint 78
Secondary immune response 152

Profunda femoris artery 129
Projection fibres 98
Proliferative phase 652
Prominence of cheeks 449
Pronation 11
Pronator quadratus muscle 50
Pronator teres muscle 50
Prone position 6
Prophase 618, 619
Proprioceptors 92
Prosencephalon 83, 704
Prostate 192
Protrusion 11
Proximal convoluted tubule 574
Pseudostratified epithelium 20
Pseudostratified epithelium 493
Psoas major muscle 60
Pterion 217, 452
Pterygoid canal 228
Pterygoid plexus of veins 264, 322
Pterygo-maxillary fissure 228
Pterygopalatine fossa 314
Pterygopalatine ganglion 318
Pubic crest 735
Pubic symphysis 735
Pubic tubercle 735
Pubis 56
Pulmonary orifice 117
Pulmonary valve sound 121
Pump handle movement of
respiration 165
Pupillary light reflex pathway 297
Purkinje fibres 121
Pyelonephritis 180
Q Simple branched tubular glands 22
Q-banding 625
Quadrangular membrane 414
Renal corpuscle 574 Secondary lymphoid organs 145
Renal tubule 574 Secondary pulmonary bronchi 156
Reproduction 27 Secondary villus 661
Reproduction 643 Secondary yolk sac 661
Reproductive system 4, 187 Secretory phase 652
Resident cells 23 Sella turcica 224
Resistance vessels 122 Semen 647
Respiratory epithelium 545 Semicircular canals 431
Respiratory system 3, 155, 545 Semimembranosus muscle 62
Reticular fibres 25 Seminal vesicles 192
Reticular fibres 503 Semispinalis muscle 368
Reticular formation 102 Semitendinosus muscle 62
Reticular tissue 25 Sensory ganglia 527
Retina 292 Sensory nucleus of trigeminal 315
Retinal pigment epithelium 293 Sensory pathway 93
Retraction 11 Sensory receptors 92
Retroauricular/mastoid nodes 444 Septum transversum 670, 673
Retromandibular vein 264 Serosa 26
Retropharyngeal space 343, 406 Serous acini 555
Rhombencephalic isthmus 704 Serous demilumes 555
Rhombencephalon 83, 704 Serous glands 22, 500
Rhomboideus major muscle 48, 366 Serous pericardium 113
Rhomboideus minor muscle 48, 366 Serratus anterior muscle 47
Ribosomes 16 Serratus posterior inferior muscle 366
Ribs 30 Serratus posterior superior muscle 366
Right atrio-ventricular orifice 117 Sertoli cells 584
Right atrium 116 Sesamoid bones 71
Right auricle 116 Sex chromatin 18
Right bronchus 157 Short bones 70
Right lymph duct 145 Short saphenous vein 134
Right ventricle 116 Shoulder region 42
Risorius 262 Shunt muscles 82
Robertsonian translocation 630 Sigmoid colon 172
Root of lung 158 Sigmoid sinus 305
Rotatores 368 Simple acinar or alveolar glands 22, 500
S
Simple coiled tubular glands 22
S phase 617
 Index 751

Simple columnar epithelium 492 Sternohyoid muscle 348 Superior orbital fissure 226, 277
Simple cuboidal epithelium 19, 491 Sternothyroid muscle 349 Superior parathyroids 438
Simple epithelium 19 Sternum 30 Superior petrosal sinus 305
Simple glands 21 Stomach 168 Superior rectus muscle 278
Simple radiography 722 Straight sinus 305 Superior sagittal sinus 304
Simple squamous epithelium 19, 490 Strap muscles 81 Superior salivatory nucleus 266
Simple tubular glands 22 Stratified columnar epithelium 20, 497 Superior tarsal muscle 281
Sino-atrial node (SA-node) 121 Stratified cuboidal epithelium 20, 497 Superior thyroid artery 351, 437
Sinus venosus 116 Stratified epithelium 20 Superior vena cava 129
Sinusoids 123, 569 Stratified squamous keratinized Supination 11
Site of intravenous injection 742 epithelium 20, 496 Supinator muscle 51
Sites of auscultation of heart sounds 734 Stratified squamous non-keratinized Supine position 6
Sites of intramuscular injection 741 epithelium 20, 495 Supraciliary arches 449
Skeletal or striated muscle 81, 515 Stretch reflex 93 Supraclavicular nerve 361
Skeletal system 67 Striated muscle 515 Supraclavicular triangle 358
Skeleton 67 Structure of cell 13 Supraglottic compartment 415
Skin 195 Styloglossus muscle 379 Suprameatal triangle 217
Skull 67, 211 Stylohyoid muscle 348 Supra-orbital foramen 228
Small intestine 169 Styloid process 239 Supraorbital nerve 317
Smooth or non-striated muscle 82, 515 Stylomandibular ligament 326 Supra-orbital notch 452
Soft palate 384 Stylomastoid foramen 228 Suprarenal glands 184
Sole 64 Stylopharyngeus muscle 406 Suprascapular artery 363
Solenoid 626 Subarachnoid space 301 Supraspinatus muscle 47
Soleus muscle 63 Subcapsular sinus 540 Suprasternal notch 452, 735
Somatic nervous system 84 Subclavian artery 361 Supratrochlear nerve 317
Somatotropes 310 Subclavian steal syndrome 363 Surface anatomy 5
Somites 681 Subclavian vein 131 Surface anatomy of heart 734
Somitomeres 681 Subclavian vein 364 Suspensory ligament of Lockwood 289
Southern blot technique 636 Subclavius muscle 47 Sutures 77

INDEX
Space of Burns 342 Subcostal plane 736 Sweat glands 197
Specialised mucosa 373 Subdivisions of anatomy 3 Sympathetic ganglia 110
Sperm 643 Subdural space 301 Sympathetic nervous system 110
Spermatic cord 191 Sublingual fossa 231 Synapses 88
Spermatocytosis 644 Sublingual papilla 377 Synaptic cleft 88
Spermatogenesis 644 Sublingual salivary gland 337 Synarthroses 76
Spermatogonia 644 Submandibular ganglion 337 Syndesmosis 77
Spermatozoon 643 Submandibular nodes 444 Synovial fluid 79
Spermiogenesis 645 Submandibular salivary gland 333 Synovial joint 78
Spheno-ethmoidal recess 393 Submental nodes 444 Synovial membrane 79
Sphenoid bone 245 Submental triangle 344 Systemic anatomy 3
Sphenoidal sinuses 397 Suboccipital triangles 369
Sphenomandibular ligament 326 Subscapularis muscle 47
T
Spheno-palatine foramen 228 Subsidiary ganglia 110 Tachypnea 166
Spina bifida 708 Substantia nigra 102 Tarsal bones 60
Spinal cord 83, 105 Subthalamus 100 Taste buds 377, 554
Spinal ganglion 90 Sulcus chiasmaticus 224 Tear film 275
Spinal nerves 83, 90 Sulcus terminalis 116 Tectum 103
Spinal nucleus of trigeminal nerve 266, 315 Sulcus tubae 219 Teeth 373
Spinalis capitis muscle 366 Superficial cervical artery 363 Tegmen tympani 224
Spinalis cervicis muscle 366 Superficial cervical lymph nodes 444 Tegmentum 102
Spinalis group of muscle 366 Superficial cervical nodes 445 Telomere 627
Spinalis thoracic muscle 366 Superficial fascia 26 Telophase 619
Spine of 7th cervical vertebra 452 Superficial inguinal lymph nodes 149 Telophase I 621
Spiral muscle 82 Superficial palmar arch 127 Temporal bones 237
Spiral organ of Corti 431 Superficial temporal artery 353 Temporal fossa 313
Spleen 146, 738 Superficial temporal artery 731 Temporalis muscle 323
Splenic vein 134 Superior concha 393 Temporomandibular joint 325
Splenius capitis muscle 366 Superior constrictor muscle 404 Tensor fascia lata 60
Splenius cervicis muscle 366 Superior gemellus 62 Tensor tympani muscle 429
Spurt muscles 82 Superior meatus 393 Tensor veli palatini muscle 385
Squamo-tympanic fissure 227 Superior mediastinum 34 Tentorium cerebelli 302
Stages of mitosis 618 Superior mesenteric artery 127 Teres major muscle 47
Stapedius muscle 429 Superior mesenteric vein 134 Teres minor muscle 47
Stapes 429 Superior nuchal lines 212 Terminal ganglia 110
Sternal angle 735 Superior oblique muscle 278 Terminal lymph ducts 144
Sternocleidomastoid muscle 347 Superior ophthalmic vein 289 Tertiary follicle 650
 752 Human Anatomy For Dental Students
Tertiary pulmonary bronchi 157
Tertiary villus 662
Testes 191
Tetraploidy 629
Thalamus 100
Thenar muscles 52
Thermoreceptors 93
Thigh 53
Thoracic cage 29, 67, 161
Thoracic cavity 34, 161
Thoracic duct 144
Thoracic vertebrae 33
Thoracolumbar fascia 365
Thorax 29
Thoroughfare channel 123
Thrombocytopenia 142
Thrombocytosis 142
Thrombopoiesis 139
Thrombosis 142
Thymus 147
Thyroarytenoid muscle 416
Thyrocervical trunk 362
Thyroepiglottic ligament 413
Thyroepiglotticus muscle 416
Thyroglossal duct 691
Thyrohyoid muscle 349
Thyrohyoid membrane 413
Thyroid cartilage 411, 452
Thyroid gland 184, 435
INDEX
Thyroidea ima artery 437
Thyropharyngeus muscle 404
Thyrotropes 310
Tibia 58
Tibialis anterior muscle 62
Tibialis posterior muscle 63
Tight junction 18
Tissues 19
T-lymphocytes 152
Toes 53
Toludine blue 485
Tongue 375
Tongue tie 381
Tonsillar fossa 401
Tonsillectomy 402
Tonsillitis 402
Trabeculae carnae 116
Trabecular bone 511
Trabecular bone 69, 73
Trachea 438
Tracheal rings 452
Tragus 424
Transforming growth factors 709
Transfusion reaction 137
Transitional epithelium 20, 497
Transpyloric plane 736
Transtubercular plane 736
Transverse arytenoid muscle 416
Transverse cervical nerve 361
Transverse colon 172
Transverse colon 738
Transverse planes 7
Transverse sinus 305 Vastus medialis muscle 60
Trapezius muscle 48, 366 Vault of skull 221
Triceps brachii 49 Veins 124, 537
Tricuspid valve sound 121 Ventricle proper 116
Trigeminal ganglion 315 Ventricular system 96
Trigeminal nerve 265, 315 Ventrolateral edge (lip) 681
Trigone 179 Venules 123, 537
Trilaminar disc 666 Vertebral artery 362
Triploidy 629 Vertebral column 64, 67
Trisomy 628 Vertebrochondral ribs 31
Trisomy 13 628 Vertex 212
Trisomy 18 628 Vertigo 433
Trochlear nerve 284 Vestibular folds 415
True or lesser pelvis 37 Vestibule 187, 371
True ribs 30 Vestibulocochlear nerve 432
Tubal tonsils 402 Vibrissae 393
Tubercle of Zinn 278 Villi 661
Tuberculum impar 690 Visceral or autonomic nervous system 85
Tunica adventitia 122 Visceral pleura 160
Tunica intima 122 Viscerocranium 679
Tunica media 122 Visual fields 299
Turners syndrome 628 Visual pathway 296
Tympanic canaliculus 228 Vocal folds 415
Tympanic membrane 426 Vocalis muscle 416
Typical cervical vertebrae 250 Vomerovaginal canal 228
Typical ribs 31 Vomiting 176
Typical spinal nerve 90
W
U Waldeyers lymphatic ring 402
Ulna 45 Wallerian degeneration 89
Ulnar artery 127 Western blot technique 636
Ultimobranchial body 691 Whartons duct 335
Ultrasound 723 White blood cells 137
Umbilicus 735 White fibrocartilage 76, 508
Unicellular glands 21 White matter 89
Unicellular glands 499 Withdrawal reflex 94
Unipennate muscle 81 WNT proteins 709
Upper limb 41 Wolfs law 80
Upper motor neuron 268 Wolf-Hirschhorn syndrome 630
Upper motor neuron facial palsy 268 Wound healing 198
Upper respiratory tract 155 Wrist 42
Ureters 178 Wry neck 360
Urethra 179
Urinary bladder 179, 741
X
Urinary system 3, 177, 573 Xiphisternum 735
Urinary tract infection 180 X-ray techniques 721
Urogenital diaphragm 40 Y
Uterus 189, 741
Uvea 291 Yolk sac 659
V Z
Zona pellucida 597
Vagina 189
Zonula adherens 18
Vaginal orifice 187
Zonula occludens 18
Vagus nerve 419
Zygomatic bones 240
Varicocele 194
Varicose veins 134 Zygomatic nerve 287
Zygomatico-temporal foramen 228
Vas deferens 192
Zygomaticus major muscle 261
Vascular shunts 123
Zygomaticus minor muscle 261
Vasculogenesis 670
Zygotene 619
Vastus intermedius muscle 60
Zymogen granules 571
Vastus lateralis muscle 60