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Deputy Director, University of Texas Rio Grande Valley School of Medicine
The upper eyelid is larger than the lower due to the presence of the levator palpebrae superioris muscle muscle relaxant drugs medication order voveran sr 100 mg free shipping. Tarsal glands deep to the conjunctiva secrete an oily substance to help seal the eyelids and prevent the overflow of tears muscle relaxant gel india voveran sr 100 mg with mastercard. The eyeball is covered anteriorly by the eyelids spasms due to redundant colon 100 mg voveran sr with visa, which protect it from injury muscle relaxant half life cheap voveran sr online visa. The skin of the eyelids covers the circularly oriented orbicularis oculi muscle, whereas internally the eyelids are lined by Table 10-1 Bones of the Orbit Bones Region Apex Maxilla Frontal Ethmoid Lacrimal Zygoma Sphenoid Lesser wing, body Palatine Floor Orbital plate Orbital process Orbital plate Lesser wing Orbital process Roof Medial wall Frontal process Orbital lamina Orbital surface Orbital process Body Lateral wall Greater wing (orbital surface) Base Orbital rim Orbital rim Orbital rim Table 10-2 Communications of the Orbit Openings Communicating With the Orbit* Optic foramen Superior orbital fissure Inferior orbital fissure Infraorbital canal Anterior ethmoidal foramen Nasolacrimal sulcus Posterior ethmoidal foramen Supraorbital foramen Zygomatico-orbital foramen x x x Bones of the Orbit Maxilla Frontal Ethmoid Lacrimal Zygoma Sphenoid x x Palatine x x x x x x x x x x x *When more than one bone is indicated, the opening is at the junction of two or more bones, or in the case of foramina, at a suture. Lacrimal gland Excretory ducts Upper eyelid Caruncula lacrimalis Lacrimal duct Lacrimal sac Lateral palpebral commissure Lower eyelid Pupil Iris Conjunctiva Puncta lacrimalia Nasolacrimal duct Figure 10-2. Chapter 10 Eye and Ear 165 conjunctiva, a mucous membrane that reflects onto the anterior portion of the sclera. In addition, the upper eyelid possesses the levator palpebrae superioris muscle, which makes it larger than the lower eyelid. Everting the eyelid permits observation of the tarsal glands deep to the conjunctiva. These glands secrete an oily substance that assists in sealing the margins of the eyelids when they are closed, and this oily substance prevents overflow of tears when the eyelids are open. These glands, along with the ciliary glands (modified sudoriferous glands located in the margin), open via small pores onto the margin adjacent to the eyelashes. The eyelashes, arranged in rows of two or three, curve upward and downward on the upper and lower eyelids, respectively. The opened margins form an elliptical palpebral fissure narrowing laterally into an acute lateral palpebral commissure (lateral canthus) and medially into a larger medial palpebral commissure (medial canthus) possessing an enlarged triangular lacus lacrimalis with its caruncula. The lacrimal gland is located outside the orb proper, housed in a fossa in the anterosuperolateral aspect of the orbit. It secretes lacrimal fluid (tears) that keeps the cornea moistened as the eyelid moves the fluid to the medial corner of the eye where the fluid is drained by the lacrimal ducts into the lacrimal sac. The sac represents the upper dilated portion of the nasolacrimal duct, which opens into the nasal cavity at the inferior nasal meatus. The orb is spherical structure with a bulge on its anterior surface represented by the transparent cornea. Because of the lateral divergence of the orb in the orbit, the optical axis and the orbital axis do not coincide. The lacrimal (tear) gland is located in the lacrimal fossa at the anterosuperolateral aspect of the orbit. The gland secretes fluid that is emptied into the conjunctival sac of the bulb of the eye. Each time the cornea dries, the eyelids, acting as windshield wipers, move the fluid over the sclera and cornea. The fluid moves medially to the lacrimal ducts, which begin as puncta (tiny orifices) at the lateral aspects of the lacus lacrimalis on the medial margins of the eyelids. The fluid passes via these the bulb of the eye is almost spherical, except for its anterior portion, which bulges away from the surface in the region of the eyelids. The transparent cornea represents a segment of a sphere occupying the anterior one sixth of the bulb, and the remaining opaque bulb represents a more complete segment of a different-sized sphere. The anterior pole of the curvature of the cornea is nearly parallel with the posterior pole of the curvature of the remaining bulb, forming the optical axis. Because of the lateral divergence of the orbit cone, the optical axis and the orbital axis do not coincide. The wall of the orb consists of three separate tunics: the fibrous tunic includes the sclera and cornea; the vascular tunic includes the choroid, ciliary body, and iris; and the retinal tunic, the 10-layered retina. Clinical Considerations Conjunctivitis Conjunctivitis is a mild inflammation of the conjunctiva, which can be either bacterial or an allergic reaction. Thus, newborns are immediately given prophylactic antibiotic eye drops to prevent neonatal conjunctivitis. The bulb of the eye is composed of three separate layers fabricated into one wall. The outer covering is the sclera, which is modified anteriorly as the cornea. The middle or intermediate tunic is the pigmented, vascular coat composed of the choroid, ciliary body, and iris. Its posterior portion is pierced by the optic nerve, and anteriorly it is covered by the conjunctiva.
Diseases
The pharynx and the skin wounds are closed in the usual way after inserting a nasogastric feeding tube and Redevac drainage spasms right upper abdomen buy voveran sr now. A fenestrated plastic or metal tracheostomy tube muscle spasms yahoo answers cheap voveran sr 100mg free shipping, preferably with a speaking valve muscle relaxant and pain reliever generic 100 mg voveran sr, is inserted and the patient is asked to phonate closing the tracheostomy tube with his finger (if it is an ordinary tube) and he does it immediately spasms meaning in hindi order voveran sr 100mg line. The phonetic steam, being obstructed by the upper end of the cul-de-sac, passes through the neoglottis into the oesophagus and upwards through the pharynx and the oral cavity for articulation. The standard operation for dealing with metastatic glands in the neck is that of radical neck dissection described by Crile in 1906. In this operation the different groups of deep cervical lymph nodes, internal jugular vein, sternocleidomastoid muscle, submandibular gland, tail of the parotid and the accessory nerve are removed en bloc with the primary tumour, if possible. The block neck dissection is elective when no palpably enlarged lymph nodes are present, definitive or therapeutic when enlarged lymph nodes are present, and functional when the sternocleidomastoid muscle and internal jugular vein are preserved. American Academic Committee for head and neck surgery and oncology has adopted the following classification for various neck dissections. Radical Neck Dissection It consists of removal of all lymph node groups (level I-V) and all three nonlymphatic structures (spinal accessory nerve, sternocleidomastoid muscle and internal jugular vein). Modified Radical Dissection It consists of removal of all lymph node groups with preservation of one or more nonlymphatic structures. Selective Neck Dissection It consists of preservation of one or more lymph node groups and all three nonlymphatic structures. Neck Block Dissection of the Neck dissection may be extended to remove paratracheal, pre-tracheal and retropharyngeal nodes and other nonlymphatic structures like hypoglossal nerve, levator scapulae muscles or carotid artery. In a patient of head and neck cancer with no apparent involvement of the neck nodes but who is unlikely to return for followup and has a tumour with a known high incidence of neck node metastasis. Incision Various incisions used for block dissection of the neck are shown in Figure 67. The structures that are preserved after a radical neck dissection are shown in Figure 67. Haemorrhage from the upper or lower end of the internal jugular vein, subclavian vein or carotid artery can be a serious problem during the operation, while subcutaneous haematomas may form in the postoperative period. Airway problems: Kinking of the endotracheal tube, pneumothorax or postoperative laryngeal oedema in cases of bilateral neck dissection may be the cause of respiratory embarrassment. Nerve damage: the spinal accessory nerve is routinely sacrificed in radical neck dissection. The nerves which may be damaged during dissection are the superior laryngeal nerve, vagus, facial, lingual, hypoglossal and phrenic nerves, brachial plexus and cervical sympathetics. Wound infection and gangrene of the skin flap are the other complications that can occur. A lateral bud from the fourth pharyngeal pouch of each side amalgamates with it and completes the corresponding lateral lobe. Goitrogens: If the iodine intake level falls to a critical level, the addition of one of the goitrogens can cause thyroid enlargement. Pathology Endemic goitre passes through a stage of diffuse epithelial hyperplasia followed by involution and the formation of a colloid goitre. Recurring cycles of hyperplasia and involution continue and unequal responses by different portions of the gland result in gross nodularity. The nodules though circumscribed 376 Textbook of Ear, Nose and Throat Diseases Treatment Partial thyroidectomy is the treatment of choice. Retrosternal Goitre this is mostly acquired though a few cases are congenital in origin. Substernal: There is a prolongation of a cervical goitre downwards behind the sternum. Intrathoracic: the whole thyroid is situated within the thorax between the great veins and resting upon the aorta. Plunging goitre: the thyroid is wholly intrathoracic but from time to time it is forced into the neck by raised intrathoracic pressure due to coughing. Later most of the nodules form cysts filled with brown, green or black watery fluid or jelly-like material. Cholesterol crystals are present and in some cases fibrous tissue overgrows and later on calcification occurs. Clinical Features In severe endemic areas, by the age of 6 years, about 20 per cent boys and 30 per cent girls present a visible and palpable smooth, soft enlargement of the thyroid gland.
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Other regions of the body spasms constipation discount voveran sr 100mg online, where interrelationships are less complex muscle relaxant over the counter order voveran sr 100mg mastercard, lend themselves to a systemic approach muscle relaxant for stiff neck generic 100 mg voveran sr with visa. Consequently spasms icd 9 code buy generic voveran sr on-line, the present textbook is written from a regional point of view because the authors continue to believe this approach is more likely to promote better student understanding. The regional method synthesizes morphologic features for the reader by correlating relationships as the reader progresses through the various anatomic divisions of the head and neck. Furthermore, this approach aids not only those who have constant access to a laboratory situation but also those who do not. And, finally, this approach eliminates the need to synthesize the final product from its component parts, thus assisting the student in mastering the intricacies of this fascinating region of the body. Anatomic Deep Face Concepts <ct> <cn> Anatomic Concepts Chapter Outline <coc1 > Divisions and Boundaries Anatomy of Anatomy of the Deep Face Gross Anatomy Temporal Fossa <coc> Infratemporal Fossa Contents Communications Muscles and Fascia Anterior Posterior are the anatoMuscles of Mastication "back. Deep Face that portion of the side of the Anatomic Position is that position of head deep to the mandible and zygothe body (facing forward with palms matic arch containing the origins and inforward) from which the position of all < k t u l sertions of three of the four muscles of structures are described. Cranial or Superior and Caudal or Temporal fossa is that portion of the Inferior are terms applied to "headward" side of the head above the ear and zygoand "tailward. Infratemporal fossa is the region inferior and deep to the zygomatic arch and the mandible. Descriptive Anatomic Terms Clinical Considerations Temporalis Masseter Medial Pterygoid Muscle Lateral Pterygoid Muscle Clinical Considerations Vascular Supply Horizontal or Transverse Plane is a Maxillary angles to Branches plane at rightArtery and the sagittal plane. Medial and Lateral are terms used to describe positions relative to the midline of the body. For example, a structure located closer to the midline than another Muscles of mastication a set of four bistructure is described as being medial to lateral muscles whose function is to it or, if farther away, lateral to it. All plane through the midline of the body originate in either the temporal plane that from anterior to posterior. Any or infratemporal fossae except the called a passes parallel to this plane is masseter muscle plane. Elevators of the jaw are the muscles of mastication, including the masseter, temporalis, and medial pterygoid muscles that function primarily in closing the jaw. Thus, canine teeth are mesial to premolar teeth, whereas molar teeth are distal to premolar teeth. Key Terms Key Terms > Proximal and Distal are positions Depressor of the jaw is the lateral relative to the body. For example, the pterygoid muscle, a muscle of masticaelbow is proximal to the wrist, whereas tion that functions in initiating opening of the fingers are distal to the wrist. Superficial and Deep are selfMandibular division of the trigeminal explanatory. Alternate terms for superficial to the muscles of mastication and senand deep are external and internal. Additional branches of the mandibular division that arise in the infratemporal fossa are bound for other regions. Chapter 12 3 4 Chapter 2 Anatomic Concepts he word anatomy, which has been derived from the Greek words ana and tome, literally Ї means to "cut up" or dissect. The human body, therefore, is described in an anatomy text as if it were dissected layer by layer. Because the study of anatomy is a descriptive science and the descriptions are related spatially, a student of anatomy must become familiar with the language an anatomist uses in describing these spatial relationships. Without understanding the basic vocabulary, the student would be unable to learn the subject effectively and to communicate with peer professionals. T Regional anatomy details a region of the body, such as the head and neck, studying all systems in that area as a complete, integrated unit. The regional approach used in this text provides the student with a more comprehensive presentation of an anatomic region, thus enhancing an understanding of interrelationships between the various systems of the body. Four major categories of anatomy study include: developmental anatomy, neuroanatomy, microscopic anatomy, and macroscopic anatomy.
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