0:22 yes [Music] good evening everyone thank you for joining with us today in this wonderful session once again from Dr Raj program uh assistant professor from Department of anatomy in madurai Medical College she is a well-known anatomist and a well-known teacher a guide and uh one class for the students and taking such a wonderful classes before exams for the benefit of students today it's our pleasure to welcome Yunnan thank you so much for once again joining with us today we are going to have a wonderful session from this date we are going to have a wonderful session every month the continuation of the grace on our conversation which we had earlier last year this year this is a place Anatomy
1:07 2.2 and wonderfully once again taken back today we are starting with most difficult topic we all think in anatomy so I think today none will make it easier for you all and you can excel in whatever exam it is maybe Refugee or an extra exam or your lease so thank you so much for joining with us today and let's get into the session quickly over to you man so very good evening to one and all thanks thanks medicine team for giving me this opportunity yes I'm Dr kohila uh welcome all to this session rapid revision of head and neck right so yes guys I don't want to waste your time of anatomy of different topics in
1:52 anatomy headache Anatomy is extremely very interesting and very important because every part of it every topic that you come across in head and neck Anatomy will be linked to some clinical Anatomy right presented ENT of tile surgery every part of heronic Anatomy is very very very important okay and uh it is very vast right hidden it's going to be covered in your like nearly like two to three months during your first time maybe you should have been covered okay yeah so now uh when I say rapid revision we are not going into the depth of each topic yes so close towards your exams I just want to concentrate on the high
2:39 yield topics right we are going to concentrate on the high yield topics and under these high yield topic I'm just going to give you the extra the key points alone right the key points alone yeah for each topic for example even today morning I was telling in my dejection table Yeah for example I'm just giving you one thing Palatine tonsil isn't it yeah so during your first mbbs you would have learned as an essay question and then in ENT or surgery right so what are the key points you would like to take home for this topic yes so the structures which are present in the lateral wall of the tonsil that forms the tonsilla bed yes you should know what are the muscles there what vessel what nerve is related and then
3:26 coming to the blood supply of tonsil what is the vessel responsible for reactionary Hemorrhage yes you know the answer uh sorry the Tara tonsillar vein right para tonsilla wing what is a cheap artery which is going to supply the Palatine tonsil right the branch from the facial artery and whenever you get a tonsilite is an infection of the tonsil there's a referred pain to the ear right so what is a nerve responsible carrying pain Sensation from the tonsil and why does referred pain in the ear because it's going to be innervated by the glossopharyngeal nerve coming to the lymphatic drainage the chief group of
4:11 lymph nodes that drain your tonsil is the gigolo digastric and development of tonsil is from the second pharyngeal pouch right so if you ask me the key points for Polytech dorsal I would list only these things yes so whatever be the power exam that you're going to face whether it's your University exam or whether it is your need PG inict or next whatever be the pattern of exam question right the topic of importance the topic of interest is going to be the same for which you should know the key points okay so another thing which students they keep asking how to remember things you know Anatomy is very very volatile I
4:58 understand right over a period of years we reinforce and we remember it right still it's very volatile so if you try to remember these key points right and image images the image based questions that appear yeah anything if a visual memory right uh retain it in your visual memory and then there are a lot of mnemonics even in today's session I'll be covering a lot of mnemonics okay which I myself have tried to frame it so remembering the mnemonics and the fourth point I would suggest is a table so comparing the four parasympathetic ganglia if you make a table that will save a lot of time before your exams you can make a quick revision of that so try
5:45 to make a comparative table and every Point try to correlate with clinical Anatomy understand the concept okay so whatever as I told you for Palatine tonsils these are the six important points which you should definitely know so whether it's a direct McQ whether it is a clinical scenario whether it's an image based person or whatever exam it is these are the key points on which the question is going to be framed got it okay so this is what we're going to do in the next one to one and a half hours the important topics in hedonic and the key points okay yes are you with me can you try to answer this question can I have the answers in the chat box
6:33 yeah you can see the question right so which of the following is not a feature of the policy shown in the image what I answered guys am I audible am I visible yes can I have the answers in the chat box so what is the image showing it's big palsy or the lower motor neuron type of facial pulse presented
7:18 guys am I audible yeah you can enter in the chat box your answers right so the picture the image is showing you Bell's Palsy all over motor neuron type of facial pelvis so what is the side that is injured this is the right half this is the left half octave phase so which side facial nerve is injured it's the left facial nerve palsy right so what are the features that you see here yeah so given uh from the options does laws of transverse wrinkles on the forehead so what is the muscle paralyzed let's say frontal belly of occipital frontalis obliteration this is your nasolabial
8:05 fold yes you can see it on the left side of literation of the nasolabial fold right why so because of the paralysis of muscles of upper lip inability to Open the Eyes is that a feature of Bell's Palsy no right so what is the muscle which opens your eyelid levator palpable superiors that's going to be supplied by the ocular motor nerve okay so what will happen in facial palsy the patient will have a inability to close the eyes inability to close the eyes because of paralysis of which muscle
8:51 orbicularis alkaline so option C is wrong food accumulates in the vestibule what is the facial muscle that's paralyzed it's due to paralysis of vaccinator okay so what is the reason for Bell's Palsy we can see the facial now coming out of this Quran and right what foramen is a Stylo mastoid foramen so injury to the facial nerve yes after it exits from the Stylo mastoid foreign that is going to be called as the Bells Palsy or lower motor neuron type of facial palsy right soon after it exits the stylus where does it enter it enters the
9:37 parotid gland but even before it enters the parotid gland you can see a branch coming out of the face what is it called the posterior auricular Branch what muscle is going is it going to supply the occipital Valley or occipital frontalis what is the second branch that you see here the temporal branch of the facial nerve what are the muscles innervated by the temporal Branch prontal belly and upper part of orbicularis alkaline this one running along the zygoma the third branch that is the zygomatic Branch IT Supplies the lower part of Broadway class alkaline you can see the
10:25 parotid duct here just above and below the parotid duct those are the upper and lower buccal nerves upper buccal nerve supplies the muscles off upper lip yes that's an important question right the lower Buckle nerve it goes on to supply what muscle yes you can enter in the chat box inator right vaccinator very good and this one lower down running along the lower Board of the mandible which is surgically important what nerve is that marginal mandibular nerve why am I telling it is surgically important
11:11 whenever you're going to make any incision over the submandibular region okay it should be two to four centimeter below the lower border of the mandible so that you don't damage this nerve okay so the relation of marginal mandible learner to submand a blood gland is very important lastly coming to this nerve going towards the neck what is that call it's the cervical branch that supplies the platysma this nerve also should be taken care of while you're making an incision over the submandibular gland okay these two nerves right now this pattern of branching of facial nerve within the parotid gland is called as
11:59 answering us why does Bill's palsy occur idiopathic and then any trauma to the facial nerve at its exit from Stylo mascular foramen or even exposure to cold can trigger facial nerve palsy right a few words about this muscle what is this muscle pointed out here it's the buccinator right a few important points later to vaccinator so this vaccinator the upper fibers come from maxilla lower fibers come from mandible opposite the molar tooth now can you see a y structure here what is it called yes that is the terigo mandibular rapid
12:49 so a vaccinator middle fibers originates from the anterior aspect of therigo mandibular Raphael now who's going to tell me these fibers which originate from the posterior aspect of Telecom what is that muscle yes that is the Superior constrictor muscle or pharynx now what is the spatia which is going to cover the superior constrictor and then extend to cover the vaccinator normally the muscles of the face they don't have a facial covering right but this vaccinate is going to be covered by aphasia pharyngeal fascia just because it's
13:34 originating from the Telugu mandibular artery which also gives origin to Superior constrictor okay this is very very special now you see something piercing the vaccinator can you tell me what is it the parotid duct do you know any other structure piercing the vaccinator yes any other structure that pairs is the vaccinator come on yes buckle branch of mandibular nerve this buccal branch of mandible learner appears at the vaccinator from inner aspect to supply the overlying skin it is a
14:19 sensory nerve what is the action of this vaccinator it is located over the cheek right so it compresses the rescue but it is also called the yes the trumpeters or the whistling muscle right so what will happen in this paralysis of vaccinator yeah the food accumulates the vaccinator cannot compress the vestibule the food accumulates in the vestibule of the mouth so facial nerve belt palsy you can write six feature right so what is the first one laws of transverse wrinkles on the forehead done second one inability two close the islands
15:05 sir laws of nasolabial pole the food accumulates in the vestibule due to paralysis of vaccinator and the fifth one that you see here what is about the angle of the mouth drooping of the angle of mouth right on the side of the paralysis and orbit class auris will be paralyzed so the patient will not be able to close his mouth so there'll be yes sixth Point drooling of saliva so these are the six features that you have to remember for patients
15:50 now coming to the last point about patient or policy yeah so this is the upper motor neuron lower motor neuron facial pulses what do you mean by upper motor neuron the neurons which are situated in the cerebral cortex you have the right and left cerebral hemispheres right lower motor neurons are the one which are situated in the brain stem and the spinal cord so you normally know the right cerebral cortex has control over the left side of the body and the left cortex Contours over the right side so it's the contralateral side whereas the lower motor neurons once it exits out of the brain stem or the
16:36 spinal cord it's going to control over the Ipsy lateral side so this is your yeah right half left half so what is the nerve injured whether it's the right facial nerve or the left facial nerve it is the left facial nerve right okay so upper motor neuron as you see in the image left side palsy has affected the right and lower motor neuron left side palsy left half of the face but what you appreciate in the upper motor neuron type of palsy the upper face is bad what is the reason because the upper phase right it is under the control of both
17:23 the cortex it is controlled by both the cortex by cortical representation so even if the neurons coming from one cortex is going to be affected the other cortex is going to control both the sides of the face okay so remember upper motor neuron upper phase is that because it has bicotical representation done so that's all about the facial nerve policy Bell's Palsy any doubt in this now we'll move on to the a little lighter side of head and neck okay yes who's going to tell me when ra proposed Sita responded by moving a atlanto occipital joint so what is the answer
18:10 yes what do you mean by that what was the answer given by Sita joint of s or joint of no which one do you want to choose from yes so this is your first cervical vertebra is also called The Atlas isn't it and this is your second cervical vertebra axis yeah so the joint between the atlas and axis yeah it's called the atlanto
18:57 axial joint so it has two components one in the midline what is this process of the axis called dense isn't it so between the dense and the atlas we have the median Atlanta axial joint and here between the phases on the atlas and acids that's the lateral Atlanta axial joint so this median Atlanta axial joint yes it is an example of favorite type of synovial joint lateral is plane so what is the function of pivot type of synovial joint it permits rotation isn't it where else in the body do you get is
19:42 the pivot type of synovial joint anyone who can tell me yeah pivot synovial joint is found in the yes between the Superior and inferior radio ulna joint which permits supination pronation of your forearm has entered okay so the median Atlanta axial joint which permits rotation movement of the your neck it's called as the joints or no right and this joint between the yes what bone is here this is your occiput
20:30 this is your Atlas right so this is the atlanto occipital joint which is an example for anyone who can tell me what is its example of what type of cyano will joint it is ellipsoidal right it is an ellipsoidal type of synovial joint which permits what type of movement flexion and extension are the synovial joint which mean it can just bend and straighten your neck so these are called as joints of yes okay so what could be sita's response to Ram yes Atlanta occipital joint yeah
21:18 so what's the answer come on yes Atlanta occipital joint joins of yes Atlanta axial joint joins of no another important thing related to this cranial vertebral joint is that yeah you see the dense fixed to the atlas there's a ligament bridging gear yes holding the dense in position it's called the transverse ligament or the Ayla ligament of dense okay so what happens in suicidal hanging how does Death occur yeah so either rupture of this transverse ligament of dance or the Ayla ligament of dense or fracture of the
22:04 dense itself can you appreciate it here yeah what will happen so the dense is kept in position by this ligament the ligament is going to rupture the dense is going to move out of its position and what is that even the vertebral Canal the spinal cord right so compression of the dense over the spinal cord or the lower part of the medulla which has the vital centers right that leads to death yes now moving on to the next topic okay yeah what is a what is B who's going to tell me yes Capital hematoma capital yeah we'll see few points about that so you know the five layers of scalp presented skin connective tissue upper
22:50 Neurosis loose areola tissue pericranium which is called the dangerous layer of scalp the loose areola tissue now with the latest relation to Capital hematoma and capital they are concerned about pericranium so you can see the pericranium here right if there is going to be a collection beneath the pericranium what happens you can see the pericranium this is your suture for example remember this is your sagittal suture between the two parietal bones what happens to the pericranium here it's going to dip between the suture and continuous with the endosteum so any collection beneath the pericranium what is there yes you can tell me does it cross the suture no
23:39 no crossing of the suture and it will form a localized collection okay but any collection that's going to be above the pericranium okay what will happen yes it of course crosses the suture right and it will have a generalized swelling Okay so yeah so you can see a localized swelling here a generalized swelling and a better picture of this yeah so what is a what is b a is yeah to remember it easily remember C and yes
24:28 cap put it crosses the suture right and B and it produces a generalized swelling what about B yeah you can see swelling on either side of the switch it's not crossing the suture right so no Crossing suture and it's a localized collection this is going to be careful hematoma any hematoma is going to take few months to subside right okay it's due to rupture of some blood vessel cap is just a soft tissue swelling that's subside within a week right so we are done with the third topic okay now what is the vertebral level of the pointed structure
25:14 so the midline of the neck has so many important structures which we should know right so what is the vertebral level of that structure pointed yeah that is a cricoid cartilage right so what is its vertebral level yeah guys you can enter in the chat box am I able to see your answers keep entering the chat box okay so are you with me uh we'll start okay so let's start from here this is the symphysis men die so what is sympa is this meant I the mandible is actually formed by the union of two half and this two half will OS if
26:01 I write how will it OS if I are on what time will it Aussie file yeah around one to two years right the next important structure you see in the midline is the diaphragmar overus what is diaphroma oras what muscle contributes to the floor of the mouth Milo hyoid which is innervated by inferior alveolar nerve right coming from mandibular Division I am now coming to here what is that bone that you see here this is the high oil what is the vertebral level of hyoi C3 the hyoid developed from which
26:47 pharyngeal arches second and third can you tell me the artery which originates exactly are the tip of the great Econo of the hyoid bone a branch of external carotid okay its origin from the external carotid is opposite the tip of the greater one of the high oil the lingual artery okay and then this one below the hyoid connecting the hyoid and the thyroid that's the thyroid hyoid membrane now tell me the structure piercing it the internal laryngeal nerve and Superior thyroid artery
27:33 right what is the vertebral level of the thyroid cartilage yes it corresponds to C4 C5 isn't it and here we have the cry coil the vertebral level of the cricoidal C6 isn't it and then we have the infamous what is the estimates correspond to posterior relation of these thinners they keep asking it frequently right second third fourth tractial rings what is the upper border of the system is related to the upper border of the system as you can see sometimes an extension right what do you call it as yeah the
28:18 pyramidal law sometimes a fibromuscular structure the levator glandulate thyroid a what is special about the lower border of the estimates you can get to see a bunch of veins coming out of the lower border what are they the inferior thyroid veins another thing sometimes apart from the superior thyroid artery and inferior thyroid artery a branch coming from the Iota yes enters the thyroid at the lower border of the estimates can you tell its name yes that's the arteria thyroidism and just about this sternum what is the
29:06 space going to be called it is the supraternal space of burn what are the contents of the suprasternal space of burns Eternal header ternocleidomastoid a ligament connecting the clavicle of both the sides interclavicular ligament the jugular venous Arch the anterior jubular veins of both the sides connected by the jugular venous Arch and sometimes a lymph node okay so the midline structures of neck are clinically very very very very very important right now
29:51 who's going to answer which of the following doesn't contribute to the floor of the Carotid triangle yes yes can I have the option come on so that is the Carotid triangle in this picture yeah we'll do it so this is the posterior belly of digastric right this is the superior value of omohyoi this is kernocleidomastoid so this area you see here is the Carotid triangle there are four muscles that contribute to the floor of the Carotid triangle what are
30:38 they hyoid from the hyoid going up will be the Hyo glasses from the thyroid going down backwards will be the inferior constrictor plus one more muscle middle constrictor the Sterno thyroid will be a part of the muscular triangle right is that okay any doubt so remember the thyroid hyoi from the hyoid higher glosses and middle constrictor from the thyroid the thyro pharynges part of inferior constrictor these four muscles lie in the floor of the Carotid triangle what are the contents of carotid triangle quickly we will store the content
31:43 branches so what are the five branches of external carotid given up in carotid triangle yes Superior thyroid artery lingual artery yes facial artery yeah then two more ascending pharyngeal artery and the occipital artery yes five branches of external carotid and then we have the vagus within the Carotid sheet again five branches from Vegas what are they pharyngeal branch yes and then we have the superior laryngeal nerve Branch to corroded body
32:29 carotid sinus the cardiac branches cervical cardiac branches and the fifth one important who's going to tell me the right recurrent laryngeal nerve why not the left recurrent laryngeal nerve thorax and not in the neck okay and what lies in the anterior wall of the Carotid sheath we get to see the answer cervicalus in the posterior wall of the karotechi cervical part of the sympathetic trunk what are the other cranial nerves related to carotid triangle can you tell me two important cranial nerves related to the Carotid triangle of course the
33:16 hypoglossal nerve and the spinal part of the abscessary nerve also you get to see the the lower part of the parotid and then in relation to the ijv jugular digastric and jugular homo hyoid nodes right so all these things in relation to carotid triangle Now quickly about external carotid artery so what is the extent of external carotid artery right from the upper border of the thyroid cartilage which corresponds to C3 to C4 what level does it terminate Mandeville of course you know the mnemonic right to
34:02 remember the branches of the external carotid artery the superior thyroid artery is the first branch of external carotid artery can you tell me the name of the muscle yes guys please answer in the chat box okay what is the muscle which divides the lingual artery into three parts Hyo glasses okay and then the ascending pharyngeal artery is the only medial branch coming from the external carotid artery the muscle dividing the massillary artery into three parts is okay yeah
34:48 as I told you this is the greater corner of the hyoid right the artery which arises opposite to it that's the lingual artery below a superior thyroid artery facial artery okay so now uh the facial artery if you see what are the landmarks related to facial artists are quite important so we saw it arises opposite the superior corner of hyoid Rhine and which triangle is a given off in the Carotid triangle after that it enters the digastric triangle and what is the gland located there in the digestive triangle you can see the submandibular
35:33 salivary gland it grows the posterior aspect of the submandibular salivary gland right and then what does it do you can see the mandible here the lower border of the mandible you can see ascending over the lower border of the mandible and the pulsation of the facial artery over the face where is it felt what is the muscle that becomes are like strong when you clench your teeth around the anthro inferior angle of Mercy term right so these are the important landmarks for facial artery what are the branches of facial artery you see over the face yeah you know this is the inferior labial relation to lower lip
36:21 superior labial upper lip lateral nasal and this one is important the termination of the facial artery which is called the angular artery why is it important this angular artery is going to harness the most well a branch from the ophthalmic artery called the dorsal nasal Branch so what this ophthalmic artery is a branch of internal carotid artery so the medial angle of the eye whereas anastomosis between the facial artery and a branch from the ophthalmic arteries and anastomotic side called ECA and ICA external carotid artery and internal
37:07 carbon artery okay now what they ask is that yeah what are the branches of facial artery in the neck can you tell me yes so the branches over the face is easy to remember right yeah there are four branches given open the neck in the digestive triangle so what are they yeah they keep forgetting it so I tried an mnemonic for it okay so branches to supply the submandibular gland Branch to supply the Palatine tonsil the inferior tonsillar branch which is cheap source of blood supply to the Palatine tonsil and then we have the ascending Palatine artery and subnetal Branch okay so you
37:52 can try to remember the branches of facial artery using this mnemonic is that okay yeah coming to the nest next question can you try answering it yes injury to the pointed structure will result in paralysis of which muscle come on waiting for your answer in the chat box you can text in the chat box the answer what is the pointed structure so that is the posterior triangle right the yellow arrows pointing towards the spinal accessory nerve what are the two
38:38 muscles innervated by the spinal axis Arena yes trapezius and sternocleidomastoid presented so few things about this journal Guido mastoid the high the key points related to sternocleidomastoid yeah you know that's a very important muscle in the neck right it's going to have two heads and there's one important triangle between these two heads yes anyone know its name the cellular triangle cellular triangle between the external head and the clavicle head why is it clinically important this is the area they chose to
39:26 yeah introduce into the internal jugular vein okay that triangle is an important Landmark to access the internal jubular vein okay yeah now this kernel keto mastoid muscle along with trapezius is going to be enclosed within the investing layer of deep cervical patient it's anterior borders related to the anterior triangle posterior border to the posterior triangle now this posterior border that is the nerve Point okay where the nerves emerge can you name them this one going up is the Lesser occipital nerve this one going horizontally will be the transverse
40:13 cervical cutaneous nerve and the one coming down there's one going towards the year yeah that will be the greater or equal now so that thinner point of this turn of leader mask time what is this condition called yeah yes doctor Aruna correct okay so what is the torti call is pass them off this turn or Play-Doh master now I want you to figure out or on the left so for this you should know the action right so if my right turn of Plato
40:59 mastoid is Contracting what will be the action of it yeah if someone is going to slap on my right cheek rattle my chin go chin will turn to the left and the head will be on the same side of the shoulder right the chin goes to the left and the head will be on the same side of the shoulder on the side of the contraction okay now can you tell me yes so 30 call is now in this case where is the chin turn chin is turned to the right isn't it so this is a case of pass them off let
41:45 turn out leader mastoid muscle do you agree with me have any doubt please enter in the chat box right okay so this person is in a contracted state what is this can you identify so this Turner keto mastoid inserts into the mastoid process behind the ear isn't it so in case of otitis media the pus can travel in different directions okay so if it's going to break out through the mascoid process into the uh Turner clear mastoid insertion what is this abscess called name of the ABS is
42:31 time yeah now what is this in relation to this oil bronchials bronchial fistula this is the anterior border Optics the cell is always at the upper end whereas the fistula is at the lower end what is the embryological reason for this you know the pharyngeal Arches are in the neck right okay that's the region of the pharyngeal Arches so the Arches what happens how do you get your smooth neck yes the second pharyngeal large the mesoderm of the second pharyngeal Arch is going to overgrow the cleft of the
43:16 other arches and fused with the lower most Arch so this Gap that is created here yes that is called as the cervical sinus the cervical sign is normally will oblitrate that's why you get a smooth neck sometimes the cervical sinus may pass this gas assist which is called as the bronchial cyst that's found at the upper part of the anterior border okay now if this second Arch fails to fuse with the last Ash here at the lower end what will happen does the communication of the cervical sinus outside right with the exterior that is called as the bronchial fistula so the fistula has found at the lower end
44:02 okay that's why it's found at the lower end of the anterior border of sternocleidomastoid right so we have seen so many things about this Kiana mascular Drive the clinical importance including the cellular triangle torticollis bezels absence bronchial cyst and fistula now we'll move on to the next topic we'll identify help me identify um yeah I'll put this as a b c and d can you enter in the chat box which of the following muscle is not innervated by hypoglossal nerve yeah come on waiting for your answer yes come on enter the answer
44:48 so this is an image showing you the muscles of the tongue grind so what is a a is coming from the palette palette above going towards the tongue that is these coming from the styloid process to the tongue right that will be thylo glosses and the third one seeds coming from the hyoid to the tongue that will be higher glosses and the fourth one Fanning out right from the tip to the base of the tongue that's going to be genioglossal very good Ashwin Aruna that's the Geniuses okay d yes so all the muscles of the tongue are
45:34 innovated by hypoglossal nerve it's a big palette of glasses now tell me what is the action of palletoglossus palatogloss as well it's going to pull the tongue up Elevate the tongue what is the action of Stylo glosses it's going to yes from the styloid process right it will retract pull the tongue backwards higher glosses and Genial glosses what will happen will pull the sides the sides of the tongue down yes and make the doorsm of the tongue convex an important action of the genio glasses right because it's going all the way from the tip to the base it will pull the tongue out the tip of the tongue out
46:20 protrude it will protrude Geno glosses is going to protrude okay this is your genio glasses Fanning out okay it's going to protrude your tongue out and that is clinically important so this is your right and left okay when my left Genial glosses is Contracting the tip is pushed to the right side and when my right Genial glosses is Contracting the tip is pushed to the left when both right and let genioglossus contract the tip is in the midline can you appreciate it okay now tell me now this is the concept you're going to apply this in a given image and give me
47:07 the answer okay so here this side is paralyzed yeah so the tip of the tongue is deviated to the right or left to the left isn't it so the muscle injured or the paralyzed is your left Genial glosses so in hypoglossal nerve injury the tip will deviate to the paralyzed side so everything about the tongue is very very very very important isn't it yeah so usually ours is a nerve supply of the tongue you can make out the sulcus terminal
47:55 in front of the foramen these are your circumvalid papilla isn't it what are these papillae that you see here it's the fungi in the anterior two third now what are these ones yeah these are the in the posterior one third those are the lingual tonsil this area here between the tongue and the epiglottis right this is your epiglottis between the gloss or epiglottic poles this is the valricular okay now coming to the nerve supply of the tongue we are dividing it into anterior two third this area
48:40 right posterior one third this one and yes posterior most which is the region of the valricular okay and two types of sensation what are they yes General sensation and taste sensation okay so anterior two thirds when I say General sensation it means the sensation of pain hot and cold you're able to feel right pain temperature touch all this from the anterior tutor is carried by the lingual nerve taste sensation is by the coda tempan a
49:25 branch of facial nerve okay posterior one third along with the circle Valley papilla right along with the circum Valley papilla yes both General and taste sensation is by the ninth nerve okay and the posterior most part the region of the valricular general and taste sensation is by the vagus nerve right so these are the things which have been frequently asked about tongue muscles nerve Supply and of course you read about the lymphatic drainage also the principal lymph nodes of the tongue are they jugular homo hyoid nodes right everything about the tongue is
50:11 very important moving on to the next one a lighter part which of the following is not a bad Dural venous sinus yes who can tell me which of the following is not a bad venous Diamond urine once again okay just five minutes ma'am will be joining you shortly
51:08 kindly hold on for five minutes ma'am will be joining shortly
52:42 guys am I Audible yeah we'll continue yeah so moving on to this which of the following is not bad during venous sinus okay yes so can you tell me what is the answer you can enter in the chat box a b c d okay so how many Dural venous liners are there anyone who can tell me how many Dural venous sinus are totally 15. you can also remember another thing branches of maxillary artery they also correspond to 15 okay but the easier to remember them using a mnemonic
53:30 right so you'll identify with me sinuses here this is the superior sagittal sinus this one imperial sagittal sinus the one lower here that's the occipital the smallest of all sinus right okay now you can see a vein joining the Imperial sagittal sinus any idea what is this the great cerebral vein of gallon this great cerebral vein of gallon it joins the Imperial surgical sinus to form the straight sinus okay
54:17 now in this picture you're going to tell me what is the transverse sinus it's going to continue with the sigmoid sign this is the Peter's part of the temporal bone along its Superior border Superior petrosal sign along its inferior border inferior petrosal sinus now this is the area where you see a sort of a plexus yeah where the pawns is going to spit the right over the Clive that's the best Venus
55:02 right now coming to the most important one on either side of the body of this penile cavernous minus over the yeah along the Lesser wingspanoid right this one is this Pinot parietal Pino parietal sinus connecting the cabinet sinus in the front and behind what are they anterior and posterior intercavernous sinus apart from this we have the middle meningeal vein or the sinus and an occasional Petro's
55:49 grammar science okay now how to remember all these 15 you can just try to memorize at least one okay yeah this is uh the unpaired Dural venous sinuses are seven in number so if you remember this yeah you can easily click off with the pad Dural Venus line is also yes that's the mnemonic you have to remember the superior sagittal sinus B is for basilar venous blood cells I Imperial surgical sinus yes s is again for straight sinus o is occipital sinus A and B what are they anterior and
56:37 posterior intercavernous sinus got it okay so this again frequently Asked in your need PG or insect yeah the name the pad and unpad Dural venous sinuses okay yeah again coming to the area of nasal cavity which of the following structure does not open into the probes Bay so I'll probe this space let's say right middle can you enter in the chat box okay which of the option doesn't open into the probes pay come on
57:23 yes waiting for your answers come on yeah so it will be the posterior model apart from that what are the key points that you should know in relation to your uh nasal cavity so this is the nasal septum this is the lateral wall of nose okay so what are the bones that you see here in the natal septum can you tell me what is this bone that's the perpendicular plate of ethylamine this one green color below yes that's the Omer okay so these are the two main bones that contribute to the nasal September in the lateral wall of nose what are the
58:10 bones we get to see Superior nasal conquer middle nasal contact inferior nasal contact why is the superior and middle conquer given a same color and imperialism given a different color the superior and middle nature part of ethmoid right the inferior nasal Concha is an independent bone it is the longest of all the three okay large and long next the other important topic about important point about the nasal septum is that yes it's going to be dividing into four quadrant right and true Superior and to inferior post Pro
58:56 Superior postpro inferior so in the nasal septum over its anthro inferior quadrant does the important area called the little area even a small scratch that a trauma that can cause severe bleeding why because there's a plexus of vessels situated there which is called as the T Cell bats plexus what are the arteries contributing to these fluxes here we have the anterior and posterior model artery which are again branches of the of thalmic artery ophthalmic again is a branch of internal carotid artery okay
59:42 and other branches are spino Palatine artery greater Palatine artery which are coming from the maxillary artery and in front we have the septal Branch coming from the facial artery and we know that Max 3 artery and facial artery are branches from the external carotid artery so this is again another McQ question octave branches which one is coming from internal or which one is coming from external okay can we put in either way so nasal septum Andro inferior portion Littles area right so this R3 okay which
1:00:28 causes epis or nasal bleed the artery of epistasis it's called okay no Palatine artery Branch from the third part of maxillary artery right now this is the picture again nasal septum lateral wall showing the nerves doubly so the roof is going to be from the all Factory nerve the anterior part of it anteriorate model nerve from ophthalmic division of trigeminal nerve okay no fine now you can see the terigo Palatine ganglion here that's the terrigopolitan ganglion
1:01:15 now what I want you to appreciate is can you tell me what is this area that's the incisive canal now there are two structures which are going to transmit it yes yeah what are they the one you can see here running along the groove of the Oma yeah what is it called the nasal Palatine or these Pino Palatine nerve and vessels remember from its name it has to supply the nasal cavity and the palate but it supplies the nasal cavity first right IT Supplies the nasal cavity and then
1:02:03 exits out of the nasal cavity through the incisive Canal so the structure which exits out of the incisive Canal nasos Palatine or spino Palatine nerve and vessels now coming from here below can you see here this one yeah from the terrigopolitan ganglion you see a nerve running along this lower border of the heart palate and then entering the nasal cavity what is it called yes come on tell me its name greater Palatine no greater palatinum enters the incisive Canal okay so you should know what is
1:02:49 this drug after supplying the palette it enters the nasal cavity to supply it so structure exiting the incisive Canal is your spanopolitan entering is the greater part of time yes now coming to the meatus okay coming to the Miatas that you see here uh inferior Miata middle which receives the opening of these phenoidal sinus fine now you know inferior meat is released opening of nasolacrimal duck what are the features you get to see in the middle meatus you see a bulbous projection here right that is called the Bulla
1:03:35 below the bulla you get to see a canal a gutter like thing right that is called the hiatal Penny lunaris this Hiatus semilonaris is going to continue upright as a blind pouch that will be called as the ethmoidal infundibulum ethmoidal infandibular okay now on the surface of the Pula can you see some pit like depression here yes what is it due to so the bulla itself is produced by the underlying middle okay so what receives on the bulla the middle at the model as cells and in the Hiatus you can
1:04:22 see your opening right that is the opening of the maxillary sinus to the infundibulum to the infantibulum on the wall of the infantibulum opens the anterior ectomoidal and to the stomach the top of the infant emblem receives the opening of frontal sinus so middle meatus is going to receive the opening of four important paranasal sinuses okay you can remember it by a mnemonic foreign anteriorate model middle ethmoidal prontel and maxillary okay but they can separately ask you what opens into the Bulla
1:05:08 what opens into the Hiatus what are the structures opening into epimoidal infandibular if they are separately also you should be able to answer it and this is the superior meat is posterior ethmoidal group of acids open in two right so you can identify the problem is here this is the frontal sinus between the orbit and the eyeball orbit and the nasal cavity this is the etymoidal can you make out the same here this is your right orbit this is your nasal cavity this is the ethmoidal group of cells at model anterior middle and posterior and here this is the maxillary
1:05:57 this picture is to show you the sphenoidal okay it's beenoidal and here yes easy to identify the yeah I'll take a different color this one yeah what are they frontal as sinus medial wall of the orbital the etymoidal this one here maxillary sinus this is the open mouth view right to show you the pinoid right so this is again an important topic in the nasal cavity nasal noise region next one which of the following is not the
1:06:44 feature of the palsy of the nerve involved okay in the image given so what is this image showing you this is the right eye the left eye which one is normal which one is abnormal what is prominent in the left eye you can see the left eye drooping right toses it is very characteristic of which cranial nerve palsy yeah come on tell me you can enter in the chat box toses or drooping of the upper eyelid is common in yes which now palsy yes the third Cranium of ocular motor nerve palsy right due to paralysis of
1:07:30 which muscle levator palpable superiors why does dilatation of pupil occur because the sphincter pupillae which causes constriction or meiosis that is paralyzed loss of accommodation is due to paralysis of celiers okay so this is the odd one out why yes it supplies what muscle Superior actor inferior actors medial rectus yeah inferior oblique Superior injury to the I mean paralysis of medial rectus will cause external strabismus
1:08:15 external Sprint okay you won't be able to adapt the eyeball you try to attack the eyeball will deviate outwards causing external strabismus okay yeah a few points about the orbit that I want you to understand so it's like a square right with a roof flow medial wall lateral wall so imagine this is the eyeball the recti muscles are closer to the eyeball so this will be superior rectus inferior rectus on the medial wall medial rectus over the lateral wall lateral rectus right but other than the
1:09:00 lateral wall the other three walls they have two muscles can you tell me what is that above the superior actors we get to see superiors about the medial rectus we get to see Superior oblique below the inferior rectus inferior oblique right so please remember yeah all the walls have two muscles except this lateral wall and now Supply you know lateral rectus is six thinner coming to the actions of muscles right easy lateral rectus and medial rectus they're
1:09:46 only one action isn't it lateral rectus is going to cause abduction medial rectus will cause adduction coming to the other four muscles Superior active inferior rectus Superior oblique and inferior oblique their primary action Superior oblique is going to elevate the eyeball inferior rectus will depress the eyeball Superior oblique contraction will cause depression of the eyeball and the inferior oblique will Elevate the eye bond why the oblique muscles are inserted behind the equator okay the recti muscles are inserted in
1:10:33 front of the Equator coming to the other actions of these four muscles remember this mnemonic the recti are going to order next the oblige are going to abduct next the superiors the superiors are going to Yes cause in torsion in torsion and the inferiors the inferiors are going to cause a extortion so having this in your mind tell me
1:11:18 superiorities apart from elevation it is going to cause adduction of the eyeball recti is attracting okay Superior is going to cause in torsion of the eyeball other than that that also causes adduction yes and extortion Superior oblique very very very very important okay it's already depressing your eyeball being an oblique it's going to cause abduction and then Superior intuition Superior oblique is very very very essential when you lower down your eyes to read a newspaper when you walk down these cans it turns your eyeball down
1:12:05 and out okay turns the eyeball down and out coming to the inferior oblique what is it going to do again it's going to abduct because it's an oblique muscle in fear it's going to cause extension okay so I'm sure your Taro with all this easy to identify the muscle right so on the medial wall you can see here the tendon turning around the pulley that is superior oblique below that medial rectus lateral wall only one muscle lateral rectus on the roof which one is on the top levator palpable brace superiors superior rectus
1:12:53 and in the floor what are these two muscles that you see here inferior rectus inferior oblique right so identification of the muscle shouldn't be a problem now coming to the features of these nerve palsy so this you know already it's a third nerve policy right right and left third nerve palsy now I am going to give you a mnemonic to remember the features of third nerve palsy petal as we have seen due to injury paralysis of levator palpable superioris external stravismus due to paralysis of
1:13:38 which rectile yes medial rectus dilated pupil due to paralysis of parasympathetic component which supplies the painter pupillae laws of accommodation due to paralysis of parasympathetic component that supplies say muscle okay now most of the muscles are supplied by Outlet so the eyeball itself sort of becomes flabby right that's why I get a apparent fructose so these are the features of ocular motana palsy now looking into this image a right left what is problem with the
1:14:25 right time the patient has a difficulty to turn the eyeball down and out so whenever he or she reads a newspaper or climbing down the star there will be diplopia so what is the muscle paralyzed here come on enter in the chat box the muscle paralyzed Superior oblique right Superior or oblique and the cranial nerve which innervates little thing trochlear nerve okay now coming to this image see again right and left drawing and Lead so which is the problem here appreciate this one and this one
1:15:10 what is happening in the second part of email C now the right type and the left eye wants to turn towards the right okay so the right eye is supposed to turn right for that it should abduct isn't it so the patient is not able to abduct so what is the muscle paralyzed it is the lateral rectus which is innovated by the abducent nerve okay so you should be able to identify the uh feature using the image given okay which nerve is involved which muscle is paralyzed
1:15:56 right coming to this a 50 year old male who underwent parotidectomy complained of loss of sensation while shaving which nerve is affected more that was a recent question in one of your inict exams right yes who's going to give me the answer come on make a guess please yeah can I see the answers in the chat box waiting for your answers yes so you know that what do they mean by this question yeah
1:16:41 laws of sensation while sharing which is which is that area it refers to the king nobody came over the parotid blood King over the parotid gland okay what is the nerve Supply to that yes can you give me the answer yeah so you know that the skin over the entire face right the skin over the entire face is innovated by the trigeminal nerve Yes except which area the region over the parotid gland and the angle of the mandible you see it shaded in a
1:17:27 different color here right that area the skin is going to be innervated by the lower part or the skin over the angle of mandible right that is innovated by yes come on tell me great auricular no this great auricular nerve is coming from cervical plexus it's a branch from C to C3 right C2 C3 okay yeah so few things why is it given in relation to parotid line
1:18:13 yes so you know facial nerve is going to be entirely motor supplying the muscles of face right and mandibular now coming from the trigeminal nerve IT Supplies the skin over the lower face foreign okay so quickly we'll go through
1:19:01 important points about the parotid gland okay so the parotid lot as you see here is situated in front and below the ear right yeah upper rotate surrounding the ear yeah now there are important bony landmarks around it you get to see the rammus of the mandible here the zygoma above external acoustic meat is mastoid process needle you get to see these thyroid process also right so a lot of bony landmarks there okay and the you can see the submandibular salivary gland here so you know that the investing layer of the deep cervical fascia it is going to split to enclose the submandular
1:19:46 salivary gland after that it comes up it splits to enclose the parotid also for example if you see this is the parotid right what is happening the investing layer of the deep cervical fascia is splits into two a superficial layer which is attached to the rigoma here okay which is attached to the zygoma here The Superficial layer okay what is happening to the Deep layer it's attached to the styloid process it's attached to the styloid process and it forms a sort of a thickening that is going to be called as Tylo mandibular
1:20:34 ligament what is special about this kylo mandible ligament it separates the parotid from the sub nandibular salivary gland right okay now yes we get to see the facial nerve within the parotid gland right yeah the branch is all we have seen right now what are the other structures within the parotid line yes the deepest structure within the parotid gland is the yes external carotid artery we saw that the external carotid artery terminates of the neck of mandible right what is happening to it yeah it's giving its terminal branches one goes horizontally
1:21:20 across the Marcilla the maxillary artery and one goes upright to superficial temporal artery so external carotid artery within the substance of the parotid is going to divide into superficial temporal and the maxillary and in the intermediate layer we get to see the Retro mandibular vein which is formed by the union of superficial temporal vein and marks the remain and The Superficial structure the one which is on The Superficial part in within the gland is facial nerve now I have a chocolate question for you can you tell me this is the flag of which country
1:22:05 yes you see the yellow on the top the blue in the middle and the red below yes come on waiting for your answer you can give a try yeah take a chance guys okay it's easier to remember what is this plan it's the flag of Colombia okay yeah so as you see here 80 percent of the gland that as it lies it lies superficial to the nerve and the vein So
1:22:52 This Plane which divides the blood into a superficial lobe and a deep lobe is called the facial Venus plane of Tate right 80 above and twenty percent below the plane so that whenever you do a surgery of the parotid the parotid tumor is right yeah uh pleiomorphic cardio was very common you can remove 80 percent of the gland right without uh affecting the branches of the facial nerve and abs is of the parotid okay what type of incision are you going to make a vertical incision or a horizontal incision if you make a vertical incision whatever what is the damage you're going
1:23:37 to do you're going to cut across all the branches of facial nerve right so it's a better to do a horizontal electrician this horizontal incision across the parotid you have to let out the absence what is it called yeah Hilton incision right sometimes you can make a skin incision that is vertical and then over the parotidomastic fascia you can make a horizontal incision to enter the parotid and let out the past this is called as blood incision right now what are the things you're supposed to know about the parotid duct here the stencil yeah it is about five centimeter long
1:24:25 you can see it running over the masseter after it emerges from the anterior border of the parotid gland over the mosquito and then it appears the buccal pad of fat it appears as the bucco pharyngeal fascia it pierces the buccinator and then the mucous membrane of the mouth to enter the vestibule right yes so this goes between the mucous membrane and the buccinator sort of oblique it's not straight passing through okay and finally bad as it open it opens opposite the upper second molar tooth okay upper
1:25:12 second molar tone there's another important Landmark right 1.25 centimeter lateral to the angle of the mouth modules where lot of muscle take crisscross before reaching the angle of the mouth okay and injury to that can lead to facial asymmetry okay this module is situated opposite the upper second premolar tooth right yes exam they keep asking you different components of the pathway right so this one the Secreto motor pathway for the parotid it begins in the Imperial
1:25:59 salivatory nucleus it's tympanic branch which is called as the Jacob sensor that enters the middle ear to form the tympanic blood cell and the nerve that emerges from the tympanic flux is the Lesser petrosal nerve right this lesser petrosal nerve is going to synapse in which ganglion try to supply the Carotid gland okay so remember the Secreto Mota 5 was right the Secreto motor fibers they reach why
1:26:47 are they auricular temporal nerve whereas the skin over the parrot it is innervated by the great auricular nerve from cervical fluxes so any injury to the region of the parotid gland okay parotid region that can be a misdirection of the regenerating nerve fibers fibers they're reaching the sensory fibers so whenever you eat you get perspiration sweating over the skin over the parotid plant and you're familiar with the syndrome yeah praise syndrome right and one important point to locate the facial nerve this is the tragus right the tractors of the external ear
1:27:33 okay one centimeter below and one centimeter deep or medial to the tragus yes please make a note of it right so if you are done with the parotid glass yes now in these two pictures yes you can make out the difference right the right part yes is adjective is abducted but what is happening to the left chord it is kept in a cadaveric position you are not able to either or abduct so what do you think
1:28:19 which nerve is paralyzed can you tell me waiting for your answer which nerve is paralyzed yes whether it's the internal original nerve or external laryngeal now or recurrent laryngeal nerve you can enter in the yeah wants to know about how many minor salivary glands are present right yes different books giving different numbers yes you have the parotid submandibular and sublingual these are the major ones apart from the minor salary glands like over the nasopharyngeal area the one recently covered but there are not major documentation on it okay and it's not an
1:29:06 important key topic also which one is uh responsible for the paralysis of the left core yes very good okay so we'll quickly revise about the yeah so what are the actions of vocal cord what are the actions of vocal cord you can tell me you can either abduct the vocal cord right or you can attack the ocal chord yes abduction is for respiration adduction is production of voice right you can tense your vocal cord what do you mean by tens like a rubber band stretching right when you want to increase the pitch of the voice
1:29:52 like to produce a high pitched song you can tense the vocal cord or relax now what are the muscles responsible for it now this image you can identify the thyroid cartilage is my the color of the pen is it visible this is the thyroid cartilage yes you can make out the cricoid cartilage this one is your private sitting on top of the cricoid this is the original this is your occur ligament I will shade it green this is the oakle ligament right this muscle just lateral to vocal
1:30:39 ligament what is it that is the ocalis right the one next to it too I will label it just next to ocal is that's the thyroid this one this one which connects the cricoid and the thyroid that is the crypto thyroid okay now connecting the arithinoid of both the sides this is the transverse okay now this one going across these are the oblique arcanoids sitting on the posterior surface of the cricoid posterior cricority noise
1:31:27 inserting into the anterior aspect of the lateral process lateral priority noise foreign to happen that's the safety muscle of larynx okay the posterior trichoor retinoid what are the adapters of the local card
1:32:12 I'll write it here so Abduction of the ocal cord is going to be caused by posterior triquarity noid that is the safety muscle adduction of vocal cord is caused by muscles which help to adapt the vocal for transversary retinoid yes lateral retinoid oblique retinoids the muscle the only muscle which cleanses your vocal cord what is it right thyroid right to produce a high pitch voice relaxation of vocal cord is by the one which is sitting next to your occur ligament oh callus and thyroid
1:32:57 [Music] right okay now we know that all these muscles are going to be innervated by recurrent laryngeal now except that is innervated by external laryngeal nerve okay now tell me yes what are the function of each nerve internal laryngeal nerve is entirely sensory IT Supplies the mucosa of the larynx what will happen if it is going to be injured yeah no muscle is paralyzed only that the sensation from the mucosa of a
1:33:44 vocal cord like when you're going to aspirate something whenever you normally put particles enter the larynx you cough it out right but if the sensation of irritation is not happening what will happen yes that will lead to aspiration okay coming to the next no external laryngeal nerve which innervates the right pothyroid what is the cryptoide do it tenses your oval cord right to produce a high-pitched voice you want to shout and call someone who's standing far away right but you are not able to tense if the muscle is paralyzed how will the voice turn out you try to shout but to others it will appear as a weak
1:34:30 husky low pitched voice right so here no sensory components purely motor now what will happen if the red correct laryngeal nerve is paralyzed it innovates all the muscles it innovates the posterior crico retinoid it also supplies the mucosa below the ocal Pod right so the three features of recurrent laryngeal nerve policy please make a note of it it is going to cause aspiration the safety muscle of larynx is paralyzed the abductor is gone right so that will be difficulty in breathing this neon most of the muscles of larynx are
1:35:15 paralyzed so the patient will have will our present with a very forced voice aspiration dyspnea postness right yeah now coming to I think this is the last part of today's session we'll be winding up with this what is Christmas yes it's also called the lock jaw right so what is the problem here patient is having difficulty in opening them out Beyond a certain angle you just pass them off muscles off mastication now what are the muscles of
1:36:00 mastication you know yes can you identify this this is they temporal this one here is the mercita so what are the things you're supposed to know about temporalis yes it is a fan shaped muscle over the temporal bone right what will happen if it contracts yeah it is going to the fibers are going to here pull your mandible up also pull it back right elevation retraction isn't it right what about mercita yeah before that one more important point for
1:36:45 temporalism which part of the mandible does it in the temporal is inserts into the coronoid process okay yeah which is hidden here the coronoid process of mandible so these are the four points we should know about temporalis fan shape zygomatic process of mandible inserting into the ram as outer surface of the ramus it is an example for cruciate muscle and the contraction of mercita what is it going to do again it will Elevate and
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