Transcript for:
Head and Neck Anatomy Overview

so this is the session in which study we were uh in the session of the neuroanatomy where all the important aspect was covered for the neuron atomy and as much as I was able to complete it but today uh the maximum I will try to cover entire head and neck in this series and all the important topics which is uh actually very important for you to know in the head and X Series so let me start with the session I just want to check with the students I'm so exactly I want everybody to know about the things which will be covered in the headen X Series and which is very very important actually one of the part of the headen X Series that was of cranial for amas few topics are overlapping with the neuroanatomy and headen X Series which we have already done okay so if I talk about the important aspects to be covered up it's important that we should be uh so yes the thing is that the all important aspect will be definitely covered so please don't worry about it and the important things to be covered in this topic is we will start with the scalp then we will go with the important structures of the phase then we will go with all the triangles of head and neck so actually what happens why the triangles are very important when I'm talking about the triangles of head and neck it means uh that you have all the structures in the anterior triangle uh the sub triangles of the anterior triangle we have got koted we have got digastric we have got the submental we have got uh the muscular triangle we have got the uh subclavian triangle we have got the occipital triangle we have got the scelo vertebral triangle we have got suboccipital triangle actually many many triangles are there and all the important uh aspects of the triangle should be covered because it's entirely very important yes good morning everyone other than that you should have an idea of glands of henite like uh you should be knowing about the pared gland you should be knowing about the submandibular gland you should be knowing about the thyroid gland other than that I will also cover farings laryn okay these are the important aspect to be covered up so exactly many things has deep cervical fascia so actually all these will be covered up along with the mcqs which is very necessary to solve few mcqs because entirely McQ session can be taken afterwards also other than that I will also cover the tongue tongue is a very important topic if you are targeting the fmg exam or in the neat PG exam tongue is very very important topic so we will cover up the tongue we will cover up the orbit the extraocular muscles so actually today I have taken too many topics all the vessels important vessels and branches of the arteries will also be covered up so let's start with this so the first topic of today's session is layers of scalp okay so as in the previous session also when I started with the actually my how I start with the topic is like for example if I'm going with the neuron atomy I will open up the skull cap and go inside in the brain and the covering same way when I start with the head and neck I would like to start with the scalp so you have to know the scalp layers as you proceed from uh superficial to deep as you proceed from superficial to deep so actually uh here we have got the first layer which I'm talking is the skin so the layers can be spelled by the word scalp the spelling of the word scalp so here s for the skin C for The Connect tissue a for the epon neurotic layer l for the loose connective tissue and P for the pericranium so we have got scalp the five layers and we have got all the all the structures in the same proportion as you proceed from superficial to deep skin the connective tissue layer which is dense the epon neurotic layer which is Theo which is the epon neurotic layer for the two muscle bellies that is the frontal and occipital muscle bellies we have got loose connective tissue and we have got the pericranium so all these structures as you proceed from outside to inside is constituting the scalp layer the epicranial epon Neurosis the lose arol tissue the pericranium so all these are the layers so actually when you see the skin if you this is the skin and in the skin what you can see the hair follicles has been shown the glands Associated the the Sous gland and all then we have got the subcutaneous tissue which is adherent to it this layer of the cutaneous tissue the connective tissue layer will be dens this is the Appo con neurotic layer which is containing two muscle valys and we have got the loose connective tissue which is also called as the dangerous layer of the scalp I will tell you the reason why it is called as the dangerous layer of the scalp and the innermost layer will be the P for the pericranium so these are the layers of the scalp as you proceed from Outer aspect to the inner aspect now I would also like to show you in another image which will help you to understand this Concepts so we have got the skin we have got the subcutaneous tissue the muscular urtic layer and lose arola tissue and the pericranium all these layers are arranged in the same way and we have to know the important structures residing in this now uh one of the few points which I want you to tell actually you can get confused that there are two connective tissue layer one is the second layer that is the connective tissue layer that is gens and the fourth layer is the loose connective tissue layer the fourth layer that is the loose connective tissue layer if I talk about the fourth layer it is highly important why I will tell you the reason why why it is important is actually uh the reason why it is important is because it contains Emissary vein what does it contain Emissary vein the fourth layer is containing Emissary vein and this is forming a connection with the uh veins of the scalp on the outer aspect with the veins lying inside that is Ural Venus cusis what does that means that means the infection from the outer aspect of the skull can be uh transmitted inside and can be leading to uh the infection of the Dural Venus cusis so that is highly important for you to note down so done with this now we'll talk about the epon neurotic layer the third layer is the epon neurotic layer let me slightly enlarge it so when I enlarge it you can see there is a frontalis muscle as you can see here this is the frontalis muscle belly so there is a frontalis muscle belly on the anterior aspect and there is an occipitalis muscle belly on the posterior aspect so actually this is very important that you should know about both of these why uh because uh if I talk about the frontalis muscle it is not having any bony attachment so these two bellies here is the frontalis bellies and it is not having a bony attachment it is merging actually what happens if I talk about the frontalis muscle belly it is merging with the skin so exactly it is actually merging so it is inserting uh it is merging with the epicranial epon neurosis and it is merging with the tissues over the eyebrows and the root of the nose and the eyebrows and all structur so actually it is not having a bony attachment but when you now I also want you to se in another muscle belly that is posteriorly that is called as occipital muscle belly so when I am talking about the occipital muscle belly what happens it is actually having a bony attachment it is arising from the lateral two3 part of the superior nucle line if you will see in the posterior aspect of the occipital bone there are two lines which is diverging okay in the skull when you sp the skull from the posterior aspect the two lines which is diverging is superior nucle line and occipital muscle belly is attached to that Superior nucle like the two side occipital belly and the frontal belly will fuse with each other leading to the formation of epicranial epuris so the gap which is lying between the frontalis muscle belly and that of occipitalis muscle belly is fused with epicranial epon Neurosis okay so it's it is important for you to note down and other than that it's also important that these muscle bellies are getting innervation so they are getting in ation from the branches of facial neres so I just write down here one important point which I want everybody to note down is the front Talis muscle bellies arises from it arises from the tissues over tissue over the ibrows and root of nose and it runs backward actually what happens it runs backward and merges with actually it runs backward and merges with that of epicranial the deeper fibers of frontalis so this was one important the deeper fibers of frontalis muscle valy is actually longer and it is actually merging with the muscles it is merging with the muscles like procerus muscle corrugator superciliary and orbicularis OC so it merges with procerus muscle corrugator super sly and that of orbicularis O so actually these are the musle so we have got quet superly orbicularis o so actually these are the muscles around here in the nose and also the muscles which is lying at the so we have got these muscles uh here so we have got orbicular so actually these are merging with the muscles here so exactly that is highly highly important for you to note out so in short what I want everybody to understand is that if I'm talking about an important aspect here so if I'm talking about an important aspect here I just want everybody to understand that these is very important why I will tell you because this is how it's uh it is not having any bony attachment so this is entirely for the reason that this is not having any bony attachment so uh so if I talk about occipitalis muscle so in between I will check with the mobile if you have got any doubt you can ask in the chat box so Oxalis muscle belly is actually attached to if I talk about occipitalis muscle bellies they arises from the lateral 2/3 of superior nucle line and extend and merges with epicranial epon Neurosis so actually the Gap is filled with the Gap that is epicranial osis and this is having a bony attachment now the frontalis muscle belly so I will actually if I talk about the frontalis bellies they are innervated by temporal branch of facial knob and the occipitalis bellies are inner ated by posterior oric branch of facial so in other words you can say both of these are inated by the motor branches of facial what you can say both of these muscles are inated by the motor branches of facial now I would also like to explain the nerve Supply actually scalp nerve Supply is very important so the nerve Supply can be understood by seeing this image so let me just U check with the students also are they are able to understand or not if anything which you are not able to understand you can just let me know okay so yes ma'am yes ralis okay thanks for the appreciation uh uh uh so exactly uh so I just want that you should see this image and you can understand the ination which is lying on the scalp so if I enlarge this image you can see there are actually whole of the scalp is having eight nerves okay how many nerves the scalp is having the scalp is having eight nerves so just focus on this image so it is having an overall of eight nerves and in that 10 nerves are there eight are the sensory and two are the motor so to two motor already known which is giving inovation to frontalis muscle valy and that of the occipitalis muscle valy but if I talk about the other sensory branches what you can see the sensory branches are giving inovation to the scalp area anterior to that of the Oracle and posterior to that of the Oracle so there are four sensory nerves which is giving innervation to the anterior part of the scalp and there are other four sensory nerves which is giving innervation to the posterior part of the scal so exactly here we can uh uh here we can see this is the supr trar nerve so I just want to highlight it so just know the name of these nerves so this is the suat trar and this is the supraorbital ner so actually supr trar supraorbital nerves these are are the branch from the Opthalmic division of trial n and then we have got jagatic temporal jagatic temporal ner is the so if you want I can slightly enlarge it let me just see can you appreciate yeah so we have got the supr trar we have got oric temporal so we have got these nerves we have got these nerves yes you are right actually yes medicine you are right so actually Supra tra Supra orbital are the branch of opthalmic division of trium gigomatic temporal is the branch of maxillary division of trium and orico temporal is the branch of mandibular division of trial ner so that means these are the branches of trial nerve okay absolutely right shahil and then we will come to the nerves which is lying posterior to the Oracle if I'm talking of the posterior aspect we have got following nerves we have got great oric nerve I just want everybody to know the name of the nerve and also the root values because in few of the questions being asked in the previous year of examination they have directly asked about the root value of this nerve so great oracular nerve is having the root value of C2 and C3 the leather occipital is having the root value of C2 and that of Greater occipital the great occipital nerve is having C2 and third occipital very easy to remember it will be C3 yes so exactly you are right sahil if we talk about great oracular lesser occipital greater occipital and third oxal they are the branches of cervical plexus so shahil is absolutely right so how many so in overall what you can say there are eight sensory nerves there are eight sensory nerves in the scalp and there are two motor nerves two motor nerves so actually motor nerves has already been done and we know that the frontalis muscle belly and occipitalis muscle belly is getting motor ination is it okay is it okay dear so that all are getting inovations and uh so let's talk about the next so here also I just want to rub one important yeah so here I want this is an another image where I want everybody to appreciate the arterial Supply and the nerve Supply so let me slightly enlarge this image so actually nerves has already been done so there are 10 nerves and there are five arteries which is giving there are 10 nerves and there are five arteries which is giving uh the arterial Supply onto the scalp so that is important for you to note down so let's talk about the arterial Supply so in that case what you can say the name of that five arteries are Supra trar Supra orbital okay Supra tral sua orbital superficial temporal posterior oracular artery and that of occipital artery so these are the five arteries these are exactly the five arteries yeah these are exactly the five arteries which is giving arterial supply to the scalp in this case what I want everybody to understand the Supra can anybody give me the answer Supra trar and supraorbital arteries are the branches of the CH can anybody give me the answer Supra trar supraorbital arteries are the branches of which artery so sahil is telling it's internal cared arteries sahil you are absolutely right wenes is also telling yeah but I got a better answer opthal branch of internal car this was what I was searching for yes so these Supra tra supraorbital are the branch of Opthalmic artery which is subsequently the branch of internal kotd artery same way here superficial temporal is the terminal branch of external koted artery posterior ular and occipital are the posterior branch of external koted artery so you are absolutely right so if you want you can write this also so I just want to enlarge this image and I just want we have already done the nerves part so I just want everybody to concentrate on the arterial Supply so you can just write it yes sahil you are absolutely right I just want everybody to not down here Supra trar Supra orbital are the branch of Opthalmic artery and Opthalmic artery is subsequently the branch of AA internal kotd AR superficial temporal is the branch of superficial temporal is a terminal branch of ECA external koted Ary posterior oracular is the posterior branch of EA that is external koted artery occipital artery is posterior branch of ECA that is external carot so you can see these are the branches and you have to know the name of these arteries now I would also like to talk about the Venus drainage which is very important for you to understand actually this is a image where which will help you to understand about the scalp and the facial weight uh drainage on the face why it is very important because already in the st's session we have completed cavernous sinus and uh I just want everybody to pay attention to this because cavernous sinus infection is quite common leading to cavernous sinus thrombos so there are certain Roots which is draining the infection from the dangerous triangular area of the face to that of cavna so that roote will be also known to you but important veins which is draining the face and the scalp so I just want to enlarge this Im so when I'm enlarging it here I want you to show okay so you can see this is the Supra trar and supraorbital veins these are actually draining angular veins and they are subsequent ly draining angular winds and they are subsequently forming the facial wind so what is this this is the facial wind form that is clear to you now I just want U you to explain about the formation of retromandibular ve so please focus on which ve retromandibular way so all of you pay attention to retromandibular way so this is the retr mandibular vein so when I'm talking about retro let me slightly enlarge it yeah when I'm talking about retro mandibular vein in this diagram itself you can appreciate this is the retromandibular vein this is formed by what is the formation so you can see it is formed by the joining of Max ve so it is formed by the joining of Max we and that of the superficial temporal w so this is superficial temporal vein and this is the maxillary vein so these two veins superficial temporal and maxillary vein will join and lead to the formation of retromandibular vein in short we talk about retr Mand if we talk about the retromandibular vein RMV the word we use and this is how it form now after the formation of retromandibular ve if you want slightly yeah after the formation of retromandibular vein what happens it divides into anterior and posterior division so you can see this is the anterior division of retromandibular ve which will join with the facial vein and lead to the formation of common facial vein this will lead to the formation of common facial vein and common facial vein is draining into which wind it is draining into internal jugular vein it is draining into internal jugular ve clear now now we will uh see that there is a posterior division of retromandibular vein which will join with the posterior oracular vein so this is the posterior oricle vein which joins with the posterior division of the retromandibular vein and leads to the formation of external jugular vein so this is posterior division of retromandibular vein okay so where were we I will just come to that point yes so we were here so let me slightly enlarge it okay so we were here and in this case you can see this is the posterior division of retromandibular vein and as I told you the posterior division of retromandibular vein this is the posterior division of retromandibular vein which is joining the posterior oricle vein so this is posterior oricle vein and this is the retroband ve both of these will join and lead to the formation of both of these will join and lead to the formation of external jugular vein external jugular vein is draining into which vein it drains into subclavian ve it drains into subclavian wi so is it clear to you everyone other important point which I want everybody to concentrate if you have got any doubt you can ask me the facial vein will communicate with the Deep facial vein as shown in the diagram and the Deep facial vein will communicate with teroid venous flexus and will drain infection to Via Emery vein it will drain infection to C sinus it will drain infection to cavernous sinus so this root is also important for you facial wind as we have seen the facial Wind forms communication with deep facial wind deep facial wind form communication with teroid Venus flexus teroid Venus flexus why ve Rin infection into the cavernous signs so these are the important veins formed if you want a quick um important points can be uh also done so if you wait a minute okay now see here so I just want that everybody if you want I can read I can just write important aspects of it so quickly we can write it if you want because few must can get confused so one of the root of infection please write down root of infection root of infection of cavernous sinus thrombosis so one of the root of infection of cavernous sinus thrombosis has been shown here and in that case that root of infection is V facial vein communicate with the facial vein the facial vein communicate with teroid venous plexus teroid vinous plexus communicate via Emissary vein and the infection is reaching to which structure the infection is reaching to cavernous sinus and leading to the condition of cavernous sinus thrombosis and leading to the condition of cavernous sinus thrombosis uh which vessel lead to the infection in brain in inferior nose and upper border of the superior Li actually inferior aspect of the nose and the upper area of the face that is called firstly an earlier time it was called so Vates in earlier time we were telling this area into the dangerous area of the face now we take a whole triangular area of the phas which is the dangerous area and why there are two three rule there are two roots of infection one is bya superior Opthalmic vein other is facial vein communicating with the deep facial vein so it is by Deep facial vein and facial vein the infection reaches to the teroid venous flexus ultimately bysty vein it is transmitted to the cavernous sinus leading to cavernous sinus thrombosis is it okay venkatesh so this is the root which has to be explained now I also want everybody to understand surgical layer of the scalp so that whole pathway I have written you can go through it okay W it is the other communication is also via Superior Opthalmic vein the infection can drain into the interior of cavernous sinus thrombosis in the st's class I already have explained it if you have missed out you can see that neuroanatomy session okay surgical I have explained that in the cavernous sinus thrombosis cavernous sinus session so you can just see that now talking about the surgical layer of the scalp so actually three layers of the scalp there are three layers of the scalp we have got the skin so we have got the skin we have got the connective tissue layer connective tissue layer so actually this connective if I talk about this connective tissue layer this is actually dense so this is the first layer this is the second layer and we have got a third layer that is EP cranial epon Neurosis which is connecting two muscle valys frontalis and that of the oxy and these three layers these three layers together these three layers together is called as surgical layer of scalp now the doubt which must be arising to you why these two layers are these three layers are called as surgical layer of the scalp the reason is that the uh three layers of this is very difficult to separate okay it's very difficult to separate these three layers and together they are called as surgical layer of the scalp or called as scalp proper in earlier times in case of in earlier times uh also there was a procedure of giving uh punishment to the uh to the to the accused person and in that case they have removed they for punishing the punishment they removed the three layers of the scalp that is scalp proper in case of punishment for the rape cases now the next is black eye so actually Whenever there is a direct blow or hit if there is a direct blow or hit on the face what happens there is actually accumulation of fluid and blood in the area around the eye this condition is called as black eye and if you remember I told you yes you are absolutely right raccoon eyes yes you absolutely right actually the reason I want you to explain the reason is that the frontalis belly is not having any bony attachment it's not having any bony attachment it is just merging with the um muscles like corrugator super cular proas and orbicularis O so exactly the blood can penetrate it cannot it will be letting accumulated inside and around the ey so this is the reason and the reason is that the frontalis muscle belly is having no bony attachment frontal bellies has no bony attachment now other condition which I want everybody so firstly I want you to give few differentiating feature of the two condition which is called as captive suum and the other is called as seal hematoma so I just want to enlarge it there is one condition that is called as cap captive suum and the the other condition is called as seal hemat so it's important to differentiate both of it actually the most serious one is Seal hematoma the most serious one will be seal hematoma actually seal hematoma in case of seal hematoma there is sub perial bleeding which bleeding the reason of formation of seal hematoma is sub parosteal bleeding but the reason of formation of cap suum is just the pressure which is actually this is very superficial accumulation of soft tissue being compressed when the baby's head during vaginal delivery there is compression of the head part of the baby by the Bony cervical canal and all so exactly it's the fetal head is compressed against the cervix during the labor and in that case there can be compression of superficial veins and it will be corrected in about 7 to 10 days so it sometimes in few hours only that that swelling is gone and it does not increases in size but the seal hematoma increases in size and the other important point is the swelling crosses the suture line so the swelling is a generalized swelling if I talk about the condition of captured suum there is a generalized swelling but if you will see the seal hematoma condition there is a correct outline of the swelling and so swelling does not crosses the suture line in the case of seal hematoma the swelling for example most commonly the parital reason and it will accumulate the parital r will not be seen in the occipital reason so the marking and the swelling is demarcated by the suture line but in case of captur it can cross the sutal the complication is associated with seal hematoma because it is caused due to sub peral hemorrhages and it takes much more days and months to get resolved and it can be complicated also so I just want everybody to see the two condition one is captive suum so you can see the baby is born can everybody appreciate the baby is born and in this condition of captive suum what you can appreciate what you can appreciate there is a generalized swelling there is a generalized swelling but why I am showing you this images because it can come as image based question but when you are seeing seal hematoma you can see the swelling has got a definite size the swelling is having a defined border the swelling is having a defined border now I would also like to show you an image here you can appreciate about the accumulations so you can see the condition of caped suum the accumulation of fluid is just in the second layer that is the connective tissue layer beneath the skin seal hematoma you can see the blood collection is there and exactly it is just in between the epicranial and the partium layer this is the epidural and the subal hematoma is the accumulation beneath the epon neurotic layer so actually these all layers has been demarcated in the scalp and also shown you the accumulation of fluid and the so basically the difference which you have to know is the difference between captive suum and seal hematoma which has already been enumerated now let's come to a very very important topic that is triangles of the neck triangles of neck is a very important topic and many many triangles are there and I will cover entire triangles and many of the structures residing there okay so can we start with the session everyone so we have got posterior triangle and we have got an anterior triangle okay dear so I just want everybody to firstly understand what is posterior triangle and what are the structures lying inside how is the roof of posterior triangle formed what is the structure which is forming the floor of posterior triangle what are the structures residing in the posterior triangle so I just want everybody to understand all these important features so if you will see this image I'm just enlarging it you can app appreciate the posterior triangle so the outline of posterior triangle is this so I just want this is the whole outline of the posterior triangle okay so here what happens the posterior triangle is defined by so we have got a muscle which is lying anteriorly we have got a muscle which is lying posteriorly so I would like to use a brown color for it and you can see this muscle is stno cleoid muscle which muscle is this this is the stern nooid muscle so you can just write down this muscle is stoco myroid muscle which is lying in the anterior so this is forming anterior border of the posterior triangle and the muscle which is Ling posteriorly is the trapesius muscle musle this muscle is the T for trapezius muscle we will mention t for the trapezius muscle so here this is the T for the trapesius muscle so exactly uh if I have to define the boundaries of the posterior triangle how I'm am going to Define it the stoc mustri muscle is forming the anterior border of posterior triangle the trapesius muscle is forming the posterior border of the posterior triangle and this is the Apex so Apex is the area where the stoco mus and trous muscle is meeting actually that is the area of superior nucle line of the oxital bone and the base is formed by this what is this this structure is forming the base and this is the middle 1/3 of the clavicle so this is formed by the 1/3 this is formed by 1/3 middle part of clavicle middle 1/3 middle part of clavicle this is formed by 1 of the middle part of Clavin so done so you can clearly see this okay now here I uh so we can see the boundary of the entire posterior triangle and also I want you to define the belly so here in this diagram you can see this is the omo hard muscle belly so actually there is inferior Belly of omad the Triangular space which is lying above the inferior belly of HOH that triangular space is the occipital triangle and the Triangular space which is lying below the inferior belly of HOH that is called as the subclavian triangle so it is important that you should Define the boundaries of occipital triangle you should be knowing where is the subclavian triangle and you have to know the contents the roof and the floor so everybody are you clear with the boundaries are you clear with the boundaries of posterior triangle should I move further okay done okay everyone so done everyone let's write the boundaries so I just want everybody to uh this is the roof this is the roof this the floor so I just want everybody to First write the boundaries so let's start with the boundaries so all of you please write on the heading boundaries of posterior triangle boundaries of posterior triangle of neck boundaries of posterior triangle of neck boundaries of posterior triangle of neck so the boundaries are please write on what is this boundaries of posterior triangle of neck and the boundaries are so anteriorly it is bounded by posterior border of stoc cleoid muscle posteriorly it is bounded by anterior border of trapesius muscle inferiorly or base inferior or base is formed by Superior aspect of middle 1/3 of clavical okay Apex if I talk about Superior aspect or apex apex is formed by meeting point of meeting point of sternomastoid stern croid and trapas muscle and trapas muscle at the superior nucal line of oxital bone at the superior nucal line of o ipal Bard okay so done so here we have done with the boundaries so what we have done we have done with the boundaries so everyone is it okay we have done with the boundaries now I want everyone to concentrate for the uh so we have done with the boundaries now let's talk about the floor roof firstly so as I want you to tell about the roof so if we are talking about the roof structures the roof is formed by investing layer of Deep Survival field so we know that whole of the neck is surrounded by a fascia the name of that fascia is deep cital fascia so in this categorization the roof of posterior triangle is formed by investing layer of deep cervical fascia and this is stretching between the stern mus and trapas muscle and actually uh the investing layer of deep cervical fascia will be overlapped by The Superficial fascia and the Skin So roof is and also roof here we can see this is the muscle this is the muscle which is is lying in The Superficial fascia of the roof that is platisa muscle which muscle is this platisa muscle so exactly roof roof of posterior triangle is formed by roof of posterior triangle is formed by investing layer of deep cervical facia it is formed by investing layer of deep cervical fascia it is formed by investing layer of deep cervical fascia and which is actually overlapped by The Superficial fascia is covering the roof so you just can write this also The Superficial fascia is covering the roof and it will contain few important structures it will have the it will have external it will have a muscle that is platisa muscle external jugular vein and cutaneous nerve so actually I just want everybody so all of you please concentrate on this cadic image so this is a cavic image which I'm sharing with you and actually in this cavic image what you have to understand in this cavic image what you have to understand is the structures of the roof and what are the structures which is residing so exactly um I just want to use black color so this is Sterno cleoid muscle which muscle is this this is the stoco myid muscle this is stoco myroid muscle this is stoco myroid muscle okay posteriorly we have got this is the part of the muscle which you are seeing this is the part of the muscle which you are seeing is this so this is the joining of both the muscles okay and the this part which you are seeing is a for the Apex and this is B for the base and this muscle which you are seeing here is the trapezius muscle this is P for the trapezius muscle this is T for trapas so done so in short we have done with the boundaries so I feel that you can understand the boundaries of the posterior triangle of the neck now the next point is to know the roof structures what all the structures are residing in the roof so that is important for you have to understand that so for that I just want everybody so I just want everybody to concentrate so exactly here we have got uh important structure so nerves are there so exactly we can uh we are having important nerves so this is the nerve which you are seeing this is the nerve which you are seeing this is the nerve which you are seeing and these are the nerves which you are seeing so actually uh the nve which is shown lower down going towards the clavicle so I just want to use uh yeah so this will be Supra this will be the Supra clavicular nerves this is supraclavicular nerves yes these are the this is the cervical point and the nerves are emerging out from these Point yes these are the cervical Point are the posterior border of the stoco and we have got uh so other than that we have got many important nerves residing we have got great oricle nerve we have got transverse cervical nerve so we have got a transverse so this nerve which you are seeing here will be the transverse survive so this is transverse cervical nerve this is the supraclavicular nerve which already written yeah this will be the Great oracular and the Leer occipital now so this is the Lear occipital and this will be the great oracular nerve so so these are the nerves which is uh seen in The Superficial fasia of the posterior triangle and what about the vein so the vein is I'm just using blue color for the vein and this vein which you are seeing is the external jugular vein so the vein is also visible and that is external jugular vein which will be seen in the posterior triangle of the neck so exactly these are the structures in the cavic image of the posterior triangle of the neck which we have which have have just seen I would like to write the details of it also so we'll talk about the details of of it also so please write on the heading roof of posterior triangle and the structures residing roof of posterior triangle of neck roof of posterior triangle of the neck so if I talk about the roof of posterior triangle of the neck we will uh know the details so the roof of posterior triangle of the neck is having it's formed by investing layer of deep cervical fascia which I have already written and The Roof Is overlapped by so it it is overlapped by superficial fascia and this superficial fascia will contain so if I talk about The Superficial fasia there are certain structures residing in The Superficial fascia and The Superficial fascia will contain a muscle that is platisa muscle so can anybody tell me the muscles which is lying in The Superficial fascia we get uh we yes you are absolutely right shahil if I talk about the import certain structures in The Superficial fasia we have got external jugular vein we have got the branches of the cervical plexus we have got the platisa muscle here the platisa muscle is residing in The Superficial fascia and the muscles which is residing in The Superficial fascia a common term is used for these kind of the muscle and what is it called as it is called as a type of panicular gnosis muscle so platis is there we have got a uh external jugular vein we have got branches of cervical plexus and here we have got four cutaneous nerves so let's talk about that four nerves the four cutaneous so we have got four cutaneous branches of cervical flexes we have got leer occipital nve which is having the root value C2 we have got the greater oric nerve having the root value C2 and C3 we have got uh the transverse cical now having again the root value C2 and C3 we have got the supraclavicular now which is called as C3 and C4 four so actually all these are the branches of the cervical plexus done with this all these are the branches from the cervical plexus now so we have done with this now we will talk about the floor of posterior triangle so it's important to know the floor of posterior triangle and actually uh if we see the floor of posterior triangle it is also overlapped by uh the layer so it is overlapped by the other layer yes sahil you are absolutely right that supraclavicular nerve is ultimately having so sahil is giving an extra information that is absolutely correct that supraclavicular nerve is having lateral medial and intermediate branches and can you tell me among these branches which is the branch which is piercing the clavical bone and that is the reason clavical bone is an example of atypical long bone can anybody tell me sahil can give me the answer s is absolutely right that there are three branches so he is absolutely right that there are three branches and among this I just want to know which is the branch which is piercing the clavicle and the name of that branch is intermediate branch of supra clavicular n so only the clavicle is regarded as a atypical bow okay floor of posterior triangle is covered by pre vertebral layer of deep cervical fasia it is covered by pre vertebral layer of deep cervical fasia and we have to know know the name of the floor muscle we have to also know the important structure which is plastered on the prevertebral layer of deep cervical fasia it's also important that you should know the prevertebral layer of deep cical fascia will continue in the axila and will lead to the formation of axillary fascia so you can just write floor of posterior triangle is formed by PR vertebral fascia that is the part of deep cervical fascia pre vertebral fascia is the part of deep cervical fasia and it's important to know that all the muscles which is forming the floor so we have got many muscle and few important muscles which is very important for you to know is semi spinalis capitus we have got splenius capitus we have got lator scapi lator scapi we have got scalenus medius scalenus medius and we have got first digitations of sometimes first digitations of sometimes we have got first digitations of first digitations of seratus anterior muscle seratus anterior muscle so all these muscle which I have written is the muscle forming the floor or posterior triangle all these muscles are forming the floor of posterior triangle and the floor of posterior triangle is covered by pre vertebral layer of deep cervical fure now the uh so here we can see the boundaries and we can see the muscles also we can see the Apex base and the anterior posterior boundary of the posterior triangle and here we can see the muscles forming the floor of posterior triangle which I have already written semispinalis capitus has been sown splenial capitus has been swn the latus cap the scelus medus muscle has been swn the next important thing is to know the content of posterior triangle so if I want to pay attention to this point the content of posterior triangle can be memorized by knowing the content which is lying in the occipital triangle and by knowing the content which is lying in the sub clavant triangle actually there is a muscle belly which is called as inferior belly of omo hard muscle which is overall dividing the posterior triangle into two parts the area which is lying above the inferior belly of HOH hard is the occipital triangle and the area which is lying below the inferior belly of HOH is the subcl triangle and individually you have to know the contents in each of these triangular spaces in the occipital triangle and in that of the subcl Triangular spaces you have to know the content so examp exctly we will talk about the contents of these individual triangle so firstly I will write the content but I just want everyone to see this image actually in this image the occipital triangle has been designated and the contents has been denoted with the red color and actually all important by the name only it is called as the occipital triangle so it will contain occipital lymph node it will contain occipital artery it will contain spinal accessory nerve actually spinal accessory nerve is a very important content of occipital triangle the spinal accessory nerve is sandwiched between the roof and the floor layer and it is giving inovation to stern must and tedious muscle so we have got spinal accessory nve we have also got the other contents like we have got the the four branches of the cervical plexus cutaneous branches is the content we have got the C3 C4 nerves we have got we have got the dorsal scapular nerves and we have got the super occipital lymph nose and sometimes superficial transfer cical Lal in the lower triangular space which content has been sewn with green color that is the space which is the subcl triangle which is also called as supraclavicular triangular space and in the supraclavicular Triangular space again you can see the trunk of breel plexus lies the third so actually the third part of subclavian artery and the branches like subclavian vein also the lymph nodes we have Got The Superficial transverse cervical dorsal scapular arteries all these are important structures residing so that is enough to sub clavis and suprascapular nerve that is the nerve of upper trunk of Bal plexus so I just want everybody to write the details of contents so please focus on this topic contents of posterior triangle so please write down contents of posterior triangle content of posterior triangle so firstly you can write the contents in occipital triangle content in occipital triangle and in the B part you can write the content in the subclavian triangle content in the subclavian triangle which is also called a supraclavicular triangular space so these two contents you have to understand okay so let's start so the contents are if I talk about spinal accessory nerve please write down the important contents the important most important content is spinal accessory nerve actually the spinal accessory nerve is prone to get injured in the posterior triangle why it is more injured in the posterior triangle because of its location it is exactly traversing between the roof and the floor layer it is passing between the investing layer and the pre vertebral layer of deep cervical fascia it is plastered in between these two layers so whenever there is any case of uh drainage has to be done any absis is there in the posterior triangle any lymph node has to be dissected out or has been operated in this area there can be a chance of injury of spinal accessory nerve the other nerves are third and fourth third and fourth cervical nerves third and fourth cervical nerves then we have got dorsal scapular nerve then we have got the four cutaneous branch of cervical plexus we have got four cutaneous branches of cervical plexus we have got four cutaneous branches of cervical plexes then we have got superficial transverse cervical artery super faal transverse cervical artery other than that we have got uh oxy lymph node and occipital occipital lymph node and occipital artery actually the four cutaneous branch of cervical plexus name I have not written because we already have mentioned that four branches transfer cervical supraclavicular great oric leer occipital in the roof part okay now coming to the contents of the subcl triangle so if we talk about the contents of subcl triangle you can just write down the content of subclavian triangle in the subclavian triangle we have got the third part of subclavian artery we have got the subclavian vein we have got the terminal branch of external jugular vein terminal branch of ejv external jug ve we have got the trunks of Briel plexus as the content we have got TRS of Briel plexus as the content we have got the lymph node supraclavicular lymph nodes actually the branches of the trunk of braal plexus that is the n to sub cavis Nerf to sub cavis and we have got NF to sub clavis and we have got suprascapular nerve okay and also the arteries sometime so arteries are also there that is the uh suprascapular artery dorsal scapular artery super FAL transverse cervical artery so all these are also the contents so basically important contents you have to know so we have done with this now I would like to talk about anterior triangle so everyone can we go to the next that is anterior triangle okay third and fourth okay third and fourth is giving Branch two so a question has arised Yes dear third and fourth so yes third and fourth cutaneous cervical no you want to know third and fourth cervical nerve is giving innervation to lator scapi muscle and trapas muscle so is it okay shahil no it's what is a question asked by wenes wenes third and fourth nerve is giving Innovation to the skell uh muscle and also giv giving inovation so exactly it is also giving Innovation to the muscle of the trapesius muscle so it is giving latus caply it is giving innervation to to live it a capap and trapezius muscle okay now anterior triangle so let's focus on to the next topic that is anterior triangle so anterior triangle is another very important triangle which you have to know so individually you have to know about the four triangles which is lying inside but before starting the individual triangle I would like to show you this image so just enlarge this image so when I enlarging this image you can see uh the dotted line which has been shown to you the black dotted line which is showing you the whole boundary for the anterior triangle so anterior triangle is bounded so you can see here the anterior boundary is by the anterior median neckline so it is bounded anteriorly by the anterior mid neckline it is bounded by the anterior mid neckline it is bounded by the anterior mid neckline anteriorly and it is bounded posteriorly by stoc croid muscle the base is lying above which is formed by the lower border of mandul and an imaginary line drawn to the mustri process so an imaginary line going towards the must was this hole is forming the base this hole is forming the base the Apex so if I talk about the Apex the Apex is lower down the Apex is lower down which is at the level of Supras sternal notch so this is is at the level of Supras sternal notch this is at the level of supra's teral not so this is the overall boundary of anterior triangle so you can just write on the boundaries write on the heading boundaries so anteriorly it is bounded by anterior mid neckline posteriorly it is bounded by the stern croid muscle Apex is formed by the Supras sternal notch base is lying in the up above Direction and is formed by the lower border of mandible base is formed by the lower border of mandible and an imaginary line extending to the mid process of tempo extending to to the must process of temporal Bond extending to the must process of which bone of the temporal bone so done now I just want everybody actually the main uh thing which everybody has to understand is the subdivision of anterior triangle because individually you have to understand the Triangular spaces and individually I will talk about the Triangular spaces and the details so that is very important for you okay so uh actually there are uh there is a muscle that is the poster belly of digastric so there is digastric muscle that is there is superior belly of homide so Superior belly of homide digastric muscles are dividing the whole triangular area of anterior triangle into four subt triangular area into how many subt triangular area into for subt triangular area so I first want to Define so this is stoc croid muscle so let me just so exactly this this is stoc cloid muscle this is the anterior neck line and this is actually the mandible lower border going towards the must so black outline which you are seeing the black outline which you are seeing which I have marked here is the whole of the boundary for the anterior triangle so you can see whole of the anterior triangle I have marked out so no worries about this let me just check with the students so exactly uh everybody if you have got any doubt yes you are right sah so exactly if I talk about the overall boundary of anterior triangle has been so now I want you to know about the sub triangular spaces for example pink color area which you are seeing actually this is one half of a triangular space that is submental triangle which triangle is this this is the submental triangle so wait a minute so I'm talking about this triangular space this is the submental triangle area okay this one half of the sub so actually below the symphisis M what is this this is symphisis M on both the side here there will be a complete subt triangular area and this is lying below the symphisis M but it is lying above to this bone which bone is this this is the hyoid bone so this is H for hyid bone so this is lying above the hyid bone so it is lying above h bone so this is L above hyoid bone okay this bone I will use gray color for it this is the hyoid B done now there is a green color triangular area so exactly this triangular area we are talking about this triangular area this green color triangular area which has been shown here this is the next triangular area that is sub Mand triangular area actually subm triangular area is also called as digastric triangular area and it is bounded by the anterior so actually in between the two anterior bellies of the digastric muscle the small triangular space which is lying above hyid bone and Below symphisis M that is submental triangle area yeah so exactly uh the base of the mandible and the line going towards the musite process below it here we have got a triangular area here this area this is called as digastric triangular area or the sub mular triangular area so exactly lower to it you can see the the bellies of the muscle so this is the digastric muscle belly and Stylo head so this muscle bellies are forming the boundaries and this is the anterior belly of digastric muscle so you can see here the two digastric muscle is there and the yellow color triangular area which you are seeing here is the muscular triangle area actually this muscle belly is the superior muscle Belly of the omo hard muscle which is uh which is uh participating in the division of the anterior triangle now and the blue color triangular area which you are seeing is the koted Triangular area which is like anterior to sternal PLO must muscle and in between the superior Bell of mohide and the digastric muscle so don't worry I individually also I'm going to tell you about the boundaries so this was just a uh just a overall subdivision of the Triangular areas of the anterior triangle but overall I will give you the individual definitions of the boundaries of the Triangular area so four triangular areas are there let's start with the first triangular area which is called as submental triangular area which triangular area I'm talking about submental so let me just enlarge it can everybody appreciate the submental Triangular area okay so exactly you can see this small triangular so this is the mandible bone and this is the hyoid bone so what you can see that exactly exactly below the mandible so exactly this is the area this is the mandible bone and this is the high bone exactly below the mandible in between the two side anterior belly of digastric muscle we are talking about the anterior belly of digastric muscle so this is exactly this green muscles which you are seeing here are the anterior belly of d muscle these are anterior anterior belly of digastric muscle so these are anterior belly of digastric muscle and above the high bone we have got which triangle we have got the submental triangle and what is important for your examination is to know the contents of submental triangle and the boundaries is it okay so let's talk about the submental triangle so I just want to enlarge this and I want everybody to write uh the details of submental triangle you have to know about the boundaries and the content so on each side it is bounded by [Music] anterior bellies of digastric muscle anterior bellies of d gastric muscle anterior belly of digastric muscle base body of hyid bone if Apex symphisis Mente so done so these are all about the boundaries so these are all about the boundaries of submental track so these are all about the boundaries of submental triangle and the next is to know the content of submental triangle and next is to know the content of submental triangle so the content of submental triangle is so the roof is formed by if I talk about the roof so if I talk about the roof the roof is formed by investing layer of deep cervical fascia roof is formed by investing layer of deep cervical fascia so roof is formed by investing layer of deep cervical fascia and the content is the content is some mental lymph node and that of submental lymph node and also the vein which is commenced and for here is anterior jugular ve so it contains some mental lymph node it contains some mental lymph node it contains commencement of anterior jugular ve so the submental lymph node the anterior jugular vein all these are the contents for the submental triangle now I just want also that you should know the floor of submental triangle so it's also important so this this is about the roof this is about the content and what about the floor so can you please note down the floor so if I talk about the floor the floor of submental triangle is formed by uh uh just one muscle that is the mohide muscle and which is meeting in the midline to form miloy rapid so the floor is formed by mohide muscle miloy muscle and it is meeting in midline to form Milo hyoid rapid done done everyone so the next thing is to know the next triangular space which I want everybody to understand is the digastric triangle or the submental triangle okay dear if anybody uh so is the pace okay is the pace okay should I go more faster or is it okay are you able to understand now the next triangular space is the digastric triangle which is also called as submandibular triangular area digastric okay so very good D so stud everyone was telling me to go slow today they are telling okay so here wenes is telling okay you can go at a faster rate very good yesterday everyone was telling please go slow soly I started slow so okay the other name of digastric triangle is can anybody tell me median ra okay you are not under so Hassan is tell Hassan is asking what is median ra actually if two muscles meet in the midline the fibers which is interdigitating so the fibers of interdigitating muscles is called as median RAF Hass I will show you an image for it so if you will see this image this is about the submental triangle so Hass can you appreciate here see here H so you can see these fibers are meeting in the midline so if you will see the F mus muscle fibers of the muscle fibers of the two side mohide muscle is meeting in the midline so if you will see the muscle fibers are meeting in the midline I should use black color so that you can understand see here so you can see the fibers are meeting in the midline and these meeting of the mohide fibers together is called as uh Medan RAF so Hass is it okay have you understood okay now let's talk about the digastric triangle the other name of digastric triangle is some mandibular triangle so I will go slight faster because everybody is okay for it so you can see this is the mandible bone lower border this is the so this is the anterior belly of digastric this is the posterior belly of digastric along with the styo hard muscle and this is the hyoid bone so this triangular area which you are seeing is the is the submandibular Triangular area or the digastric Triangular area so I just want everybody to quickly write it because yes we have to finish many topics so I want to be slightly faster so let's uh write the boundaries of digastric triangle boundaries of digastric triangle so the boundaries are ano inferiorly Antero inferiorly it is bounded by anterior belly of digastric muscle okay postero inferiorly and if I talk about postero inferiorly postero inferiorly it is bounded by posterior belly of digastric it is bounded by posterior belly of digastric muscle and this is supplemented by one more muscle and the name of that muscle is stoh highed muscle the name of that muscle is stylohyoid muscle now coming to the base the base is formed by the base of mandible base of mandible and the imaginary line which is extending till the level of must process so I think plus the must process imaginary so I think it is uh it is known to you this is an imaginary line extending till the level of mastoid process Apex if I talk about Apex the Apex is formed by intermediate tendon of Apex is formed by intermediate tendon of digastric muscle so done so here we have done with the boundaries of digastric triangle and now I want everybody to note down the floor so floor muscles you can see these are the floor muscles so you have to know about the floor muscles and the floor muscle of digastric triangle are so then we will come up with the content so the floor muscles are please write down the floor of digastric triangle floor of digastric triangle is formed by Milo hyid muscle hyoglossus muscle and that of middle constrictor muscle mle constrictor muscle posteriorly now what about the contents so if I talk about the contents as the name only suggest the digastric triangle will have some mandibular Tri so the digastric triangle is having some mandibular gland it is having actually the content of content of the digestive triangle or the sub man triangle can be categorized as the content lying in the anterior part and the content lying in the posterior part if I talk about the content in the anterior part it contains some Mand gland it contains some Mand lymph node it contains hypoglossal ner it contains facial vein facial artery the submental artery Milo hard nerves and the vessel when we will proceed more posteriorly it will have the external koted artery the part of the koted sheath also and the structures which is passing in between the external and internal carotin artery so we will write the important content so I just want you to the cadic image in this cavic image you can see the outline of the submandibular gland which is an important content for the digastric triangle you can also appreciate the facial artery as the content you can also appreciate the facial vein as the content you can also appreciate the Milo hard muscles and you can see other important contents also has been shown so see here the important so you can important content which I want want everybody to note down here is the nerve so we have got hypoglossal nerve so you can see this is the hypoglossal nerve which is an important content we have got mohide nerves and the vessel NF to mohide is there these are all important so we can see here important contents of the digastric triangle is been shown so we have we are seeing the hypogen L we are seeing the miloy nerve to miloy nerves and we can also see the other contents here as the SU ular gland the facial vein facial artery you can see the facial vein and facial arteries okay so all the important contents of the digastric triangle is done so let me just write quickly everyone is it okay can we write quickly the contents so the contents are contents of the anterior part the contents of the anterior part yes so the contents are submandibular gland a very important content submandibular lymph node hypoglossal knob facial vein facial artery facial vein is there the facial artery is there as the content we have got submental artery we have got miloy nerves in the vessels miloo in the vessels all these are the contents other than that content in the posterior part now in the posterior part of the digastric triangle we have got other important contents like a part of ECA external koted artery will be seen a part of koted sheath and its content will be visualized and a part of uh structures between structures ECA external coted artery and that of IC actually that all St stoidis will be seen related structure the next triangular space is so exactly I will just check is it okay important contents only you have to know yes yes dear cordal part of parotic gland is also there yes yes bankes you are right the codal part of parotic gland is also there absolutely correct yes a thumbs up goes for you that is also correct yes that is also correct but I I just want everybody to focus on the most important content because uh that is highly important for you to know so can you see this triangular area outline that is the koted triangle so this triangle is the koted triangle which is bounded by following muscle so it is bounded by stoco muscle this has styo high digastric and also the superior belly of omoh heart so all of you please write down the koted triangle boundaries so carot triangle boundaries superiorly carot triangle boundry so superiorly it is bounded by superiorly it is bounded by posterior belly of digastric posterior belly of digastric and it is supplemented by Stylo hyid muscle ano inferiorly if I talk about ano inferior aspect so ano inferiorly if I talk about the boundaries of the koted triangle it is bounded by Superior belly of omy posteriorly it is bounded by anterior border of sternal Clomid muscle anterior border of stern Cleo must muscle okay now the next thing is to know the R so I would like everybody to know the important contents which is very very important for you and also you have to know the floor muscle you have to know the floor muscles and the roof so I'm not telling the roof one by one for every individual triangular space the reason is that because we already know that the roof is formed for the both anterior and posterior triangle the roof is formed by investing layer of deep cervical fascia so I'm not writing it once again okay please write down the floor structure so please write down floor heading floor of digastric if I talk about the floor the floor of digastric triangle is containing four muscles it contains thyrohyoid muscle it contains thyroide muscle it contains hyoglossus muscle it contains middle constricted muscle it is formed by middle constrictor muscle it contains inferior constrictor muscle it contains inferior constrictor muscle it contains inferior constrictor hylis and thyro hard muscle so done with this these are the floor structures now other than that let's talk about the content so if I talk about the content the content of the koted triangle why it is one more point I want everybody to understand the koted triangle is mentioned as koted triangle the reason is why because it is containing all koted it is containing common carot Ary it is containing internal coted artery it is containing external koted artery it is containing koted body coted sinus it is containing last three cranial nerves that is 10th 11th and 12th it is containing Ana cervicalis uh is a nerve Loop which is embedded in the anterior wall of carot it is containing deep cervical lymph node and cervical part of sympathetic chain so exactly uh you can see overall many important things has been as a Content so you can see the actually carot sheath is containing internal jugular vein cared artery and vagus nerve so blue color structure is internal jugular vein then we have got the common coted arteries we have got the vus knob these are the image where you can see the internal jugular vein you can see the hypoglossal nerve you can see the also the common koted artery external and internal koted arteries here so here is a schematic diagram to make you understand the contents so what you can see important contents of the koted triangle which is shown in this image will be the vagus nerve has so exactly last three nerves vus nerve is there the hypoglossal nerve is there and the accessory nerve is there we have got all the koted arteries we have got the branches of koted arteries are also we have got five branches of the koted artery which is a Content so the branches are facial artery lingual artery Superior thyroid artery ascending parangal arteries occipital artery so you can see lingual facial Superior these are the three anterior branch occipital and ascending parang Ares are there and we have got the Ansa cervicalis embedded in the anterior wall so quickly write down the contents of koted triangle so the important contents are it is called as koted triangle because all koted arteries are the contents so it contains common koted artery it contains common carotid artery it contains external kotd artery and its branches if you want you can write the important branches also it contains internal koted artery so in other words you can say all the important arteries koted arteries is the content of the koted triangle it contains Superior thyroid artery it contains facial lingual artery facial artery is there lingual arter is there there is also ascending fenal arter and occipital AR so all these are the contents for the cared triangle other than that it contains last three cranial nerves so when I'm using the word last three cranial nerves it means it is containing containing the vus nerve it is containing the spinal accessory nerve the 11th cranial nerve and it is containing the 12th hypoglossal cranial nerve it also contains koted sheath and its contents koted sheet so we have got three contents of the koted sheet vus nerve IV koted artery other than that it contains koted body koted body it contains koted sinus in the other than that it also contains Ansa cervicalis it also contains uh the Deep cervical lymph nodes and it contains the cervical sympathetic chain cervical sympathetic chain so all these structures are the contents of carot triangle all these structures are the contents of koted triangle now I just want everybody uh so exactly I just want everybody to know also about uh I uh so exactly uh if I want to talk about about uh the important part uh so I just want everybody to know the details of accessory now okay so uh uh exactly accessory uh nerve is also in the anterior triangle yes you are right it is also in the anterior triangle and other than that I would also like to take uh tell you about if I talk about I just want everybody to also know about Ansa cervicalis okay so exactly so exactly if I talk about Ansa cervicalis it's a nerve Loop which is embedded in the anterior wall it's it is actually embedded in the anterior wall of the koted sheet so it say embedded in the anterior wall of koted sheet so let me just check so yes uh accessory n yes it is actually we have got this as an anterior triangle and this is the posterior triangle so it is in the part of koted triangle also and then it is traversing through the through the posterior aspect through the middle of the posterior aspect of stern muscle and giving ination to stern and trapas muscle is it okay wenes so it is traversing in the part of the koted triangle of uh of the anterior triangle and then it passes into the plastered in between the investing and pre vertebral layer of deep cical fascia and it is giving inovation to the two muscle sternomastoid muscle and the trapas muscle is it okay WESH okay now one of an important thing which I want everybody to understand is the Ansa cervicalis loop it's a nerve loop it's a nerve Loop which is embedded in the anterior wall of koted sheath and it is formed by so exactly you can see the lower limb of Ana cervicalis is formed by C2 C3 and the superior belly so exactly if I talk about the Upper Limb of Ana cervicalis it is formed by C1 which is running along with the hypoglossal so actually all the infrahyoid muscle is supplied by the Ana cervicalis nerve Loop except thyy because thyr hard is supplied by the hypoglossal LA which is running along with C1 so this is the odman out so Ansa cervicalis nerve Loop is Ansa cervicalis is embedded in it is embedded in the anterior wall of carage sheath it is embedded in the anterior wall of koted sheath okay and it is formed by so it's a it's super Superior root it is having a superior root it is having an inferior root it is having a superior root and inferior Superior root uh Superior root if I talk about the superior root it is formed by the C1 nerve fibers running along with hypog nve and C2 and C3 is inferior so it runs along with the hypoglossal nve okay run along with the hypoglossal nve so C one and all the other important point is all the infrahyoid muscle all the infrahyoid muscle so infrahyoid muscle cells Stern noide Stern thyroid omoide all are supplied by the Ansa cervicalis nerve Loop except thyroide this has been asked several times in the examination so all the infr hard muscle is innervated by Ana suralis no glop cervicalis Loop except thyroide muscle so exactly thyroide muscle is not innervated by the nerve Loop It Is innervated by C1 nerve which is running along with the hypoglossal nerve so this is not exactly innervated by the loop of Ana cervicalis now the other important point is as I told you I just want every everybody to see this image actually in this image you can appreciate uh the location of nerve Loop and yes good afternoon dear so exactly what you can see if we are talking about so it is lying on the anterior wall of the carage sheet so exactly I'm using this this is the koted artery this is the common koted artery actually this is the koted artery which has been sewn this is the koted artery no doubt about that now other than that you can see the jugler also this is internal jugular vein and this is the vus n okay so these are the contents of Ansa cervicalis and anterior to it anterior to it the nerve Loop is traversing and you can see here this is the nerve Loop which is traversing anterior to it this is the nerve Loop which is traversing anterior to it and this nerve Loop is this nerve Lo so this is Sr this is a superior and this is the inferior nerve Loop of this nerve Loop is Ansa cervicalis nerve Loop which is lying anterior to the content of koted sheet this is lying anterior to the content of koted sheet okay done with this now we are uh now I would like to talk about the last triangular space in context of the muscular triangle so you can see the yellow color triangular area which has been outlined here this is triangular area which you are seeing is the the so this triangular area which you are seeing is the muscular triangular area this is the muscular triangular area and if I talk about the boundaries of this muscular triangular area uh it's important to know the boundaries it's important to know the boundaries and it's also important to know the content so the first thing is that why it is called as muscular triangle because no neurovascular structures are residing it is mounded anteriorly by the anterior mid neckline anos superiorly by the HoHo muscle so enteros superiorly by the HoHo muscle Superior belly of HoHo muscle and if I talk about postero inferiorly byoo musine muscle anterior border this is the boundary and it contains muscles it contains actually infra hard muscle Stern hard Stern thyroid and thyro hard muscle these are the muscles which is forming floor and the content of muscular triangle so please write down about the muscular triangle first thing is to write the boundaries and the boundaries of muscular triangle is it is bounded anteriorly by the anterior median neckline anterior median neckline it is bonded uh ano superiorly by it is bounded ano Superior if I talk about anos Superior aspect so ano superiorly it is bounded by Superior belly of HOH Superior belly of omy muscle it is bounded by Superior Belly of the omo hard muscle and postero inferiorly it is bounded by postero inferiorly it is bounded by the sternomastoid muscle to be more specific it is bounded by anterior border of sternomastoid muscle so it is bounded by it is bounded by anterior border of stern plutoid muscle so done with this so if I talk about so exactly if I talk about the content and the floor so if I talk about the content and the floor are similar so you uh if you will see this is the muscular triangle which we are talking no this is the muscular triangle so exactly in this muscular triangle we have got the muscles only we have got steroide sto thyroid and thyroide muscle which is similar the Flo and the content is similar so please write down please write down the heading content and floor of muscular triaging content and floor of muscular triangle so if I'm talking about the content of the floor and muscular triangle these are similar so it is it's it is having the content and floor as a similar structures three important structures are L they are Sterno thyroid muscle sternohyoid muscle and that of thyrohyoid muscle thyrohyoid muscle okay so is it okay anything which you yes good afternoon uh uh Mr ramu but I just want if you are not understanding anything just let me know please let me know now we have finished with all anterior posterior two more triangular space I want you to tell because these are the other two important triangular spaces in brief one is the scalino vertebral triangle so if I talk about scalo vertebral triangle you can just see here this is the muscle which is the longest coli muscle this is the longest coli muscle which you are seeing this is longest coli muscle and this muscle is scaliness group of muscle this is the scelus group of muscles we have got scelus group of muscle so exactly in between scelus muscle longest CI muscle and inferiorly we have got the subclin artery inferiorly we have got the subclin artery so exactly in between the subclin arteries in between the scalenus muscle and in between the longest CI muscle the Triangular space which you are seeing the Triangular space which you are seeing so I'm just talking about this triangular space if you want I can use another this triangular space so this triangular space I'm talking this triangular space which I have SED in slight green that triangular space is scalo vertebral triangle and it is having the first part of the vertebral artery residing in this area so scelo vertebral triangle is bounded by longest scoli muscle it is bounded by scelus muscle and inferiorly by subclin artery and it contains first part of it contains scelo vertebral triangle contains first part of vertebral artery as a vertebral artery as the content okay now basically I just want everybody to note down the important Point only so here you can see again if you will see this image you can understand so here we once more I want to show this image this is the scelus muscle scelus an this is longest coli muscle okay this is the subclin artery so this is the subclin artery okay this is the subclin artery so there is a subclin artery there is a scelus anterior muscle there is longest CI muscle which is forming the boundary and the content which is lying inside is the vertebral artery so most important content is the vertebral artery which is lying inside also you can see in the left side there is the content so in the left side there is thoracic duct also here we will have the Sate ganglin so all these are the content for the scelo vertebral triangle now I would like to talk about the next triangular space so here we can have uh more of the images to understand so actually uh in the left side in I just want to note down important in left side scalino vertebral triangle contains thoric duck also it is related to Sate gamon and one more structure is there that is actually here you can see in this triangular area there is one Ansa subclavia which is also the content there is cervical gangon also the content and there is also the Ansa sub subclavia I will talk about Ansa subclavia also which is the content now I just want everybody to see this cavic image actually this cavic image is importantly showing the most important content so what is basically important for us is to know the most important content so I I just want here this is a subcl an artery this is the vertebral Ary this is the subcl artery this is the vertebral artery and here this is the longest coli muscle this is the longest coli muscle this is the scalenus anterior muscle so this triangular space which we are talking is the uh this TR okay okay just a minute I just want to rub this okay so I'm talking about this triangular area so if we are talking about this triangular area yeah so this is subclavian artery and the structure lying inside is the the structure which is lying inside is the vertebral artery so you can just use this color this is VA for vertebral artery and this is sa say for the subclin AR so these are the structures so this triangular area which you are seeing is the scalino vertebral triangular area so this triangular area is scal youo vertebral triangular area yes now uh I just want that in this triangular area we have also got the uh one and important nerve Loop that is Ansa subclavia so an important nerve Loop is there that is called Ansa subclavia I would like to talk about Ansa subclavia so actually Ansa subclavia is called as subclavian Loop and it is also called as vense it's a nerve Corde connection between it's a Nerf code connection and this n code connection is lying between the middle and the inferior cervical gang so uh exactly this is lying between the middle and inferior cervical gangon it is commonly fused with the first thoracic gangon and it is called as state gangon so exactly when we talk about the Nerf Corde connection which is taking place between medial and inferior cical gangon it get fused with the first thoracic gangon and lead to the formation of state gangon is it okay so this is exactly the content so this is also the content of on the sco vertebral triangle scalino vertebral triangle got it everyone got it now uh one of an important triangular space which is very very important so many questions has been asked from this topic so exactly you have to also know if any of the students is not understanding anything please let me know okay if you are not understanding anything please let me know my dear students okay so next triangular space is sub is that of the sub occipital triangle and you can see in this image I have just highlighted this triangular space which you are seeing is a suboccipital triangle so exactly if I talk about this uh uh exactly if I talk about this triangular space we have to know about the boundaries okay we have to know about the boundaries of it and we have to know the important structures actually subcl triangular space sub occipital triangular space has been asked so many times it has been asked so many times in the in the examination okay okay so exactly that is very important so actually one of the student has asked me about Sate gangon so actually if I talk about Sate gangon uh it is a uh collection of sympathetic nerves which is found anterior in the neck reason and the important function is that it is giving uh it is most important providing sympathetic nerve Innovation to head neck arm and also a part of upper chest okay so it's a part of autonomic nervous system and it is respons responsible for controlling many of the ination in the area of head neck arm and a portion of chest also is it okay is it okay venkatesh so that is a function okay that is a function it is important function for the innovation of the autonomic nervous system of the head and neck areas now suboccipital triangular space if you will see in this image you can see the suboccipital Triangular space which is having the boundary so it is bounded by rectus capitus posterior major as the supro medial oblas capitus Superior this is oblas capitus superior muscle as the suol lateral boundary inferiorly we have got the oblas capitus inferior so these are the three muscle which is forming the boundary of sub oxital triangle medially superomedially rectus capitus posterior major superolaterally oblas capitus um Superior inferiorly we have got oblas capitus inferior muscle so I just want everybody to write down the boundaries so one more image is there where different color has been used so here red color muscle is inferior boundary which is oblas capitus which is oblas Cap which is exactly oblas capitus inferior muscle oblas capitus inferior this is the oblas cap and the blue color muscle is rectus capitus posterior major oblas Capital Superior is the green color muscle and these are the three muscle forming boundary of sub oxital triangle so write down heading boundaries of suboccipital triangle boundaries of sub occipital triangle so if I talk about the boundaries of suboccipital triangle you have to know the important structures forming the boundar so we have got following important structures so suo medially supro medially is bounded by rectus capitus posterior major muscle suo laterally it is bounded by oblas capitus Superior muscle oblas capitus Superior muscle inferiorly it is bounded by oblas capitus inferior muscle oblas capitus inferior muscle so uh these are the boundaries of suboccipital triangle and we have to know the floor and the content so if I talk about the floor the floor structures are so we have to talk about the floor so here itself you can see the floor structures floor of suboccipital triangle floor of suboccipital triangle is formed mainly by the two structures one is posterior arch of for cervical so one is the posterior Arch so please don't get confused with the third part of vertebral artery it is not the floor but it is the content so posterior atlanto occipital membrane so two structures are forming the floor one is the posterior atlanto occipital membrane and the other is posterior arch of first cervical vertebra we have got posterior arch of first cervical vertebra so this is the two structure this just AE these two structures are forming the content of Flo so we have got posterior arch of C1 and we have got posterior posterior atlanto oxy membrane posterior atlanto oxital membrane now the content is the third part of vertebral artery the sub oxital Venus flexus and sub oxital nerve so if I talk about the content so in this diagram we can see the content content is sub oxital kn vertebral artery third part and sub oxital so you can see here this is the third part of vertebral artery which is residing inside so we have got the third part of vertebral artery we have got also the suboccipital nerve and also suboccipital Venus plexus as the content so please write down the heading content of content of suboccipital triangle so the content of suboccipital triangle is following it contains it contains sub occipital KN which is formed by the dorsal Ramis of for surv so it contains sub oxital nerve as the content so it contains sub occipital knob as the content it contains suboccipital Venus plexus as the content sub oipal Venus plexus as the content and it contains third part of vertebral artery it contains third part of vertebral artery as the content third part of vertebral AR contains third part of vertebral artery as the contain so you can see here all these structures which has been mentioned here is the content of sub oxital triangle so done with this one time the question which was asked in the previous year was the boundary of sub oxital triangle that was superolateral boundary and superolaterally it is bounded by oblas capus Superior muscle so we have finished all the Triangular spaces of the neck so we have finished this topic also now I want to tell you about the important arteries so everyone can we proceed with the next category all the arteries all the important arteries of the head and neck series so all the important arteries of head and X Series is we have to know about the branches of external koted artery we have to know about the branches of maxillary artery we have to know about the branches of facial artery these are the few important arteries which is very very important important for you to note out so exactly if I talk about external carotid artery it is a branch of common carotid artery the bifurcation of external koted artery and internal koted artery from common koted artery takes place at the level of C4 cervical vertebra so exactly it takes place at the uh at the uh at the area of C4 cervical vertebra external koted artery is a very important artery it is giving arterial Supply to head and neck reason and internal koted artery will give blood supply to that of the brain area so done with this now I just want everybody to note down the important branches of external carotid Ary I actually there is a pneumonic to know the branches of external carot that what is that pneumonic that pneumonic is some anatomist like freaking out po medical students some anatomists like freaking out poor medical students so you have to know about the branches in the same way okay so you have to know all these are very important so actually in koted trangle it gives following branches so it gives Superior thyroid artery as one of the anterior Branch ascending fenal arter is the medial branch lingual arter is an anterior Branch facial arter is also an anterior Branch occipital posterior arular arteries are actually the branches from the posterior part and we have got two other branches maxillary and superficial temporal these are the terminal branches so here in this diagram all the branches of external cared artery has been shown to you so everyone as you can see here so exactly in this condition if I just want to yeah so exactly if I talk about superficial temporal and the maxillary artery okay other are giving other pneumonic okay so I will give May on other pneumonic which I like so superficial temporal very good dear very good oshama so superficial temporal and Max are the two terminal branches so these are two terminal branches okay the posterior and the occipital if I talk about posterior occipital these are two posterior branches these are two posterior branches of external koted artery facial lingual and Superior thyroid these three are the anterior branches these three are the anterior branches of external koted artery and we have got just one medial branches we have got just one medial branch that is ascending parangal so one medial branch of external koted artery is the ascending fangel artery so all these are the branches of external koted arteries so next important point is to write this so exactly I just want everybody to write a pneumonic for it so write down the pneumonics so write on the pneumonic yes you are right W it is some anatomist like freaking out poor medical students so this is a pneumonic for the branches of external cared artery so here we have got s for Superior thyroid artery here a for ascending fenal artery L for lingual artery f for facial artery another o n p for occipital and posterior oricle artery posterior oracular artery M for maxillary artery and another s for superficial temporal Ary so exactly here together you can get 1 2 eight branches so all these are the branches of external carot artery done with this now I just want everybody to know with the other arterial artery that is maxillary artery so as we know maxillary artery is one of the so one of the terminal branches of external cared artery and maxillary artery branches are very very important so maxillary artery branches are very important so exactly maxillary artery is divided into three parts by a key muscle in the infratemporal regon and the name of the key muscle in the infratemporal regon is lateral teroid muscle lateral teroid muscle is dividing maxillary AR into three parts it is dividing into three parts first second and third the first part is lying uh exactly uh in the mandibular part it is also called as mandibular part actually it is lying uh the first part will be lying above lateral teroid so exactly it is traversing towards it is starting from the neck of mandible to the lateral teroid muscle posterior to lateral teroid muscle is the second part and the part of lateral ter and the part of maxillary Ary which is traversing through the Tero maxillary Fisher and to the Tero magary area that is the third part so that means we have got three parts in the max R3 and we have to know the branches of individual parts so in this diagram you can see the key muscle of the infratemporal reason this is the upper and this is the lower head so in this diagram you can see the upper and the lower head of the lateral teroid muscle and in correlation to these muscles we have divided the maxer Ary into three parts actually what is important for you to understand is that you have to know the branches from the individual component of maxat so there are very many pneumonics but I think pneumonics is good but you have to understand the branches so that you will this will remain in your functional area of the brain for long duration of time so let's talk about the branches of first part of magat Mag so maxillary are three first part so first part is called as the mandibular part of the maxat and you have to know the branches from this part so the branches of these part that is the branches from the mandibular part of maxat is following and the branches are the branches are actually there are five branches from the so actually there are five branches from the first part so so actually there are five branches from the first part and the five branches of the max artery or Mand part of Max arter is following the branches are two is towards the ear two is towards the ear that is anterior tanic and de paricular artery so and one is Middle menal artery other is accessory middle menal artery and the other is inferior alol artery so exactly uh what I think I should firstly explain and then write it to you so I just take a image for it yeah see here so actually this is a schematic diagram this is a schematic diagram where the three parts of magary artery has been swn so in the first part you can see this is external koted artery and its two terminal branches has been sown one is superficial temporal this is superficial temporal and the other is maxillary Ary so here is the the first part okay so we have got the first part of Max artery and we have to know the branches from the first part so how many branches are there from the first part so if I talk about the branches five branches are there and I'm just highlighting these five branches so this is the first Branch yes many pneumonics are there many pneumonics are there that is so here wenkes is telling damn I am poor dreamer but uh but start dreaming prefer my P so yes you can make your own pneumonic what I feel is how to remember the first part is we have got two going towards the ear that is anterior tanic and deep oricle one is going inside the oral cavity inferior arol artery two is going towards the menes of the brain that is Middle menal artery and accessory middle manal artery so exactly if I want to tell about these branches so we have got together five branches and these are the five branches so here we have got deep oric we have got anterior tanic middle manal artery accessory middle manal artery and we have got inferior alol artery which further divides into mental mohide branches now I will you use a different color for the second part branches so I'm using brown color for the second part branches because second part branches the branches of second part of maxillary artery are all muscular so why I have used brown color all the muscles are in anatomy sewn by brown color and all the branches of the second part is also muscular so we have got anterior posterior temporal teroid buckle buccinator mric and teroid so all these branches so we have got branches to teroid muscle we have got branches to the uh vinator we have got branches to the masor and temporalis muscle so all these exactly the we have got anterior and posterior deep temporal teroid we have got Bator and uh meor so all these branches are the muscular branches and the third part if I talk about the third part branches the third part branches are six and also a terminal branches given so most of the branches of the third part is having p is having P name attached to it so one is the odman that is inferior orbital artery otherwise we have got posterior Superior alol we have got spop Palatine artery which is the terminal Branch artery to terog Canal fenal artery and descending palatin Ary so how you are going to remember in the six branches most of the branches is having p word attached to it so we have got all together how many branches we have got six branches from the third part of maxar arric so we have got six branches from the third part of maxar arric so it's important that one by one you have to know the paths branches because the question will be asked like this so let's talk about that so first part branches please write down the branches of the first part so first part branches are deep oric anterior tanic artery yes hello to you Anor tanic artery yes monaa hello middle manal artery then we have got accessory middle manal artery accessory middle manangel artery yes yes Balaji hello wenes yes yes you are absolutely right it is the inferior alol Ary so altoe we have got the first part of the maxillary ARP is called as the mandibular part the magary artery and this Mand part of the magary artery is giving five branches the Deep oric the anterior tanic the middle manal artery accessory middle menal artery and inferior alol artery now talking about the second part so actually I just want to elaborate one of the branch actually middle menangel artery is clinically very important if there is a direct hit or striking on the lateral aspect of the skull it can lead to the bleeding from the middle menel AR to be more specific it's the anterior division anterior trunk of the middle manangel AR3 along with the Sylvian sulcus which is overlining on this area and there can be a bleeding from this Branch so exactly you can see here this is the middle menal artery branch of maxillary artery first part and this is an X saap suture what is this xap suture called as tyon so at the level of tyon we have got the anterior trunk of the middle manangel artery lying there so if there is a hit or a direct stuck on the lateral aspect of the skull bleeding can occur from the middle menangel artery anterior division leading to epidural or extradural hematoma so it's a it can be injured at the level of at the level of tyon and it can be lead lead bleeding from a bleeding from from anterior division or trunk of middle menal artery can take place and this condition will lead to epural or extradural hematoma so done with this yes you are absolutely right Wes EDH extradural hematoma at the level of Theon yes you are absolutely right the same thing now talking about the next so let's talk about the second part branches so if I'm talking about the second we have so if I'm talking about the branches from the second part all muscular branches you can just write all muscular branches and these are the muscular branches to the adjoining area of the muscles which is lying nearby so we have got deep temporal Branch we we have got deep temporal artery which can be again anterior and posterior we have got mric artery we have got teroid artery we have got the buck Buckle artery buccinator Branch Buckle artery so all these are the branches from the second part of the maxillary artery and all these are muscular branches now talking about the branches from the third part of maxillary the third part of the magary artery is the terop Palatine part because it will Traverse through the Tero magary fure and it is giving six branches how many branches it gives it gives six branches and it also gives the terminal Branch the name of the terminal branch is uh is the is the sphenopalatine artery yes Balaji you are absolutely right the second part branches are the muscular branches absolutely correct Balaji now let's talk about the third part the third part it is giving six branches and uh how to memorize this branches I would like to suggest that these all branches is having p word in this name and only infraorbital is the odman yes monaa you are absolutely write the branches are posterior Superior alol Ary please write on the name the names are as following posterior Superior alol artery posterior Superior alol artery again it is having P name attached to it we have got descending Palatine artery the descending Palatine artery will further give two branches the greater Palatine and the Lesser Palatine artery then we have got parangal artery artery to teroid Canal we have got infraorbital artery and sphenopalatine artery so actually these are the six branches so actually these are the six branches which is given from the so exactly we have got the six branches so exactly we have got the six branches which is actually given uh so these are the six branches which is exactly given from the maxillary RP so it's important that you should know all the branches name and it's also important that you should know that the spop Palatine artery is the terminal Branch so if I talk about spop Palatine artery it's the terminal branch of uh it's it's a terminal branch of maxillary Ary so you can just write down that so just write spop Palatine artery is the terminal Branch it's the terminal Branch it's the terminal Branch so now I just want everybody so we have done any of the students is having any doubt please let me know if you are having any doubt please let me know uh if there is an any doubt you are not able to understand any anything you can just uh uh just note down is it okay everyone please let me know I will just uh check okay greater Palatine artery infra yeah yes so G this biology is telling greater palatin artery yes you are right descending Palatine artery further GES greater than the ler palatin AR yes I can understand that some of the students get confused with the word palatin artery greater Palatine a few books have written as a greater paltin artery I I want to elaborate the the correct answer will be descending Palatine artery which further gives greater and the Lesser Palatine artery so descending Palatine is artery is a direct Branch from the third part Tero Palatine part of the magary artery which further gives the greater Palatine or lesser Palatine artery okay Dr shifa so Dr shif shifa is from Pakistan okay okay dear okay so let's talk about so yeah it's good that from many U different area and parts of the world the uh all of you are listening to this lecture so I'm so blessed now talking about the facial artery so facial artery is an another artery which is a very important branch of external koted artery it's a branch it's an anterior branch of external cared artery and this facial artery if you will see it's giving branches onto the face it is giving branches on the cervical reason so I just want to elaborate this image so if you nicely appreciate this image what you can see the branches of the facial artery is having torturous scores you can see this is the facial artery which is a branch from the external koted artery anterior branches so it will give many branches and it will be giving four branches in the cervical region and it will give four branches in the in the facial regon so actually it is having a torturous course the facial artery is an anterior Branch from external cared artery passes over to the masor muscle and then traverses towards the mandible and it will run along the nasol labal fold towards the angle of the eye so exactly it passes beneath the digastric muscle and passes through the muscle ultimately it passes through the submandibular gland so actually uh what I want everybody is to understand the facial artery branches it gives four branches on the face and it gives four branches in the cical reason the four branches in the cervical regon is tonsilla submental ascending Palatine glandular so these are the four branches which is given in the cervical region and four on the facial is the angular lateral nasal Superior labal and inferior label so all these you have to know these are the names of all the branches of the facial artery so together how many branches are there we have got eight branches already we have talked about the epidural hematoma and we have seen the bleeding occur from the bleeding occurs from the middle menal artery which get injured at the level of tyon so actually this is tyon where the middle menangel artery ruptures and gives the case of extradural hematoma now I just want everybody so everyone I I just want everyone to solve this McQ this is a clinical McQ I will give you one minute time or few seconds time 30 40 seconds to solve this McQ a 23 year old female ccasian female is brought to the emergency room she is unconscious when she is brought to the emergency room after a motor vehicle accident and a linear fracture is seen in the area of the junction of four Bones the four bones Junction is so we have got four bones which Junction is involved here and that is frontal parital temporal and spinoid so that is frontal parial temporal and spinoid these four bones Junction which is called as ston as I know I have just explained you can you tell me which of the following artery is CED at this location option is occipital maxer Opthalmic middle cerebral sphenopalatine and facial can you tell me the answer so I will give you few seconds so I will give you a few seconds please let me just check actually I have just explained and I think it's it will be easy for you to make give the answer so actually the location where this four bones are meeting that is called as ston that hint is given and we know the artery can so please write down the name of artery being involved firstly write down the name of the artery being involved so exactly the artery being involved is the if I talk about the artery being injured is the middle menel artery and we know that the middle menel artery is a branch of which artery middle menal artery is a branch of maxillary artery so definitely B is the right answer now let me just check with the students are they able to understand or not okay so yes dear students Max artery Branch middle man yes Dr SK you are absolutely right the maxillary artery is the right answer so directly they have not asked about the middle menangel artery in the option they have given the source of mdl menangel artery that is the maxillary artery so that is the right answer absolutely four bones are meeting at this location and due to the injury of these four bones located at the junction of this ET suture tyod leads to the bleeding from m menel R3 that is a branch from the that is a branch from maxillary R3 now next topic is tongue okay everyone so tongue is a very important topic for your competitive exam so I just want to complete tongue is it okay should we start with the tongue so after completion of tongue I will give you a break of uh uh 25 minutes we can take a break of 20 minutes 25 if you want to have your lunch is it okay let me know Dr SK Dr Balaji Dr Mona Sharma Dr wenes do Ajit Balaji everyone those who are uh uh uh here can we have the session so I just want to complete tongue and then I want to give the break if you want now you just let me know so because that is important that you should be I'm going to start a new topic it will take another 25 minutes and all so yes osma osma shake so everyone is okay if I complete tongue or should you want a break let me know so I should continue with the tongue I think we should continue with the tongue is it okay with everyone after completion of the topic of tongue we can have a break so tongue is a muscular organ and it's a it is made of skeleton muscle it is made of fibrous septums it is made of fat lymphoid structure and is also having mixed glands so this is the overall composition of the tongue you have to know the gross anatomy of the tongue and you have to know the detailed Anatomy so for that I just want to enlarge this image so when I'm enlarging it you can see the parts of the tongue are the root tip and the body we have to know the structures Ling in the dorsum and inferior part of the tongue we have to know about the tongue muscle we have to know about the arterial supply of the tongue we have to know about the nerve supply of the tongue vinus drainage lymphatic drainage and the clinical Anatomy so if you see this is the part of the tongue which is shown this is the dorsum part of the tongue and in the dorsum part of the tongue we have got Tong papillas okay so exactly I just want to firstly explain and then I will uh give you the details so all of you please see this image so all of if you just see this image if you see this image you can appreciate so what exactly is shown here is the dorsal is the dorsal part of the tongue so when you see the dorsam part of the tongue you can see there is a sulcus terminalis okay there is a uh there is a v-shaped sulcus terminalis so this v-shaped is the sulcus terminal posteriorly it will meet at a place that is called as foramen seeum what will it called as it will be called as FC what is FC it is called as foramin seeum that is the remnant of thyroglossal duct so that means this part which you are seeing will be the anterior 2/3 part of the tongue and this part which you are seeing will be the posterior 1/3 part of the tongue and it is important to know that what are the structures lying in the anterior part of the tongue and what are the structures lying in the posterior part of the tongue so exactly if I talk about the anterior part of the tongue it is incorporated by different kinds of papill so different kinds of papill is located here we have got four types of papill we have got the fil form papill we have got exactly I just want to highlight the papilles so we have got following papillas we have got circum valid Pap the largest Pap these are the circum valid Pap which is lying just anterior to sulcus terminalis we have got Philly form papl which are very small P distributed overall area of the anterior part part of the tongue fungi form paple will be slightly larger than the Phil form paple and it is it is in the anterior lateral aspect and also rudimentary papill is there this is the rudimentary papill which is called as the foliate pap so this is fungi this is Philly this is circum valet and this is the rudimentary which one is called as foliate papill so how many papillas are there 1 2 3 and and this is the fourth one so we have got four papes okay so just in brief you have to know about this P the papilla will have the tongue papillas will have taste word and that is important for Taste sensation the largest papill is a circum valid papill lying anterior to sulcus terminalis and it is having maximum number of taste word it is located just anterior to sulcus terminalis anterior to forarm and seeum it is actually lying in the anterior part of the tongue or you can say at the bord of anterior and posterior part of the tongue posterior part of the tongue if you will see on the dorsum aspect it is incorporated with you can see here it is having incorporation of lymphatic aggregation and this lymphatic aggregation is forming lingual tonsil what it forms it forms the lingual tonsil so it is forming the lingual tonsil what is it is forming it is forming the lingual tonsil also in this diagram you can appreciate that lingual tonsil is posteriorly having an attachment with this uh uh epiglottis what is this epiglottis what is epiglottis dear epiglottis is one of the lenal cartilage so this attachment will be via median glosso epiglottic fold and lateral glosso epiglottic fold and in between median glosso epiglottic fold and lateral glosso epiglottic fold I have cross there this is the area of vula okay so if I talk about overall epithelium lining of the tongue it is statisfied scus non- kariz epithelium but only the odd man out is Filly form Pap which is having the cratonization that is giving gritty appearance to the tong so yes so here uh if I talk about so I just want everybody to write few important things okay so I just want everybody to include one of important features the lining epithelium of the ter so lining epithelium of tongue is statisfied scas nonkeratinized epithelium it is statisfied scus non cariz epithelium so the lining epithelium is statisfied squamous non- cariz epithelium one the odd man out is the Filly form Pap so I just want to enlar this and I just want one or two important points to be written on this Pap okay so here uh if I talk about circum valid or valid Pap it is the largest papet it is largest location is already explained it is lying anterior to sulcus terminal it is having maximum number of taste birds so it is having maximum number of taste words it's very tiny and the Filip form papill is having keratinization so that means it will have statisfy scamma kenize epithelium it will have stratified squamous keratinized epith okay the fiate is the rudimentary papill it is a rudimentary papill and fungi form papill is also having taste word and it is uh it is actually uh it is actually inter so foliate is also having taste word but it is rudimentary in case of human beings okay so uh that are the important points which you have to me remember here okay now uh exactly in the posterior part of the tongue so this was about the anterior part of the tongue which is having actually other than that it is also tongue itself is made of muscle so it is made of intrinsic group of muscles and the muscle which is connecting the tongue to the neighboring structure is called as extrinsic group of muscles and exactly if I talk about its posterior part it is it is actually called as the fenal part and this fenal part of the tongue is having the aggregations of lymphatic uh nodules which is forming the lingual tonsil what is forming lingual tongil the posterior part of the tongue is attached to it is attach if we talk of the posterior part of the tongue it is attached to epig glotus the posterior part of the tongue is attached to epig glotus the posterior part of the tongue is attached to epig glotus by median and lateral glosso epiglottic fold glosso epiglottic fold and in between the median and lateral Glo epiglottic fold we have got the vula the location is of vula so we have got vula at this location now let's talk about the inferior surface so we have done with the uh Dome part of the tongue inferior part of the tongue will have few important things which you have to know so we have to know about the inferior part of the tongue which is highly important so if any of the student is not understanding anything they can ask me is it okay okay now inferior part of the tongue you can see there is okay vula you're not understanding okay one of the student vula you're not understanding so let me just enlarge this image okay you can see this is the epiglottis what is epiglottis epiglottis means the lenal cartilage and this is the elastic lenal cartilage and in the midline you can see the connection of epiglottis with the posterior part of the tongue is via median glosso epiglottic fold and laterally the attachment of the epiglottis to the posterior part of the tongue is by lateral glosso epiglottic fold so that means this is this is median gloo epiglottic fold and this will be lateral this will be just a minute this will be lateral glosso epiglottic so the space which is ly can you see the cross mark area the space which is lying between the medial and lateral glossoepiglottic fold that space is called as that space is called as vula so Asif have you understood ASF so this space is called as vula so we know that epiglottis is attached to the posterior part of the tongue by folds what is the name of that fold in the midline that fold is called median gloptic fold in the lateral aspect it is called as lateral GL tic fold so in between medial and lateral glossoepiglottic fold there is a space that is marked by a cross and that space is called as vula clear now okay as if okay now in the inferior aspect of the tongue we have got the location of deep lingual vein we have got another fibrous area here you can see the inferior part is connected to the the inferior part of the tongue is is connected to the oral cavity inferiorly by a attachment of mucosal fold that is called as fulum lingu and also there is a fated fold laterally okay yes good evening Mahendra good evening so actually there is also opening of the orifices of sub mandibular duct which is called as Von duck so that means in the inferior aspect we have got following things we have got perum lingu we have got deep lingual vein we have got Fila fimata and also the opening of submandibular duct submandibular duct is also called as won duct is also called as won stuck it is also called as Wen stuck so done with this okay now I would like to talk about the muscles of the tongue so actually the tongue Mass if I talk about the tongue Mass it itself is made of intrinsic group of the muscles and that intrinsic group of muscles are the uh are the superior longitudinal inferior longitudinal verticalis transverse group of muscle fibers they are forming the intrinsic muscles of the tongue but tongue is attached to the neighboring structure that is called as extensive group of muscles and the name of that extensive group of muscles are it is having genioglossus hyoglossus styop plat and condres actually krosis is the muscle which is derived from the hyoglossus only so we have to know about this five muscles of the tongue which is called as the extrinsic muscles of the tongue so in this diagram we can see the muscles we can see the genosis muscle we can see the hyoglossus muscle styloglossus muscle the loglis muscle and also we know that qur glossus muscle is the part of hyoglossus muscle one so one by one I will talk about all the extrinsic group of muscle the first fan shaped muscle which is appreciated in this image can you see this fan shaped muscle appreciated in this image so this muscle is hyoglossus so exactly sorry this muscle is genogen please correct it this is Gen iosis muscle so this fan shaped muscle which you are seeing here is the genioglossus muscle and it is attached to the genial tubercles of the mandible and it is Fanning out as you can see in the image and let it get attached to the lateral aspect of the tongue as shown in this image this muscle is called as genioglossus muscle so the bulk of the muscle if I talk about the bulk of extrinsic muscle which is formed the bulk of extrinsic muscle is formed by genioglossus muscle it arises from the mental spine and also it is attached to the tubercles to the genial tubercles and it is merging with the uh it is merging with that of the lateral aspect of the tongue and a very important function is attached actually in the previous year of examination this has been asked as an inance question for the N PG exam and also for the fmg exam which is the safety muscle of the tongue the answer is the Gen neosis muscle is considered to be the safety muscle of the tongue and the reason why it is considered to be the safety muscle of the tongue is because among all the extrinsic muscles of the tongue this is the only one muscle which is protruding the tongue outside so it is able to protrude it is it is not letting the tongue to roll back it protrudes the tongue and that is the reason it is regarded as the safety muscle of the tongue when acting together the muscle uh genosis muscle can Di press the center part but one of the important action is it protrudes the tongue and so it is its important action is protrusion of the tongue so it is called as the safety muscle of the tongue it is called as the safety muscle of the tongue now let's talk about the other muscle which is quadrangular in shape so I just want to actually uh here we what I have highlighted in this image is the quadrilateral or quadrangular muscle this I'm using H for it this is the hyoglossus muscle lower down you can see it is attached to the hyoid bone and also in the upper aspect it is again merging with the sides of the tongue so actually hyoglossus muscle is the quadrilateral muscle and it is actually arising from the hyoid bone greater Corona of the hyoid bone and it passes vertically upward and it get inserted into the sides of the tongue exactly between the styloglossus muscle and the inferior longitudinal muscle of the tongue inferior longitudinal muscle of the tongue is the intrinsic muscle of the tongue styloglossus is one of the extrinsic muscles of the tongue the important point about hyoglossus muscle is that it is forming the floor of submandibular triangle which we have already completed in the previous part hyoglossus muscle important function is it depresses the tongue that is most important retracts the tongue and make the dorsum of the tongue convex so basically it is making the dorsum of the tongue convex it is making the dorsum of tongue convex but retraction of the tongue is a primary action of styloglossus muscle so please don't get confused it is an additional action together making the dorsum of the tongue convex and it is depressing the tongue but other retraction of the tongue term comes or it comes for examination you have to mark styloglossus as the right answer the next is the styloglossus muscle if I talk about the styloglossus muscle it arises from the anterior lateral aspect the word so here I just want you to show this muscle this is exactly the stylis muscle this is the styloid process what is this this is the stello process and exactly on the stello process the muscle which is attached is styloglossus muscle which muscle is this this is the styloglossus muscle this is the styloglossus muscle so styloglossus muscle is attached to the stello process merging with the lateral aspect of the tongue and it will actually it will uh it has got a very important function it is creating a truff for shallowing the food and it is important function is retraction of the tongue so whenever the question comes about the retraction of the tongue the muscle which is retracting the tongue we will go with the styloglossus as the right answer now the next muscle is palatoglossus muscle the next muscle is palatoglossus muscle so if I talk about the palatoglossus muscle which has been highlighted in this image it is arising from the paltin Palatine epon Neurosis okay so this is arising from palatin epon neurosis and this has got a very important function actually this is also inserting into the sides of the tongue and a very important function attached to the Palatine platsis muscle it is the odman out muscle because its innervation is also not about tongue paralysis okay Vali will come to that yes definitely I will come to the paralysis of the tongue now it is having an action of elevating the posterior part of the tongue and it is actually uh not letting the food particles to go inside the airway cavity so it is approximating the plat glossal Arch what is the exact point function of platus muscle it is approximating the platus arch the next is the so one more muscle is there that is called as krosis to be more specific in some of the book it is written and it is a muscle of a part of hyoglossus muscle one it's a part of hyoglossus muscle only so please don't get confused because many books has not mentioned about krosis muscle but it's a part of iosis muscle it arises from the medial aspect of lesser Corona and it is continuous with the body of iode bone if I talk about its action its action is actually it is merging with the in between hylis and genioglossus muscle has got an action similar to that of adding the action of fosis muscle now let's talk about yes yes aan you are absolutely right the odman out is the platus muscle all the muscles of the tongue is supplied by hypoglossal nerve except the platus muscle which is supplied by vas nerve which is carrying the part which is carrying the part of cranial part of accessory n so yes aan you are absolutely right yes aan you are absolutely right so I will just like to cover up this tongue and then we will have an McQ session regarding this the intrinsic muscles of the tongue is superior longitudinal inferior longitudinal transvers and verticalis and all these muscle has an action of changing the changing the shape of tongue so they are changing the shape of the tongue so if I talk about Superior longitudinal they are inferior longitudal transfers veral all of this has got an action of just changing the shape of the tongue now let's talk about the arterial Supply and the venous drainage of tongue very very important for you to note down so actually arterial supply of the tongue is that it is having the so if I just enlarge this image you can see in this image the it is a image taken from the Graze anatomy and you can see that it is having arterial Supply from the source of branches of lingual artery also from the tonsillar branch of the facial artery and ascending parangal artery the Venus drainage is also important and the veins draining are deep lingual vein the dorsal lingual vein and the vena comitant what do you mean by the vena comitant the small veins which is surrounding nerves or artery they together forms the vena committ so we have got small veins surrounding hypoglossal nve and small veins surrounding lingual Ary these are the veins draining in the tongue so we will write about the arterial Supply and we will write about the vinus drain so please write down arterial supply of the tongue arterial supply of tongue so the arterial supply of tongues so we have got the arterial Supply from following sources so the important arteries which is giving AR blood supply and nutrition through the tongue is is the branches of lingual AR it is bya branches of lingual artery it is where tonsillar branches of it is why Trill branches of facial artery it is via ascending faring AR so actually these are the three sources of arterial supply to the tongue that is branches from the lingual artery we have got branches from the tonsil branch of facial artery ascending paragel now talking about the Venus drainers so when I talk about the Venus drainer the important veins draining are so we have got an important veins which is draining uh uh the tongue so let's just write on the name the veins are deep lingual this is the Deep lingual vein actually deep lingual vein is the principal vein of the tongue and the other veins actually if you talk about deep lingual vein and all there are dorsal lingual vein ultimately these all veins will be going and draining into facial vein and that of internal jugular vein the other so the other is vaa committs Vena committ ACC combine ACC combine lingual artery then we have got V committs ACC combine the hypoglossal N so it is ACC combine the hypoglossal nerve so actually uh these are all the Venus J and ultimately as I told you these blood from these venous drainage will ultimately go to the facial ve and ultimately it will drain into the internal jugular ve now talking about the innervation of the tongue innervation of the tongue is highly important so I just want everybody to concentrate on this topic because uh one or two question um is absolutely coming from this topic so exactly you have to know about the inovation so firstly I'm going to explain the inovation by taking this image so exactly if you will enlarge this image you can see on one side uh uh the red color pink color has been used and actually all the muscles of the tongue all the muscles of the tongue is supplied by which nerve the answer is hypoglossal nerve except the odman out that is platus muscle platus muscle is supplied not by the hypoglossal nerve but it is supplied by the vagus nerve and the vagus nerve is carrying the fibers of cranial part of accessory nerve it is carrying the fibers of cranial part of accessory nerve and giving innervation to it now talking about so one side we have got a motor innervation and the other side we have got a sensory innervation okay okay dear okay so actually many rali will come to the clinical aspect don't worry actually I I just removed that part from the tongue because I thought this will become a very uh big uh session because important topics of head and neck to be to be overcoming with the examination is also important but yes I will give you like some there is candida alanes in case of tongue there is thickening of the tongue there is hairy black tongue there is a also tongue ulceration is there so all these things in the different kind of fungal infection all the tongue affected hypertrophy of the lingual uh of the papil lingual all these happens and one of the most important anatomical fact about the tongue which is going to be asked is the paralysis of the muscles and the injury of hypogen now if I talk about the motor supply all the muscle is supplied by hypoglossal n except the platus muscle which is supplied by the vus now sensory Supply is that we will divide the sensory inovation into anterior parts so when I'm talking about anterior so this is the anterior two3 part of the tongue so in the anterior two3 part of the tongue the general sensory inovation is via lingual n and special taste sensation is via Koda tanic n if we talk about the posterior part of the tongue and we include also the circum valid papilla in this condition we are also including the circum valed papula this is via gloop farial knob and and that of gloop faral KN which is giving sensory Innovation to General sensation and taste sensation and the posterior most part of the tongue is getting inovation by internal LEL so actually in posterior one- thir part of the tongue both the sensory and taste sensation is bya gloal nerve now please write on Motor Supply so all the muscles of tongue all the muscles of the tongue is supplied by all the muscles of the tongue is supplied by hypoglossal nve except platus except except platus muscle which is supplied by vagus nerve carrying the fibers of cranial part of accessory carrying the fibers of cranial part of accessory now okay if we talk about sensory Supply so if I talk about sensory supply of the tongue so if we talk about the sensory Supply anterior 2/3 part of the tongue General sensation General sensation General sensory sensation so General sensory sensation means touch pain and all so General sensory sensation is via lingual nerve and we know that lingual nerve is a branch of mandibular nerve and mandibular nerve is a branch of trizomal nerve the posterior now this was about General sensation but I just want to elaborate about the taste s sensation so if I talk about taste sensation The Taste sensation is via Koda tanic nerve and this is a branch of facial n the posterior one/ thir the posterior one3 part of the tongue so not only posterior one/ thir part but also the circum valet papill also the circum valet papilla which is also included in this category of posterior 1/3 it is having the innervation by gloo farial nve the ninth cranial nerve glof farial nve actually gloop farial nve is giving ination both sensory so it is giving innervation both sensory General both sensory General plus The Taste sensation and if I talk about the posterior most part of the tongue if we talk about posterior most part of tongue so posterior most part of the tongue it is giving innervation so posterior most part of the tongue please don't get worried it will be I will be seen soon okay don't worry so posterior most part of the tongue is via vas nerve Branch vas Branch what is it internal Lal nerve internal Lal nerve and I just want everybody to note down that this is also giving both sensory that is the general plus The Taste General plus the taste I I have written in small GT is it okay that means it is large R NGL nerve that is both General plus P for the taste so both General and taste sensation so actually this is highly important for you to note down the sensory innervation as uh here we can we have to know because nerve supply of tongue so many questions has been asked in the previous year of examination now I would like to talk about the lymphatic drainage so let's talk about the lymphatic drainage if I talk about the lymphatic drainage we have to know about the uh drainage and because carcinomas of the cancers are metas sizing from one side to other side so it is important that we should know this so if I talk about the tip of the tongue the lymphatic drainage is going to the submental so tip of the tongue the lymphatic drainage is going to the submental lymph node crossing over of the lymphatic from right and left side is seen laterally it goes to submandibular and also posteriorly in the lateral aspect there posterior also the crossing over of the fibers are there lymphatics is there so actually tip of tongue drains into submental lymph right and the left half into submandibular lymph node and posterior one/ thir is draining into jugoo lymph node ultimately it drains into deep cervical lyph so actually what you can appreciate in this image that is the crossing over of the lymphatic drainage of one side to the other side is seen that means cancers of one side of tongue can metas siiz to the other side so that is a clinical aspect related to it now the other cases of tongue Tye as I told you that inferior can you see the image of the baby and you can see the baby is not able to protrude the entire tongue in normal cases see here I can protrude it why because you can see this is ferum lingu what is it this is fulum lingu and this fulum lingu which lies on the inferior part of the tongue it is the mucosal fold which is more anteriorly connecting to the floor of the mouth and it is a disorder in which tongue TI or ankylosis is the term used for it so it is it is it is not letting the exion of the tongue and it will be related with the abnormalities of thicken ferum linguage speech difficulty shallowing difficulty and eating difficulty so it's very easy to solve the case just a Nick on the fonum Ling and protrusion of tongue can be done a small surgical uh procedure has to be done now this was very important many of the student has asked about hypoglossal nerve injury actually the bulk of the muscle forming the tongue is that of the genioglossus muscle so in case of in case of lower motor neuron injury the tongue will deviate to the same side or ipsilateral side but in case of upper Moto neuron injury the tongue will to the other side so actually we know that the bulk of the muscle is genioglossus muscle and the action of genioglossus muscle is protrusion of the tongue okay so if one side of the tongue is not functioning so it is not protruding the other side of genosis will protrude and this will lead to deviation of the tongue to same side so have you understanding this concept what will happen if the hypoglossal nve of one side is injured if hypoglossal nve of right side is injured that means which muscle will be paralyze right genioglossus muscle and we know that bilateral action when the contraction of genioglossus muscle occurs it will protrude the tongue now right side is not working but left side protusion is occurring that means same side deviation Ipsy lateral deviation of the tongue will be seen in case of hypoglossal nerve injury which is more common lower Moto neuron injury so exactly uh uh the question is talking about a burning sensation the patient is experiencing a burning sensation as you can see here the patient is experiencing a burning sensation at the tip of the tongue the sensation so here hariharan has given the answer trial now what about the others hariharan has given his answer and he is telling it's the right answer is trial n what about others anyone want to add on something so actually hariharan is absolutely right he is absolutely right and he has given absolutely the right answer the triom actually uh the anterior part of the terong if we are talking about uh the sensation which is felt at the tip of tongue we mean to tell that tip of the tongue General sensation we are talking so General sensation at the tip of tongue is done by lingual law so uh burning sensation is a general sensation and this is a general sensation in anterior 23 part of the tongue in anterior 23 part of tongue and lingual nerve is a branch of mandibular nerve and mandibular nerve is a branch of trial nerve so definitely the right answer will be triom love definitely the right answer will be triom love so a thumbs up goes for hariharan yeah now here if I talk about lingual nerve the lingual nerve is a branch of mandibular division of trial n it's a branch of mandibular division of trial n and it is giving sensation so we know that uh uh burning sensation is a general sensation if it was about the taste then it was a coda Panic nerve in the anterior two3 part of the T Koda tanic is not the right answer because it is giving taste sensation in the anterior part gloop farial nve is not the right answer because it is giving General sensation and The Taste sensation both hypoglossal n is not the right answer because it is importantly giving the innervation to the muscles of the tongue vus nerve is also not the right answer because it is giving uh both General sensation and taste sensation in the posterior most part of the tongue VI its Branch internal arranger so I would like to go for a second question so let me slightly enlarge it so all of you please read the second question and give me the right answer a 35y old male comes to your office complaining of a painful tongue sword he also complains that over last two week he has a fever and has been experiencing Malia and aalia he has no other medical problems the patient work as a driver for a local delivery service he is homosexual and he admits of having unprotected sex with a stranger approximately 1 month ago physical examination reveals rash over his trunk and survical lymph adenopathy any ulcer is located on the median cus of the tongue one cm anterior to forl seeum you decide to draw a blood for the HIV viral load and describes oral analgesic to relieve the ulcer related pain The Sensation from the ulcer is carried by which of the following nerves so actually basically most important point is the location of ulcer the location of ulcer is in the median sulcus 1 cm anterior to foran seeum the pain sensation is carried by which of the following nerve that is the right answer so again your time starts now you can give me the right answer so just go through this I will give you few uh I will give you 30 seconds to Mark the right answer so I would like to give you 30 seconds to Mark the right answer so actually the location please pay attention to the location if I talk about the location of the aler it is lying anterior to the foramen seeum it is lying anterior to foran seeum and definitely if it is lying anterior to foran seeum it is located in anterior part of the tongue and as I told you anterior part of the tongue General sensation is lingual n so anterior to foramen seeum is the anterior to foran seeum the location is of ulcer which is located uh in the anterior 2/3 part of the tongue and uh the sensation is pain so pain is a general sensation pain will be a general sensation and definitely the general sensation in the anterior part is V lingual nerve and we know that lingual nerve is a branch of mandibular nerve so definitely the right answer is C so a nan you get a you get a thumbs up you are absolutely right you are absolutely right the right answer is mandibular nerve so I just want you to show this image here what happens this is sulcus terminalis this is sulcus terminalis and posteriorly there is a foramen seeum so exactly that means it is is which part of the tongue it is anterior part of the tongue and posterior to foramen seeum is the posterior part of the tongue now as we know the anterior part of the tongue General sensation is bya lingual KN so definitely the right answer lingual no will be a branch so definitely the lingual KN is a branch from foram it's a branch from mangular division of triola posterior one/ third of the part of the tongue will have both General sensation and that of taste sensation carried by the carried by if I talk about posterior one third part of the time both General sensation and taste sensation is carried by the gloop farial nerve so definitely the ulcer location is anterior to foramin seeum so it comes in the anterior part so lingual nerve is the right answer so lingual nve is the right answer so let's talk about the orbit so in this diagram I want you to show the orbit or the cavity or the socket of the skull in which different colors of the bone so uh to know the exactly what structures are forming the boundary what all structures are forming the boundary it is important to use different colors so you can see the important surrounding bones of the orbit so we have got this yellow color for the frontal we have got green color for the Lal bone so this is the Lal bone so actually I'm not writing it it's already written so we have got surrounding bones like Lal frontal Jago atic maxy we have got Palatine bone sphenoidal bone also the part of the nasal bone is Illustrated but that is not forming the part of boundary of the orbit so it is important that we should know all the structures which is forming the boundary and now next is to know about the contents so the important contents of the orbit is following I orbital retrouver fascia cranial nerves that is second third fourth and fif sixth blood vessel fat cular gangon s cular nerves lmal gland and nasolacrimal duct so all these structures which has been mentioned here all these structures are the content of orbit all these structures are the content of the orbit and you have to know the details of the content of the orbit and other than that the most important thing which is very important for your examination is to know about extraocular muscles so I would like to talk about the seven voluntary extraocular muscles so how many voluntary extraocular muscles are there together we have got seven voluntary extraocular muscles together we have got seven extraocular muscles so exactly we have got four recti muscle and we have got two oblique and one levator levator palpable superioris so we have got four recti muscle so we have got four reti muscle so exactly together we have got the superior rectus muscle we have got the inferior rectus muscle the medial rectus and the lateral rectus so together we have got four reti muscle and we have got the two oblique muscle and we have got LPS muscle levator palpable superioris muscle so together we have got seven muscles okay so one by one we will talk about it so exactly all the muscles has been sewn more superiorly is the elevator palpable Superior muscle the obl direction yellow color muscle is the superior obl we have got inferior oblic and four recti muscle what is important for us is to understand the origin insertion of all these muscle so what I want everybody to concentrate on this image so I'm just enlarging this image so exactly in this image you can understand the attachment of these muscles so we have got here medial rectus muscle we have got superior rectus muscle we have got inferior rectus muscle and lateral rectus muscle so these are the four recti muscle which is originating from so if I talk about these four recti muscle these are the four reti muscle and these four recti muscle is originating from anulus of J so they are they are so if you will see the superior orbital fure in the study class I have shown you in the center there is a ring there is a ring that is called as tendinous ring that ring is called tendinous ring tendinous ring of anulus so gin of an and from there the four recti muscle originates and these recti muscles are inserting so if you will see these recti muscle you can appreciate that these recti muscle are inserting so exactly these reti muscles as you can see here it these all muscle are inserting uh posterior to the sclero coral Junction that is all these recti muscle are inserting posterior to sclero Coral Junction or Li as you can see this black color structure is the cornea and you can see this is the Equator this is the Equator so if you will see the insertion of these recti muscle this is one recti this is one and this is the other recti muscle so what you can appreciate these reti muscle are inserting these all recti muscle are inserting anterior to Equator and posterior to sclerocorneal if we see the obli muscle this is one obl muscle this is other so we have got inferior obl and we have got the superior obl muscle so if we talk about Superior obl and if we talk about inferior obl both the obli muscle you will see both the oblique muscles so what you can appreciate both these obl muscles are inserting into poster Superior quadrant of eyeball posterior to Equator and posterior to the limbus so this is the difference between the insertion of oblique muscle and recti muscle if we are talking about recti muscle they are inserting posterior to Lim lbus and anterior to Equator but obli muscle are inserting posterior to Equator and posterior to limbus so let's write it okay let's write about these muscles so let's write about these muscle so I will start with the four recti muscle so if I talk about the four recti muscle we have all the reti muscle all the recti muscles arises from all the reti muscle arises from the corresponding margin of arises from the corresponding margins of corresponding margins of common tendinous ring common tend ring this is about the origin if I talk about insertion if we talk talk about the insertion the insertion of all the reti muscle all the reti muscle is inserted into Scara is inserted into Scara little posterior to little posterior to limbus little posterior to limbus and in front of equator and in front of equator posterior to limbus and in front of equator in front of equator got it now let's talk about the oblique muscle so let's talk about the first oblique muscle that is the superior oblique muscle Superior oblique muscle the superior oblique muscle origin from the body of spinoid so it is originating from the body of spinoid suom medial to to optic Canal supr medial to optic Canal if I talk about insertion it inserts into the Scara it inserts into the Scara it inserts into the Scara behind the equator and in postero Superior quadrant of eyeball so done with this now talking about inferior so actually uh the one more obli muscle is there that is inferior oblic muscle so let's talk about the inferior obl muscle if I talk about inferior obl muscle so I just want to write over inferior obl muscle here itself so if I talk about inferior obl muscle the inferior obl muscle originates from so exactly if you will see the origin this is the one muscle which is origin Orting so if we talk about the origin it is originating uh from the uh inferior wall so here inferiorly this is one muscle which is originating inferiorly from the orbit and this is exactly originating inferiorly from the orbit so it is originating from the floor of orbit lateral to lmal group lateral to Lal and if I talk about insertion so the insertion is it inserts so if I talk about the insertion it inserts into the Scara close to the insertion of close to the insertion of superior obl muscle close to the insertion of Superior oblic muscle done done here done now the next thing is to know about uh so the uh the one more muscle which I want everybody to know is levator palpable superioris muscle any of the student is having any doubt they can ask me let me just check if any of the student is not understanding anything okay so now now we are we are now with the LPS muscle the next muscle is LPS muscle lator palpable superioris muscle so this is the LPS muscle as you can see this is levator palpable superioris muscle and this LPS muscle is inserting into the eyelid can you see it is inserting into the upper eyelid lator palpable superioris muscle is the most Superior aspect this is the muscle lying superiorly inserting into the elevator palp upper eyelid and it is important to know the importance uh it is important to know about the origin and insertion so actually insertion is uh is in the form of Lamina so exactly if I talk about the about the uh lator palpable superioris muscle it is originating from uh exactly it is originating uh from uh from the spinoid bone it is or ating from the spinoid bone and thereafter what is most important that it will forms three lamina of insertion it will form three laminas of the insertion so you can just write LPS muscle orginates from spinoid bone and inserts in inserts in the form of three l lamina in the form of three Lam the insertion is in the form of three laminas actually uh actually it is made of it is made of both sceletal and smooth muscle so it is made of both skeletal and smooth muscles so actually it is made of both skeleton and smooth muscle and this will insert into the superior tarel plate of the upper eyelid also in the uh conjuntiva so exactly it will have dual nerve Supply that means LPS muscle skeleton muscle fibers will have inovation by okomoto and smooth muscle will get inovation via sympatic innervation so here you can just write LPS muscle is having innervation by both thir cranial law and sympathetic so other than that it is also having sympathetic innervation it is also having sympathetic innervation done with this now all the muscles if I talk about all the extraocular muscles of the eye if I talk about all the extraocular muscles of the eye it is is innervated by all the extraocular muscles is innervated by Third cranial L except lr6 and S so4 except lr6 and S so4 so here lateral rectus is innervated by Abdus nerve and that of superior obl is inserted by Superior oblique is getting innervation from the trar nerve now extraocular muscles so let's talk about the extraocular muscles so we have got following extraocular muscles and the action of these muscles are occurring in the three planes so we have got uh so exactly there is three planes that super that elevation and depression is occurring along transverse plane the adduction abduction along vertical axis movement and that of the intorsion inward rotation of the eyeball and extortion is the word used for the outward rotation of the eyeball so this is occurring along AP axis this is occuring along AP axis so it is important that we should also know the individual uh so it's also Al important that we should know the action of individual muscles so is it okay everyone so you have to know about the action of individual muscles and already in the image I have shown you that the muscle is having their actions uh depression and elevation along transverse axis abduction and reduction along vertical axis and that of intorsion and extortion along the AP axis so I would like to give you the details of all the muscle action so let's write it write on the heading action of extraocular muscles okay action of extra ocular muscles will be known to you so action of extraocular muscles action of extraocular muscle let's talk about the action of extraocular muscles so the action of extraocular muscle celles following they are superior rectus so if I talk about the superior rectus muscle the superior rectus so we have got actually oblique muscle will have the action just opposite to its name but superior rectus muscle if I talk about superior rectus muscle its action is it causes elevation it causes adduction and intorsion if we talk about inferior rectus muscle inferior rectus muscle it is causing depression adduction and extortion we have got medial and lateral rectus so if I talk about medial rectus muscle it is causing adduction of eyeball lateral rectus is having the action of abduction so this other than that we have got two oblique muscle and their action is just opposite to their name so we have got Superior oblic muscle and we have got an inferior oblic muscle so as the name is there Superior inferior oblique so the action of these extraocular muscle is just opposite to their name so if I'm talking about the obli muscle that is superior obl muscle so the superior obl muscle is having the action of depression abduction and in torsion if I talk about inferior obl it is causing elevation abduction and extortion and we are we have got a next muscle the seventh one LPS muscle the LPS muscle is causing elevation of upper eyelid done now I would like to talk about the fascal sheet so we will talk about the fascal sheet so if I'm talking about the fascal sheath it is actually a membranous envelope of the eyeball and actually uh let's talk about the attachment of the phasical sheet the attachment is an it is attached to SC Junction what do you mean by SC Junction SC junction means it is attached to sclerocorneal Junction it is attached to sclero Coral Junction posteriorly it is merging with the optic nerve and an important point about the phasical sheath of the eyeball is that it is merging with the recti muscle and it is merging with the obli muscle so the ligaments other than that fascal sheath is merging with the recti obl muscle laterally inferiorly medially and it will form a check ligament so uh it is actually having its attachment so phasical B phasical sheath of the eyeball when merge laterally it is attached to winance Tule and medially it is attached to posterior lmal crust so medially it is forming medial check ligament laterally it is forming lateral check ligament lateral check ligament is attached to winance tubercle and medial cment is attached to posterior lmal crust what about inferior aspect so when we talk about inferior aspect the fascal sheath is merging with inferior oblic inferior rectus muscle so inferiorly it forms suspensory ligament so inferiorly it forms suspensory ligament so inferior aspect it forms suspensory ligament and it will in it will give a hemoc like support to the inferior aspect and it will merge with the inferior rectus inferior oblic muscle and give support to di Iver so it will give support to the eyeball it is merging inferiorly and it merges with inferior oblic muscle and that of inferior rectus muscle and it will give hemoc like support inferiorly forming suspensory ligament of eyeball now let's talk about the clinical corelation so the clinical corelation of oculomot nerve is lesions of OT nerve will lead so exactly as I told you all the muscles extraocular muscles if I'm talking about all extraocular muscles it is getting Innovation from third cranial nve or okomoto nve we have got certain muscle which is not getting innovated like s so4 and lr6 so that means lateral rectus muscle is not paralyzed and the superior obli muscle will not be paralyzed because lateral rectus is getting Innovation from amusin nerve and Superior oblic is getting Innovation from trar nerve so that is the reason and uh exactly uh the affected eye is placed laterally by the lateral rectus muscle because of the action of lateral rectus muscle and also by Superior oblic muscle so the position of the eye in case of ocom motor nerve injury will be I is looking down and out so if you appreciate this what you can appreciate the eye is looking down and out the eye is looking drown and out okay dear now dra clear enough if I talk about the Tron nerve it's the superior oblic muscle uh uh is innervated by trar nerve so that means only one muscle will be injured that is superior obl muscle and the action of just Superior obl muscle is gone so the patient will not have much of featur seen as you see the eye but you can see diplopia and also the patient may develop head tilt away from the sight of leion so the patient will have all the other muscles are intact only diplopia is the feature which is seen and the position of eye is not affected much but there is actually no obvious sign seen when the resting orientation of the eye will was there it will seen when a sideway head tilt is done then we can see the trar nerve injury paly the other is Abdus nerve if I talk about the Abdus n if any of the student is having any doubt let me know okay so actually if I talk about Abdus nerve that is lateral rectus muscle is the only one muscle which is getting inovation from the sixth cranial love and the action of lateral lectus muscle is abduction that is lateral movement abduction so exactly the patient will develop medial squint because of the action of medial rectus muscle so the eyeball is moved medially and the patient will have medial squint because of the action of medial rectus muscle now I would also like to talk about horer syndrome actually Horner syndrome is a Trad of symptom which is produced by sympathetic trunk so exactly uh when I talk about Horner syndrome what happens the sympathetic fibers innervating the LPS muscle will be involved but ocom mot nerve is not injured actually this is conceptual please try to understand actually for the whole paralysis or a complete paralysis of LPS muscle levator palpable Superior is both the okomo nerve and that of the both OT nerve and that of sympathetic innervation has to be gone so that means LPS muscle will be will be not fully paralyzed okay so in sympathetic innervation is gone that means the smooth muscle fibers of LPS muscle is not working at the skeleton muscle fibers are working what will happen this will lead to a c case of partial tosis and the patient will have constriction of people that is called called as pupilary construction will be appreciated because of denervation of due to the denervation of dilated pupilary muscle and hydrosis will also be seen in the case of horer syndrome now can we solve an McQ related to this everyone can we solve an McQ related to this topic everyone can we have a discussion of one McQ related to this topic okay so let's Sol I will give you a few seconds okay ntin okay okay dear a 30y old male presents to the emergency room after being involved in a street fight there is significant soft tissue swelling around the left eye the Imaging study reveals orbital floor fracture with accommodation of fluid so accumulation of fluid is there so actually can you tell me which of the following structure is involved in this case idal sinus Max sinus frontal sinus spidal sinus or inferior conc so Mark the right answer here so I got an answer C from ntin frontal sinus okay so I will give you a hint left orbital floor floor is fractured orbit floor floor is fractured here orbit floor is fractured see floor floor involve which uh structure okay nitin and I just want to enlarge this image now tell me the right answer C A what about others can you tell me the fracture is of which so I'm just enlarging it C fracture is in the floor Now give me the right answer please mark the right answer so Rashmi is telling uh Rashmi bua is also telling a so a a c anyone else multiple answers are coming up anyone wants to give the right answer the correct answer is maxillary sinus the correct answer will be maxillary sinus so you can see generally the sinuses contains air so it is black in appearance floor if we talk about the floor here we have what maxillary sinus so in this case maxillary sinus will be fractured so in this case maxillary sinus will be fractured so you can see here the orbit is bounded superiorly by orbital plate of frontal bone laterally by the jagatic greater leather Wings orbital floor is formed by the maxillary sinus so you can see here orbital floor is formed by maxillary sinus so that means here actually floor and medial wall that is medial wall is formed by Lal and ethmoidal Bones ethmoidal air sinuses is there so that means floor and that of medially will see the ethmoidal layer sinus and leangle bone that is more fractured in this case so here once again I want you to show this orbital image orbit and you can clearly see the here you can clearly see this we have got this as a Max bone maxillary sinus and maxillary airbone so definitely maxillary sinus is ruptured in this case or fractured so here in this case the blun promise to the eyes is increasing the pressure and Fracture is at the floor the floor and as you can see there is air so if you can see one side there is air so it appears so there is air but other side the fluid is accumulated in the maxillary sinus so exactly the magary sinus has been not opaque now it as maxillary sinus is not containing air now it is having fluid accumulation so definitely that is the right answer ethmoidal a sinus will be lying medially as you can see if we talk about ethmoidal aay sinus it will be lying more medially it is not lying in the floor you can see in this image so this is not the right answer same goes with the frontal air sinus it will rise superiorly it will lie superiorly and sphenoidal air sinus is more located on the posterior aspect so sphenoidal sinus will be more posteriorly located as you can see here and if I talk about inferior nasal it's a separate bone in the lateral wall of the nose so it is it is in the lateral wall of the nose so most important bone to be fractured here is the maxillary air sinus deep cervical fascia of the neck is clinically very important and we know that entire neck is having a collar like covering that collar like covering is called if I talk about entire neck the it's having a collar like covering that is called as deep cervical fasia from outside to inside the Deep cervical fascia is formed by fall layers it is having investing layer of deep cervical fasia it is having pre tracheal layer pre vertebral layer and the carot sheet so we have in this topic I'm going into the details of I will explain you about the details of pre investing layer of deep cical fascia the uh the pre-trial the pre vertial and that of the caroet sheep the investing layer of deep cervical fascia the investing layer of deep cervical fascia then we have got the pre-trial layer of deep cervical fascia the inner is the pre vertebral layer of deep cervical fascia now it's important to know the uh detail of these all layers so I would like so exactly this is the image where you can see uh uh the layers as you can see see the area is surrounded the whole neck is surrounded by the investing layer of deep cervical cascia and overall here I just want you to tell about the attachment of investing layer of deep cervical facia so if I talk about the attachment of investing there of deep cervical fascia you can understand that important structure so superiorly it is attached to external occipital pance so just a minute so this is the superior attachment that is it is superiorly attached on external occipital protuberance and that of superior nucal line and if I talk about its inferior attachment inferiorly it is attached to the spine of the scapula so inferiorly it is attached to the spine of scapula as you can see here inferiorly if you will see it is attached to this spine of scapula and acromial process anteriorly if you will see both the side investing layer will merge in the midline so you can see in the mid line of neck in the mid line of the neck the both the side of the investing layer of deep cervical fascia is meeting in the anterior aspect and posteriorly it is attached to so ligamentum UK is there this is giving posterior attachment to that of deep cervical fasia and it is inclosing all important structures so it is uh so this is about the attachment which has been shown so this image is showing you the attachment of deep cervical fasia so write down attachments of deep cical faure attachment of deep surval f superiorly it is attached to ex Al occipital protuberance Superior nucal line to must process and and lower border of mandible inferiorly it is attached to the spine of scapula acromium process upper aspect of clavicle jugler Notch anteriorly it is attached to the mid line of neck actually midline neck means that is starting from the symphisis M continuous lower down to the Supra sternal notch legum Nu and spine of seven cervical vertebra so done with this that means you can just practice on your own body and you can see that superiorly it is attached to external occipital protr Superior nucal line musite proces lower aspect of the mandible anteriorly in the med nline then posteriorly going to the ligamentum nucas spine and then it comes to the to the clavical spine acromial process and and it also merges with the spine of seven cervical ver this is whole of the attachment and here you can see this is the investing layer of deep cervical fcia which is is superiorly attached to external oxy proten nucle line and in the up in the anterior aspect it is attached to the mandible bone hyoid bone and lower down it is going to the level of manuum sternite so actually there are two so this is showing you the longitudinal this is showing you the Cal section or longitudinal tracing of the this diagram is showing you longitudinal or you can say vertical tracing of so exactly so it is actually a diagram where longitudinal or vertical tracing of deep cervical fasia can be appreciated and we can see the attachment of investing layer of deep cervical fasia posteriorly and anteriorly in this image there is one uh one more image this is also showing the vertical vertical tracing of deep cervical facia so it is attached superiorly it is attached to external occipital pance on the superior aspect it is attached to external occipital fance it merges with the ligamentum Nu and lower down it is a attached to the spine of C7 cervical vertebra so lower down it attached to the spine of C7 cervical vertebra and on the anterior aspect attached to the hyoid bone it merges with a thyroid cartilage and a criid cartilage this is the investing layer and lower down it is merging till the level of manuum sternite so it will go till the level of manuum sternite this is the whole attachment of investing layer of deep cervical fascia yeah now I just want to tell about few important points about other than that so we have done with the with the attachment and soon in this diagram but actually there is a horizontal section where you can uh so this is showing you the horizontal disposition of deep cervical fure so here you can see this is the investing layer of deep cervical fascia it start from posteriorly from the lamentum muuk IT encloses trous muscle in the posterior aspect it encloses Stern cleoid muscle in the anterior aspect as you can see it is forming the roof of so exactly it is forming the roof of two triangular so it is it is forming the roof of two triangles anterior and posterior triangle it is enclosing two muscles stoco myroid and that of lious muscle and when you trace the investing of deep cervical fasia from the level of hyid bone it will go on the upper aspect and it will enclose two glands also so I just want to show you so can you see when when the investing layer is traced above the hyoid bone so when it is traced above the hyoid bone it is again uh forming it is covering the superficial fascia of the pared gland forming superficial paror mric fascia and when you see the deeper layer it is merging with a tanic plate it is merging with a tanic plate forming styom mandibular liment and this will form the styom mandibular liament will have will separate two important glands the parotic gland and submandibular gland other than that when you see with a lower down uh so you can see at the lower aspect the investing layer of deep cervical fascia in the lower down it is attached to clavicle and it enclos supraclavicular space it encloses supraclavicular space So actually it will be merging with a clavicle Supra Superior aspect so here it includes supraclavicular space so exactly it includes supraclavicular space and it includes one more so it is also having a Supra it encloses supraclavicular space and it encloses another space that is called a suprasternal space and Supra sternal space so actually what happens when you trace the investing layer of deep cervical facia lower down in the clavicle and above the uh sternal notch it is enclosing two spaces Supra sternal space and Supra clavicular space so that is also important for you to note down so I will talk about all these spaces and important structures related with that of the investing layer of deep cervical fure so I just want if any of the student is having any doubt please let me know ma'am uh ma'am zero question from Anatomy NE PG today no it's not like that don't worry there are many questions so without okay here Rashmi is telling no question problem so exactly uh with no with there are many many questions there are so exactly there are two sessions for the neat PG exam one is morning and evening session so if I talk about Anatomy questions uh it's we have got so so many questions which will be asked from the anatomy actually if it is a question of gy Ops it's a question of surgery if it is a question of medicine ENT all basic part is related to Anatomy so if you are not knowing the basic subject you are not able to solve the mcqs so sometimes what happen you feel that the question is not from the anatomy but if you're not an knowing the anatomy you can't solve the clinical aspect so it can't be like that that no questions is from Anatomy it can't be like that in 19th subject if you are not knowing Anatomy if you are not knowing muscles if you're not knowing nerves if you're not knowing vessels how can you proceed surgically okay how can you know that this muscle is lator an muscle this muscle is Stern muscle what is the boundary what is the extent what is the innervation what are the nerve Loops everything is related here it's a very core subject here and it is related with all 19 subjects so literally if you are paying attention to this subject if you are giving your heart to this subject and uh try to understand seeing multiple of images from the good standard books and all you are definitely going to solve all the question being asked in the neat PG exam also so that is very very important okay Rashmi so let's start so above above H bone above H bone investing layer of deep cervical fasia so above Hye bone investing layer of deep cervical fascia encloses above high bone investing layer of deep cervical fasia encloses paral Clans submandibular gland and form styom mular [Music] ligament now when when traced downward when traced downward when TR downward the fascia splits to enclose the fascia splits to the fascia splits the fascia splits that is the investing layer of deep cervical fascia splits to enclose splits to enclose two space okay so it splits to enclose two spaces one by one I will talk about that spaces so please write down here the two spaces are please write down one of the space is so that space is Supras sternal space that is above the manuum sternai there is Supra sternal space of burns it is also called as Supra sternal space of burns and you have to know what all structures lies in the Supra sternal space of burs so it encloses sternal head off sto leid muscle it encloses jugular Venus AR it encloses interclass vular ligament and it encloses the lymph node other than that as I told you it is also enclosing one more space so exactly uh it also enclos so two spaces it enclos one is Supras sternal space that is the space above the manuum sternai the other space is in the above the clavicle so here you can right the other space is supraclavicular space So In supraclavicular Space the investing layer of deep cervical fascia is including following that is the supraclavicular space it incloses following important structures and that structures are terminal part of external jugular vein it encloses terminal part of egv external jugular vein and it encloses supraclavicular knob Supra clavicular KN done with this now we are uh we have to also know about uh uh the rule of two Rashmi ma'am tell us about need MDS question also okay dear okay Okay we okay C is okay Vive is telling zero in anatomy how to start okay VI Sharma yeah I will tell you so you have to start that means you have to start Anatomy from beginning that means you want to start Anatomy from the beginning so you have to firstly go with General anatomical aspect then study the gross anatomy correlate with the general emology and histology part so okay neat MDS actually I'm so I we have got neat MDS and questions being solved they are more related to the head and neck part and few neuro Anatomy part so that is how we will have a neat MDS session also don't worry about that I will be coming with the neat MDS papers and sessions discussion so we will definitely have that session I just want everybody to note um the rule of two so in deep survical fasia there is Rule of two so here I just want everybody please write on rule of two for rule of two so when I'm using the word rule of two it means rule of two is for the structures being enclosed so rule of two for the encloser rule of two is for the structure being enclosed by investing layer of deep cervical facia investing layer structure enclosed by investing layer of deep cervical fascia so actually investing layer of deep cervical fasia encloses many important structures and there is Rule of two for all the structures being enclosed so we have to know about that so please write down all important structures being enclosed so please write down it encloses two muscles encloses roof of two triangle anterior and posterior triangle encloses two spaces Supra clavicular and Supra sternal space Supra clavicular and Supra sternal space encloses encloses two glands pared gland it encloses the pared gland and that of submandibular gland encloses or split to enclose two space which we have done forms the sling of two muscles forms sling for two muscles so exactly it forms a sling for the two muscle and the two muscle pulley slings are it forms a sling for HOH hard muscle it forms a sling for intermediate tendon of digastric muscle so it forms a sling for omohyoid muscle and it forms a sling for intermediate tendon of digastric muscle so done with this actually it also actually uh if we are talking about the three layers of deep cervical fasia that is investing layer of Deep cical fasia the pre-trial and pre vertebral layer so actually if I talk about preal and pre vertebral layer these are derived from the investing layer of deep survical fasia so form forms two fascia that is pre-trial fascia and pre vertebral fasia so done with this now uh I want to tell about the next layer that is the pre-trial layer of deep cical fasia so all of you so exactly yeah I can understand all of you are waiting for the neat PG exam questions to be solved so let the exam be over so today evening on night the exam is over so tomorrow we will collect as many as the questions asked for the neat PG exam and we will solve it so the next layer which you should understand is the pre-trial layer of deep cervical fasia pre treal fascia pre fascia of deep cervical fascia so pre-trial fascia or pre-trial layer of deep cervical fascia so actually this layer of deep cervical fascia is covering the sides and in front of the trachea so hence the name is pre-t tral fascia it splits to enclose the thyroid gland as you can see it is splitting to enclose the thyroid gland above it is attached to hyoid bone and lower if you will see the inferior limit of the pre-trial phasia it is merging with the fibrous pericardium of the heart so it is merging with the fibrous pericardium of the heart actually it encloses the thyroid gland and forms a false capsule for it and it is attached to oblique line of thyroid cartilage it is attached to the oblique line of thyroid cartilage and actually uh it's very important for you to note down that it is uh it is then attached to the cricoid cartilage and it forms the ligament of berry so exactly the thyroid swelling is if you will see a swelling the doctor when you come come to the any patient comes to the OPD or for the W the doctor ask he or she to move uh see check whether the swelling is moving with the detination or not so the reason is the formation of ligament of berry and also we if we see the extent horizontally it is actually emerging from the so horizontally you can see it is emerging from the investing layer of deep cervical fascia and it is actually merging with the forming the anterior wall of koted sheet if you will see the vertical tracing above it is is attached to the hyoid bone and below it is attached to the fibrous pericardium so I just want to show one more image here so in this diagram the outermost layer which we have just seen so this is the investing layer of deep cervical facia so this is exactly the investing layer of Deep Survival pacia which we are talking about okay now from the investing layer so we have seen that investing layer is enclosing the stern muscle it is enclosing the trapesius muscle as shown in the diagram and other than that if I just slightly enlarge it I can also appreciate here and I want everybody to know know that let's talk about another layer so we are talking about the pre-trial layer so if I talk about the pre-trial layer it is forming the anterior it is arising from investing layer forming the anterior wall of koted and it is covering the entire thyroid gland as soon in the diagram and it is also lying to anterior to the trachea as you can see uh here in the diagram only I'm using a different color for the pre vertebral layer which is arising from the posterior aspect of the invest layer and it is actually covering the all of the this is the pre vertebral layer covering the back muscle scelus group of muscle lus caply andol and it is forming the posterior wall or sheet of the carrot it is if we talk about carot sheet it's anterior so this is the koted sheet and if I talk about koted sheet this anterior wall is formed by pre-trial layer it posterior wall is formed by the pre vertebral layer so we have got this as the pre vertebral layer now uh this was about transfers now we will see about the uh about the vertical tracing so we have already done about the uh investing layer now my now we will talk about the pre-trial fasia here in the pre-trial fascia you can see it is attached with the hyoid bone thyroid cartilage criid cartilage forming the ligament of very merging with the Estus of the gland and lower down as you can see it is merging with the fibrous pericardium of the heart now if if you will see the another layer that is the pre vertebral layer you can see it is attaching to the base of the skull and lower down it is merging with the longitudinal ligaments so it is merging with the longitudinal ligaments and going to the level of uh T3 T4 vertebras as you can see here so here also you can see the investing layer uh we have already talked which investing layer we have already talked and we have seen that investing layer is merging above with the hyid bone below it is merging with the manuum sternite when we are talking about pre-trial lay you can see above it is attached to the hyoid bone criid thyroid cartilages lower down it merges with fibrous peric then we are talking about pre vertebral layer you can say ever it is merging with the base of the skull lower down it is merging with the anterior longitudinal ligament of T3 and T4 thoracic vertebra so done with this now I just want to go with the pre trial fascia pre-trial fascia preal faal lies please not down preal phasal lies pre-trial FIA lies anterior to trachea it lies anterior to trachea and encloses the thyroid gland it encloses the thyroid gland forming false capsule forming false capsule attached to oblique line of thyroid cartilage attached to oblique line of it is attached to the oblique line of thyroid cartilage from there to it is attached to the criid cartilage and will lead to the formation of ber ligament now uh and if I talk about the vertical extend so if you want to know about the vertical extend so you can just write on vertical tracing of pre-trial fasia so it's important to know the vertical tracing so if I talk about the vertical tracing of pre-trial fascia when traced above when traced above it is attached to hyoid bone it is attached to hyoid bone and when traced below and when traced below it blends with the Apex of fibrous pericard it blends with the Apex of fibrous pericardium of the heart it's blends with the fibrous pericardium of the heart uh now if we talk about uh the pre vertebral fascia now if we talk about pre the next layer is the pre vertebral fascia actually pre vertebral fascia the deepest layer it's very important to know about the pre vertebral layer so exactly if we talk about the pre vertebral layer you can see in this diagram the two spaces so exactly we will talk about the enclosure so pre so here I just want everybody to also know about pre vertebral fasal so if we are talking about pre vertebral fascia traced above when traced above it is attached to the base of skull and when traced below and when traced below it is attached to the it merg with the anterior longitudinal ligament it is merging with the anterior longitudinal liament of the upper thoracic vertebra of the thoracic vertebra T12 T3 and obl T4 so this is the extent and one of an important feature which you should know you should know the difference between the danger area of the the neck and the retr faral space so I just want to enlarge this so here in this diagram you can understand this so see here actually the red color area is the danger area of this space so you can see this red color area which you are seeing here this red color area is the danger space of the neck the red color area is the dangerous space of the neck and the yellow color area which you are seeing is the retr faral space this is the retr faral space the yellow color area is the retr faral space asum so exactly retr faral space is lying anterior to the danger area of the dangerous area of the uh neck and exactly dangerous area is lying between the Aller portion of deep cervical fa and pre vertebral layer anterior to it is the retral space which is lying between the all portion of deep cervical fascia actually pre layer anterior extension is Aller fascia and the posterior fenial wall so it is exactly lying between the posterior fenial wall and Aller fascia of deep cervical fascia so that is important for you to note down then we will come to the carotic sheath so here itself if you want you can write down difference between dangerous space of neck lies dangerous space of neck lies posterior to retr faral space retr faral it lies posterior to retr faral space of neck retr faral space of neck is also called as gitty space it lies between Aller fascia and pre vertebral layer of deep cervical fascia and free vertebral layer of deep cervical fasia the retr faral space the retr faral space if I talk about retr faral space it lies between it lies between Aller fascia and posterior fenial wall and posterior fenial wall okay actually the pre vertebral layer of deep if we talk about the pre vertebral layer of deep cervical fascia it is extending in into the axila to form axillary sheet so it will form axillary sheath it will form axillary sheath uh in the pre in the axillary region so that is very very important for you to note down now uh actually there is one more thing which everybody should know is the koted Sheep so if I talk about koted sheath its anterior wall is formed by koted sheath anterior wall is formed by uh pre vertebral layer pre-trial layer so pre-trial layer of deep cervical fascia forms its anterior wall posterior wall is formed by pre vertebral layer of deep cervical facia and in the anterior wall you can see there is the location of Ansa cervicalis so there is a location of Ansa cervicalis in the anterior wall and posteriorly there is sympathetic chain posteriorly there is location of sympathetic chain so posteriorly there is location of sympathetic chain and it contains the posteriorly uh there is sympathetic chain and it contains igv koted artery and vas ner which is shown in this image so done with this now the next topic is thyroid gland so should be complete thyroid gland also Dr SK it is called as dangerous area I will tell you the reason why because it is actually if you will see the extent is from the base of the skull and going down to the level of longitudinal ligament of T3 and T4 so what happens uh actually uh it can communicate with par esophagal retral spaces so posteriorly it can communicate with the many important fenal spaces it is having many of the important Fingal spaces and that is the reason there is communication there so definitely there can be spread of infection and if it is spread it can spread to the it can go interior of the skull it can go to the posterior to the fings it can go to the par retral spaces and it becomes very dangerous it can involve the vertebras also intervertebral dis also vertebral Canal also and can involve spinal cord ultimately so now uh okay Dr SK now I want to complete so let's complete the thy let's start with the thyroid gland and then I will give you a break okay so you have to know note down the location the capsules the arterial relation the venous draus the lymphatic and the clinical correlation of the thyroid gland so in this diagram you can have an idea where thyroid gland is located so you can see the location so if I talk about the thyroid gland this whole is the thyroid gland so these whole part is showing you the thyroid gland so you can see here this L for the lateral robe and this I for the esmic part so exactly the location of thyroid gland is in relation to it is lying anterior to C5 C6 C7 and T1 glands if you will see there is a extension from there is an extension from pyramidal lobe so there is a small pyramidal L from that of the estas which is extending and above it is attached to the hyid B so this extension is called as lator glandula thyroid thyroid gland is isic part is connecting the two lateral loes and it is lying uh close to the uh it is lying anterior to the tracheal rings that is it is lying anterior to that of second third and fourth tral ring so you can just write on about the details so write on thyroid gland thyroid gland is located in the lower part in the lower part and in front and in front of neck opposite C5 C6 C7 and P1 vertebras C5 C6 C7 and P1 vertebras it is f shaped it is Ed shaped it is having two lateral loopes it is having two lateral loopes and the two lat if it is having two lateral ropes it is having two lateral loes which extend upward it extend upward to the oblique line of thyroid cartilage to the oblique line of thyroid cartilage if I talk about the Estus of if I talk about Estus part EST part of thyroid gland is located across midline in front of second third and fourth tral Rings okay now you can see here this is actually the thyroid gland which has been sewn and you can see there is an extension from the thyroid glas which is forming which is a pyramidal l this extension is called as lator glandula thyroid and which is attached to a hyoid bone so it is attached to a hyoid bone as shown in this diagram this is uh this pyramidal Lo extension is called as levator glandula thyroid done now let's talk about the capsules of thyroid gland so the capsules of thyroid gland is having a outer aspect false capsule and inside it is having a true capsule so it's important to know the component so exactly now itself I have told the false capsule of thyroid gland if I talk about false capsule of thyroid gland it is formed from pre-trial fascia true capsule is formed from peripheral condensation of the thyroid connective tissues and exactly if you will see the veins so exactly if you will see the veins so you can see here these are the veins and these veins are actually lying deep to the true capsules deep to so the surgical incision in case of so if we want to save the veins we doesn't want any kind of bleeding so surgical incision will always put between the true and the false capsules between the true and false capsule so here we are knowing the false capsule is formed by PR tral layer of deep cervical fcia is formed from pre-trial layer of deep cervical fascia and the veins are lying beneath the veins are lying beneath the uh that of the true capsule and plane of surgical cleavage is between the true and the false capsule now it's important to know the import it's important to know about the uh about the relations of thyroid glands it's very important to know about the relations of the thyroid gland it is important to know exactly what is Apex what is so exactly you can see in this diagram uh we can see the anterior border we can we have this is the thyroid gland and if I talk about the thyroid gland it is having Apex base three surfaces and that of two borders so it's three surfaces are lateral surface cool lateral surface and medial surface it is also having a medial surface and it is having AIC part and it is having the two lateral Lo it is having Apex and the base so you can just see the Apex is directed upward towards the thyroid cartilage which is actually sandwiched between two muscles it is sandwiched between a sto thyroid and inferior constricted muscle so it is will very sandwich base is lying lower down as you can see in the diagram and we have got three uh surfaces so one by one I would like to show actually this is a transverse section of of the thyroid gland of the neck which is showing the relations of thyroid so relations on the medial surface medially if you will see the thyroid gland this is the whole outline of the thyroid gland medially you can see it is related with the r laral nerves and the tubes that is tracha esophagus pool laterally it is related with koted sheath and its contents and laterally it is related with the strap muscle stoh sto thyroid omoide overlap by stoco muscle muscle so please write down the heading relations of thyroid GL relations of thyroid gland so if we talk about the relations you can write down Apex is Apex is directed upwards and is so the Apex is directed upwards to oblique line of thyroid cartilage oblique line of thyroid cartilage Apex is directed upwards and the to the oblique line of thyroid cage and is sandwiched between and is sandwiched between between two muscles inferior constrictor muscle which lies medially and Sterno thyroid muscle laterally Stern thyroid muscle laterally okay so this was about the Apex now talking about the base the base of thyroid gland is related to the fifth and sixth tra kill rings now talking about the lateral surface lateral surface is also called as superficial surface so lateral surface is also called as The Superficial surface of the thyroid gland and it is literally it is it is covered by three strap muscle so it is covered by three strap muscle and as I told you this three strap muscle is overlapped by Stern cide muscle so it is related with three strap muscle that is stero thyroid that is sternohyoid and Superior belly of omoide and Superior belly of omoide and these three structures are overlapped by stoco mus muscle so medially it is related with two tubes that is tracha and esophagus it is related with two muscles and the two muscles is inferior constrictor muscle and crico thyroid muscle it is related with two cartilages that is criid and the thyroid cartilage criid and thyroid cartilage so these are about medial relation now exactly Estus relation is already known to you this is lying anterior to the trachel Rings it is lying anterior to second third and fourth trachel rings and in posterior border we have got the para thyro gland so done with this these are the important relation what is very very important for thyroid gland which has to be known to you is the arterial Supply venous drainage and arterial supply of thyroid gland is via Superior thyroid artery which is a branch of uh it's a branch of external koted artery inferior thyroid artery branch of thyroid cervical trun there is thyroid imma artery also if I talk about thyroid IM artery it's a it's actually a branch from 30% cases only it is present it can be a branch of arch of a bre I truck and it is also having accessory thyroid from the branch of esophagal and trach so you can see here this is showing the superior thyroid artery the inferior thyroid artery and we have got the thyroid artery which can be either the branch from ralic trunk or directly from arch of water so this is about the arterial Supply then we will go so please write down arterial supply of thyroid gland write down the heading arterial supply of thyroid gland the arterial supply of thyroid gland is following it is via Superior thyroid artery branch of ECA external koted artery it is where inferior thyroid artery branch of thyro cervical trunk branch of thyroid which is itself is a branch of subclin artery first part then we have got thyroid artery thyroid artery can be a branch from brachio falic trunk or sometimes from the arch of water and the fourth source is accessory thyroid arteries accessory thyroid artery which can be a source from esophagal artery or tracheal artery so these are basically four arterial Supply these are basically four arterial supply to the thyroid gland now let's talk about the venous drainage so if I'm talking about the venous drainage the important veins draining thyroid gland is superior thyroid ve inferior thyroid ve Superior thyroid inferior thyroid middle thyroid ve so we have got Superior thyroid vein we have got middle thyroid ve we have got inferior thyroid ve we have got also sometimes we have got coacher wi so actually it's important to know the drain is of these veins so these are the four veins so actually most of D so exactly all the veins are draining in internal jlin so Superior thyroid vein drains into igv middle thyroid vein also drains into igv the vein of cure which is sometimes arising between middle and the inferior thyroid vein it also drains into igv the odd man out is only the inferior thyroid V which drains into left braio calic vein it drains into left brachio calic vein now talk talking about the lymphatic drainage so lymphatic drainage has been asked it is mainly draining into pre-a lymph node it drains into prear lymph node also it rins into paratra lymph node and ultimately it will Rin into the deep cervical lymph nodee so now done with this uh so actually I would also like to talk about nerve Supply so nerve Supply is basically if you so basically if we talk about the nerve Supply nerve supply of thyroid gland is both parasympathetic and sympathetic so parasympathetic is from vus nerve so parastic is from the vus nerve and derived from the r Lal NES and sympathetic is derived from the cervical sympathetic ganglia basically the middle cervical sympathetic ganglia now correlation what is very very important for your examination is to know the clinical anatomy of thyroid gland then I will come to one question so uh let's uh check with the students so exactly it's very important that you should know the clinical anatomy of thyroid gland okay dear so if I'm talking about the thyroid gland you have to know about this so I'm just enlarging it so what you can see here that this is the an thyroid gland and here you can see this let me just yeah so I have outlined the thyroid gland as you can see yeah so this is the outline of thyroid gland so this is one number and this is two number so exactly Superior thyroid artery is running close to external Arenal nve as shown in this diagram inferior thyroid artery is running close to the recent l so this correlation is very important this correlation is very important that means when Superior thyroid artery is ligated and sometimes what happen in ligation of superior thyroid artery there can be a chance of injury of external lenel L and this will lead to the paralysis of the muscle that is CCO thyroid muscle and if the inferior thyroid AR towards the base is uh is ligated it can lead to at times the recurrent lenal nerve injury and that will lead to the paralysis of all the muscles of larynx except CCO thyroid so that corelation is very important so so here this correlation is very important so many times clinical question has been asked from this so I just want everybody to note down this Superior thyroid artery which is giving blood supply towards the apal part Apex part it is running close to which nerve it is running close to external lenial nerve and when external lenial nerve will injured it can lead to the paralysis of it can lead to the paralysis of cricothyroid muscle if it is in injured CCO thyroid muscle so if it is injured if external if Superior thyroid artery has to be liated and it is not properly done by the surgeon they can injure the external lingel nve and this will lead to the paralysis of CCO thyroid muscle if I talk about inferior thyroid artery the inferior thyroid artery give blood supply to the thyroid gland it runs along with the base and it run close to the recurrent lenel so when uh when while liting inferior thyroid there is an injury to the Recine lenal nve it will lead to the paralysis of all intrinsic muscles of the laryn so it will lead to the paralysis of all intrinsic muscles of laryn except cricothyroid except cricothyroid why not cricothyroid because cricothyroid is supplied by external LEL that means the abductor of the vocal code what is the abductor of vocal code abductor of vocal code is posterior ceroid that is also paralyzed and the person will have a have an emergency condition and emergency CCO thyroidectomy has to be done now the clinical correlation of thyroid gland injury it can lead to the conditions of as we know the thyroid gland is surrounded by many important structures it is surrounded by Lings farings and all trachea ESOP so there can be a compression and the person can have dysphonia difficulty in speaking difficulty in eating difficulty in Airway passage breathing so these are the condition associated with thyroid gland swelling yes thyro cyst that we know that there is foramin seeum and if thyro cyst is not obliterated during the thyroid gland development okay Dr pun so it is not obliterated it can lead to the condition of thyro thyroid fistula thyroglossal cstem fistula being formed this can have uh external and internal communication now I want everybody to pay attention let's solve mcqs related to it and after this McQ let me just check after this McQ I will start with a new topic but I will give you a break okay let's solve this McQ so let's start with this Ms I will give you a few seconds to answer a 34 year old male now if I talk about a 34 year old male is having a squamous cell carcinoma it's a having a scammer cell carcinoma undergo surgical neck dissection while attempting to ligate the inferior thyroid Ary the surgeon accidentally damages the surgeon accidentally damag the nerve which is lying in close proximity to it okay which of the following which of the following structure is most likely to be damaged which of the following structure is most likely to be damaged so you can see here I will just rub this so actually you have to see that surgeon is is for the operation and here the inferior thyroid artery is ligated so which of the following no is closely associated with it and can be a chance of their injury so I got an answer from ntin ntin is telling B what about others I got an answer for Punit as so everyone has given absolutely right answer just now I have so I have explained it also absolutely correct Rin lenel nerve is not the right answer Superior lenel is not the right answer as its Branch external lenel will be Liga Superior thyroid arisin Ansa cervicalis is located anterior to the loop anterior wall of koted sheet hypoglossal nerve will give inovation to tongue and accessory nerve will give inovation to stern cleoid and trous muscle that means the right answer is R lingula so in inferior thyroid artery which is a branch of thyrocervical trunk which is a branch of subclavian artery runs along with the Rin lenal nerve Superior thyroid artery runs along with the external l so so that is the right answer absolutely correct yes Superior l n if we talk about Superior LEL nve you can just have Superior lenal nerve is a branch of vas it's a branch of vas nerve and Superior lenal n divides into external lenal n and internal lenal n that means there is the chance of external arel law paralysis and external arel law is giving inovation to cricothyroid okay so now Vegas now if I talk about recent lenel no it will have the innervation so all the important structures will get injured so also Superior lenal nerve is not the right answer Ana cervicalis is a nerve Loop giving ination to yes Dr SK yes Dr SK please tell yes Dr SK please tell Ansa cervicalis is giving inovation to infra Hy muscle hypoglossal nve is giving ination to all the muscles of the tongue so exactly you have to know this uh this structure very nicely yes ma'am Superior lenal nerve damage if it is more when the super as we know Superior lenal nerve uh exactly uh this is for Dr SK Superior lenel n divides into two branches one is external Arenal love and the other is internal Arenal love so external Arenal component is damaged then the CCO thyroid muscle is paraliz if the internal Lal component is damaged the sensory innervation of the mucosa of the laring cavity above vocal Cod is injured so now the next topic is farings and laring so you will get the detail SK got it if the superior arel is injured then the both the branch will be gone external and internal arel external will be injured CCO thyroid muscle paralyzed internal lenal nerve is injured then the mucosa innervation of lenal cavity sensory innervation above the vocal cord is gone internal lenal artery it's internal lenal artery is Branched from inferior thyroid artery okay so generally so that is with internal lenal artery ligation with nerve damage that is in relation with thyrohyoid membrane but common site of injury is this okay Dr SK common site of injury is this if I'm telling if the whole bunch of superior lenel gone both internal and external is gone okay internal arrel component basically will be more damaged as you go towards the thyroide membrane or you go towards the parfor fosa okay parfor fosa so I giving you a break now I will come with a new topic after the break and we will start so let's start with the session now uh uh the next two topic which is very important which I want to cover the two more topics are there one is the fings and the lens so this two topic is highly important for the question being asked for your examination so we will uh I would like to cover up both these topic one is fings and the other is larynx so let's start with this the idea is that you have to know about the fings also and you have to know about the laryn also so firstly let me cover up the fings part actually fings is will be divided again into different components that is naso farings Oro farings and lingo faring so that all part you have to know so exactly in this diagram the paths of fings has been shown to you so exactly if we talk about the fens it is uh it is having an extension which has been shown so it is exactly starting from the base of the skull so superiorly the fence is extending from the base of the skull which is related to the body of spinoid and inferiorly it is continuous with the esophagus at the level of lower border of criid cartilage so that is the whole extent of the fings and posteriorly there lies pre vertebral fascia and anteriorly on each side there is no there will be nasal cavity oral cavity and the laryn so this is an idea of the fings location the fings is divided into three parts naso farings Oro farings and lingo farings the part of the fings which is ly posterior to the nasal cavity is called as naso farings the part of the fings which is lying posterior to oral cavity is Oro farings and the part of the fings which is lying posterior to lingal cavity is called as lingo fings so first thing is to know the overall boundary of the fings then we will talk about each component so I just want everybody to know about the extent of fings so when I'm talking about the superior aspect of the foring superiorly it extend to the base of skull and inferiorly it extends to or continues below with the esophagus at the level of criid cartilage at the level of criid cartilage posteriorly it is having the pre vertebral fascia and anteriorly there lies the opening of nasal cavities the mouth and the laryn okay okay so this is overall fings part and we have got the naso farings Oro farings and lingo farings so firstly I would like to tell about the naso farings exactly if I talk about the part of naso farings that means naso farings is lying behind the nose it is lying behind the nose orango farings is lying behind the oral cavity and lingo farings is lying behind the laryn now uh actually this is the headen soal section so this is exactly the Cal section of head and neck so this is a cal section of henck where you can see the important structures so you can exactly see the important structures in the Cal section of head and neck and you can absolutely appreciate that the boundaries of the Cal section of Ed so you have can appreciate the boundaries of sial section of head and you can see the naso farings here so firstly I would like to talk about the n naring so in this image I talking about the naso faring so I'm just enlarging this so when I talk about the naso farings it is having important structure so one of the structure which is shown here this is the naso fenial tonsil so at the junction of roof and the posterior aspect we have got mopal tonsil that is the lymphatic aggregation other than that here you can see there is an opening of aaan tube and it is overlap so there is also an opening of aaan tube which is called as auditory tube and above the Stan tube there will be aggregation of lymph node that will form tubal tonsil so exactly these are certain important things which will be seen in the naso faring so write on the heading naso farings naso faring so exactly first is to know the extent of the naso faring so if I talk about the extent of nasing it lies behind the nasal cavity and above the level of soft pallet so in this diagram you can see this this is the soft palet so exactly this is the soft palette so from here to here posterior to the nasal cavity and above the level of above the level here you can see posterior to the nasal cavity and above the level of the soft pet this whole area is called as the area of naso farings naso farings lies behind the nasal cavity it is located behind the nasal cavities and above the soft pet above the soft pet now important features so let's talk about the important features of naso Farin so one is the agregation of lymphoid tissue so if you will see the aggregation of lymphoid so there is an aggregation of lymphoid structures there is an aggregation of lymphoid tissues and these aggregation of lymphoid tissues is collection of lymphoid tissues lying beneath the mucous membrane and exactly this collection of lymphoid tissues is lying beneath the mucous membrane and the junction of the posterior and Superior aspect this will form naso farial tonsil this will form naso farial tonsil the other features is this will form the na so exactly I just want everybody to see this this is the fenal tonsil called as naso faral tonsil so exactly if you will see in this diagram you can if this is the outline of nangal tonsil which is shown in the green color you can see it is lying posterior to the nasal Cav and it is exactly lying at the junction of roof and the posterior aspect and this collection of lymphoid aggregation is called as naso faral tonsil so that is exactly called as naso faral tonsil other than that you can see the openings here so you can see the auditory opening so here is the auditory opening which is having a this is orifice of the auditory tube and above it the collection of lymphoid structure is forming tubal tonsil so this is again showing the image of naral tonsil the other important structure which is seen is orifi of auditory tube what is the other name of auditory tube it is also called as fingo tanic tube the other name of auditory tube is it is also called as fingo tanic Cube so there is an orifice of fingo tanic tube which is also called as auditory tube which is also called asaan tube it is also called asaan tube now there are two FS there are two FS so orifice is there and there is also FS so on upper got thyroid this fingo tanic tube there is collection of lymphoid tissue that is on the upper and posterior aspect that is on the upper so if we talk about collection of lymp the collection of if we talk about the collection of lympo tissue the collection of lympo tissue is lying on the upper and posterior aspect of auditory tube and this is called as tubal tonsil this is called as tub Bel tonsil now sometimes what happens this is the naral tonsil so if narial tonsil enlarges if it is enlarging if mopal tonsil enlarges it will lead to the formation of adenoid it will lead to the formation of adenoid and it can lead to mouth breathing so it can lead to the condition of mouth breathing it becomes very difficult for the patient to have breathing from the nose now other than that actually there is is also actually fold is there in auditory tube above so there is a fold so in adory tube there are fold there is is there is a two folds which is diverging here and they are salino faral fold and salop Palatine fold so collection of lymphoid tissues are there and there are two folds which is extending so mucosal fold is extending from this elevation so if you will see here mucosal F so here you can say here you can write from from tubal tonsil mucosal fold from tubal tonsil mucosal fold extends that is two two mucosal fold extends and the name of that fold is the one is called as salino farial fold the one fold is called as salino farial fold and the other is called as salpino Palatine fold salino Palatine fold so there is a salino Palatine and there is saleno parel and there is salop Palatine F salpingo farial fold is containing salino farenas muscle and the other muscle which it contains is levator lator willach muscle now there is also a Fingal recesses one more point is important for the naso faring there is a fenal recessus and this fenial recessus is a deep depression it is a deep depression behind tubal tonsil it is called as fenial recesses or called as fosa of Rosen Muller for of Rosen Muller now the next topic is Oro farings the next topic is Oro farings so if I talk about Oro farings it is located behind the oral cavity it is located behind the oral cavity so the roof is formed by the soft pallet and floor is formed by posterior 1/3 of the tongue so exactly if I talk about the Oro farings it's roof is formed by the soft pallet and its floor is formed by the posterior part of the tongue extent if I'm talking about the extent of Oro farings it is lying below the soft pallet and above the eplus I just want you to show this image see here so exactly if we talk about the extend so it is lying below the soft pallet and above the epiglottis so this is the epiglottis structure so this is the epiglottis and this structure is the soft palette this is epiglottis so in between these two structure where we have got the location of Oro farings so here will be o for Oro farings this will be NP for the naso farings and below it we have got the lingo fings so write down about oro farings oro firings extends from soft pallet to E glotus and actually at the entrance of the Oro farings actually uh I just want to tell you about the wers ring so there is a w ring there is wers ring and this is very very important for you to note down so everyone if you have got any doubt you can ask me I just check with the students okay Li uh I will take many topics don't worry at what time class going to start so it's already started okay so this is the wers ring which is formed by uh the continuation of the actually we know that there is a Palatine tonsil which is lying in the tonsil fosa so exactly there is a tonsil fosa so there is a tonsil fosa in which Palatine tonsil lies so we have got posteriorly narial tonsil we have got laterally Palatine tonsil and tubal tonsil and anteriorly there is a lingual tonsil so all these together is forming the wder ring and this is obstructing any kind of interance of any kind of infection and invagination entering into or infecting the cavities of the infecting the uh any kind of infection is not drained inside so that is very important so actually then we will talk about lingo farings so if I talk about lingo farings here we will also talk about uh uh The Smuggler fosas and all lingo faring is lying behind the lingal cavity so if I talk about the general features or extend so it is exactly it is exactly located so it is it is located between in between it is uh epig glotus it is extending from epig glotus to uh the to the criid cartilage and the criid cartilage level is corresponding to C6 cervical ver so if you want to exactly know lingo faring is L posterior to the Ln but if you want to know exactly extent of lingo Farin it is extending from the epiglottis above to the criid cartilage below that is C6 cical vertebra so here you can see and laterally there is a space so in the lateral aspect you can see there is a space as you can see so exactly uh this space is also very important for you to note down why because uh this is called as parfor fosa so exactly parfor fosa is a deep resis narrow below the anterior part of the lateral wall of the lingo Farin so it is exactly very important for you to know so exactly par fosa B if we are talking about the parfor fosa you can see this is the parfor sinus which has been sown so medially there is AR epiglottic fold so you can see here on the medial aspect there is AR epiglottic po so mediately there is AR epiglottic fold and laterally there will be a mucus membrane over the uh over the lamin of thyroid cartilage and also there is the parfor fosa there is also epiglottis as you can can see so exactly above there is an epiglottis part and medially there is AR epiglottic fold so exactly it's a lateral Food Channel so parip fosa is a lateral Food Channel lying on either side uh as you can see and it is actually a deep broad recesses which is lying on the either side of lenal Inlet so please write on par form fosa so if I talk about paror fosa it is a de paresis on each side of Lal Inlet on each side of lenal Inlet this is a d processis so it's also important for you to know the boundaries so if I talk about the boundaries so please write down the boundaries important boundaries if I talk about the boundaries medially there is AR epiglottic fold which is covering the quadrangular membrane so it is covering the quadrangular membrane then we have got the mucus laterally we have got the mucosa which is covering the thyroid cartilage and thyro it covers the thyrohyoid membrane and thyroid C and above there is epig glotus vula so this is about the boundary of parior for and the clinical importance of perform fosa is that sometimes what happens is also called as Smuggler fosa so uh exactly what happens there can be a malagant growth in this area or there can be ingestion of int some foreign structures fish bone or all can accumulate and Care should be taken to take the foreign bodies actually why because the there can be injury to internal Lal no in this area so the reason is why because internal lenial KN will be injured in this area and that protective reflex that is cup and protective reflex will be gone and it can lead to uh the blockage and it can lead to asaia okay now let's talk about the walls so let's talk about the fenial wall so if I talk about the Fingal wall the Fingal wall is come is having following layers as you proceed so mucosa fingo basill fascia the sub mucosa the constricted muscle and longitudinal muscle and the outermost layer is the buo faral fascia the outer layer is the buo farel fascia so the fenel wall is is made of mucous membrane which is forming from inside to outside it is made of mucus membrane it is made of mucus membrane it is made of fingo basill faia it is made of muscular Cod that is the fangel muscle and it is made of bangal facia okay now done with this now we will talk about the constricted muscles so now we will talk about the muscles so actually if I talk about the muscles of the so this is the diagram this is the image which is showing longitudinal muscles of the F this is showing longitudinal muscles of fings so this is showing the longitudinal muscles of fings salino fares styo fares Pat fanges and all and this is sowing the constrictor muscle so we have got Superior this is sowing the superior we have got Superior constrictor muscle we have got the middle constricted muscle and we have got the inferior constrictor muscle so all these are forming the muscles of the fings and what is very very important for you is to know the gaps in this constrictor group of musle so it's very important to know the gaps in this constrictor muscles and the structures passing through this Gap so actually I would like to uh explain and then I will write about this then we'll talk about so exactly uh this is the base of skull so the the first Gap is between the base of skull and the superior constricted muscle the second Gap is between the superior and middle constrictor muscle the third Gap is between the middle and the inferior constrictor muscle and the fourth Gap is below the inferior constricted muscle and you have to know the structures passing through all these spaces so actually the gap between the base of skull and upper aspect of the superior constricted muscle is also called as sinus of Morag and the structures passing as four we have got auditory tube we have got ascending parangal artery Palatine Branch ascending Palatine artery auditory tube and levator will pattin four structures are there if we talk about the structures which is passing between the Superior Middle constrictor muscle just two structures passes styop farious muscle and the innervation of styop farious muscle that is GL fangel now the middle constrictor inferior constrictor we have got another Gap in which passes the superior lenel vessels and internal LEL KN below inferior constrictor we have got a space that is called which is also called as the tracho esophagal groove and through this passes R Lal nerve and internal lenal vessels so I just want everybody so I just want everybody to write this so please uh write it so I just want everybody to write this important point on one side write on Gap and on other side write on structure passing through the Gap so one side we have got the structures passing through the Gap and other side we have got a gap so one by one you will write it so let's talk about the first Gap so if I'm talking the first Gap the first Gap is between so write down Gap is between base of skull the Gap is between base of skull and upper concave border of superior constrictor muscle and actually this Gap is called as sinus of Morag and the structur is passing through this Gap so we have have got four structures passing through this Gap so please write down we have got four structures passing through this Gap and they are auditory tube they are lator vtin muscle levator wi palatin muscle they are ascending Palatine artery they are Palatine branch of ascending parang artery Palatine they are ascending Palatine artery and they are Palatine branch of ascending fenal artery this is the first Gap now talking of the next Gap the second Gap is between Superior constrictor and the middle constrictor muscle so I'm writing in short between SC Superior constrictor and the middle con this is the second Gap and two structures are passing through this Gap styop farious muscle and the ination of styop ferious muscle so uh we have got a muscle and it's nerve Supply right Stylo fous muscle and its nerve Supply that is gloo faral nerve okay now the third Gap the third Gap is is [Music] between middle constrictor and inferior constrictor muscle the third Gap is between middle constrictor and inferior constrictor muscle so that is internal lenial nve that is internal lenial no and we have got Superior laral vessel Superior lenal vessels now talking about the fourth Gap so that is the gap if I talk about the fourth Gap it is between or it is below the in it is below the inferior conri this Gap is below inferior constrictor muscle and these are the structures passing is the recurrent LEL now and inferior L ver so done so exactly all these structures are passing so we can see all these structures are passing between this Gap and I want everybody to know about these gaps and the structures passing because this is highly important so I just want everybody uh everybody to know this why because this is highly important yes you are right so actually why this is very important highly important is that you should know all these structures and the Gap the next is to know about so we have done with the longitudinal muscles if I'm talking yes longitudinal muscle we have got three de that is the pat glossus muscle no no here we have got so we have got in case of tongue that is we have got styop farenas muscle we have got Salin farious muscle and we have got Pat farious muscle these are the three longitudinal muscles now exactly the next important point is to know the nerve Supply the Venus drainage and all then so exactly if I talk about the nerve Supply nerve supply of the fings so all so firstly I would like to talk about Motor Supply so all the muscle Supply fings all the muscles of fings are inated all the muscles of farings are innervated all the muscles of fings are innervated by all the muscles of fings are inated by cranial root of accessory nerve by cranial root of access nerve via fenal branch of Vegas which is carrying fangel branch of Vegas actually the ination is via fenial nerve flexes and we know that these nerve flexes is lying over these n flexes is lying over middle constrictor muscle so this this is located over middle constrictor muscle so this is located on the middle constrictor muscles of the fen this is located on the middle constrictor muscles of the fing next important thing is to know the formation of Fingal nlex so in this diagram you can see fenial nor plexus so if I talk about fenal n plexus it is formed by fenial branch of Vegas it is formed by the fenel so this ner plexus is formed by if we talk for the formation it is formed by fenel branch of Vegas fenel branch of gloo farel now and also by fangel Branch from the superior cervical sympathetic n sural cervical sympathetic gangon so branches from the superior cervical sympathetic gang this is all the fenal n flexes so done with this motor supply if you just want to know about the sensory inovation so if you just want to know about the sensory Innovation so it's important to know that the so if you want to know the sensory Innovation you can just write on sensory supply of the fing so here we have got three part naso farings we have got Oro farings and we have got fingo farings we have got lingo farings so basically if I talk about NES of farings it is getting Innovation from the fenel branch of Tero Palatine gangon arel branch of Tero palatin gangon Branch from Max Oro fares is getting its Innovation by gloo farial nerve and lingo farings is getting Innovation from internal L now done is done by internal LEL okay so done with this now uh okay if you want to know the uh arterial Supply in Venus drainage also you can write it then we can move on the laryn so I just want everybody to write this also okay now let's talk about the Venus draus so Venus draus is via parangal Venus plexus so Venus draus so you can just write down yeah Venus draus of fings if I talk about Venus draus of fings it is via farial Venus plexus and we know that fenal vinous plexus will ultimately drain into IV internal jugular ve so done with this so we have done with this now the next topic which I want to start is the larynx so I will just cover up the larynx and uh uh we will have the uh so last topic which I want yes you are absolutely right Vates you are absolutely right now the next topic is the larynx what is important in larynx is the cartilages of the larynx which you have to know so you have to know about the cartilage you have to know about the ligaments EXT you have to know about the name of extrinsic intrinsic muscles of the laryn intrinsic muscles of the Lings and the action of these muscle you have to know about the nerve Supply vascules and the clinical Anatomy so let's start with the larynx so exactly if I talk about the larynx the other name of larynx is it is also called as the wise box so it's also called as the wise box and it is extending from C3 to C6 vertebra and it connects the it is continuous with that of the trach so you can see this is the laryn this is the extent of the larynx and the larynx is lying anterior to lingo farings and its extent is from C3 to C6 cical vertebra so that is the overall extent of the larynx now it's important one time there was a question in the fmg exam was about the laryn which is the paired cartilage and which is the unpaired cartilage so total how many cartilages are there in Len so total we have got nine cartilages in this nine cartilage we have got three paired and three unpaired so here uh three paired one is yes you are right dear the un uh the the three unpaired is criid epiglottis and that of thyroid and three paired one is aroid corniculate and uniform so total it becomes how many total becomes nine yes dear I just want everybody to see this image actually if you will see this image you can uh see the cartilages you can see thyroid cartilage the epiglottis which is having the shape of it Leaf like aroid criid cartilage so we have got and also the two small cartilages which is exactly seen in this diagram so you can see here we have got the uniform and we have got the corniculate cartilages okay so together these are the ctil what is important for you is to know which cartilage is made of th hen cartilage and which is made of elastic cartilage so generally the thyroid cartilage is proted outward forming the Adam apple larger in males and that and they is also inside and outside the lenal cartilages are connected forming extrinsic membrane and ligament and intrinsic membran and ligament thyroid cricoid yes venes you are right corniculate and uniform is elastic not only that uh we have got epiglottis which is also elastic and the Apex of eroid is also elastic okay wenes so please write down thyroid cartilage CID cartilage eroid cartilage aroid cartilage except the Apex so all these three cartilages are made of hen cartilage and if we talk about four 5 six you just write on apex of aroid cartilage Apex of aroid cartilage epiglottis corniculate and uniform corniculate and uniform C so these all cartilages these all cartilages these are all C are made of elastic cartilage these are on which variety these are of elastic cartilage variety these are of elastic cartilage variety so the composition of cartilage is also very very important for you to note out so actually uh we have just now appreciated so exactly we have just now appreciated that laryn is having cartilages and membrane on outer aspect and it is having larynx is also having cartilages uh it is having membrane and ligament in inner aspect so all the cartilages of laryn to work as a single entity it it work together if we want to make all the cartilages working as a single entity so what is important for us is to that we should know about so that is important that we should know that there will be membranal ligament which is connecting the larynx cartilage so that it work as a single structure so lenal membrane and ligament which is supporting this carlous framework on outer aspect is called as extrinsic membrane and ligament and the in uh the larynx cartilage and cartilage membrane ligaments which is protecting it or connecting the larynx cartilage on inner aspect the membrane and the ligament which is supporting it from the inner aspect is forming intrinsic ligament of the L so it is important that you should know the name of important extrinsic and important intrinsic ligament so here it's very important that you should appreciate one of the ligament that is thyrohyoid membrane so this is one of a very important membrane which is called as thyrohyoid membrane why it is very important actually this thyro me if I talk about this thyro membrane this thyroide membrane is pierced by so this thyroide membrane is pierced by internal lenal n and Superior thyroid AR so why it is very important is that because this thyroide membrane is pierced by internal Lal nerve and Superior thyroid artery so thyroide membrane is connecting so here you can see this is the thyroid cage and exactly this is the hyoid bone and this is the thyroid cartilage so exactly thyroid cartilage and Hy bone is connected by a green structure that is thyroide membrane and it is pierced by two important structures internal Arenal nerve and Superior LEL so in the mcqs and in the previous year of examination it has been asked that thyro hard membrane is pierced by two important structures the answer is it is pierced by internal Arenal nerve and Superior thyroid artery so first important membrane which you have to know is the thyroide membrane the thyroide membrane is spanning between so what is the from where to where it is extending if you will see the thyroide membrane in this diagram it is spanning between the thyroid cartilages and the hyoid B okay so it is called as thyroide membrane and it is pierced literally by Superior lenal vessel and internal lenal nerve so this is very very important point for your McQ that it is pierced by it's very important for you to note down that it is pierced by Superior lenel it is pierced by the superior L vessle and internal LEL L this is important point for the mcqs okay now if I talk about other ligaments we have got medium thyro ligament actually the thickening of thyroide membrane medially is medium thyro laterally is lateral thyro ligament and H epiglottic Liam so if you remember the name only you can understand H epiglottic Liam when I'm using the word hyoepiglottic it is connecting the epiglottis and hyoid bone so here you can see this is the lateral thyroide ligament this is thyroide membrane and here you can see this is the H epiglottic ligament which is connecting the Hye bone and the epiglottis this structure which you are seeing is e for epiglottis and this is the hyoid bone which you are seeing now CCO the more the other two important extrinsic membrane and liament is cot tral ligament connecting criid cartilage and that of the trachea median CCO thyroid means it is connecting the criid and thyroid cartilage medially so all these names which I have just told you like thyroide membrane median lateral thyroide ligaments I have told you H epiglottic liament cotri liament median CCO thyroid ligament all these are extrinsic membrane and liament of thyroid uh of the laryn so let's talk about intrinsic the next important point is to know about the intrinsic so in intrinsic category we have got two membrane and we have got two ligaments so in intrinsic category we have got two membranes and two ligaments so if I talk about the membrane two uh membranes is we have got a quadrangular membrane and we have got a COV vocal membrane so in this diagram you can see we have got a quadrangular membrane and we have got a coval membrane so exactly if I talk about quadrangular membrane it is important for you to note down that it is spanning between the aroid cartilage and lateral aspect of epiglottis so what will be the attachment of quadrangular membrane it is exactly located in between aroid Carz and lateral aspect of epiglottis it is having a free upper and lower border and its lower border is forming the vestibular ligament its lower border is forming the vestibular ligament so here you can see this is the qu so I just want everybody to concentrate on quadrangular membrane you can see this is the quadrangular membrane which is spanning between the aroid cartilage you can see this is the aroid cartilage and that of epig glotus and uh its lower free margin is called as vestibular Lig so it's lower free margin here is called as the vestibular ligament done now the other one is coval so when we are talking about the CCO vocal you can see here this is the another membrane which is lower down you can see so I just want to say the this is the quadrangular membrane connecting aroid and epiglottis lower down we have this is the muscular process and this is the vocal process of aroid so it is connecting the Arid and it is also merging with the thyroid cartilage here you can see here here it is merging and its upper aspect we have got the vocal ligament so it is having the vocal ligament so all together I just want to write down the name we have got quadrangular membrane and COV vocal membrane and two ligaments we have got the uh vestibular ligament and the vocal ligaments vestibular ligament and the vocal ligament so four of these structure is forming two intrinsic membrane and two intrinsic ligaments so that is very very important for you to note down now let's talk about the muscles of the laryn so if I talk about so basically I'm concerned with the intrinsic muscles of the larynx not the extrinsic one because intrinsic muscles of the larynx are uh is actually extrinsic is the surrounding muscle that is Supra and infrahyoid muscles are there that is extrinsic but when I talk about intrinsic muscle we have got many important muscle in this category posterior ceroid lateral ceroid thyro ticus AR iglus obl eroid uh so many muscles are there and I just want that you should understand these muscles on the categorization of their action so according to the action you have to understand these muscles so uh we will categorize these muscles so important muscles has been shown here as you can see here we have got obl eroid we have got transverse eroid abductor yes absolutely right wenes the most important of it is abductor of larynx only one abductor is there and the name is posterior ceroid posterior ceroid is the only one abductor we have got transverse eroid we have got thyo eroid lateral ceroid so one by one I will tell you so actually we can categorize this muscle according to their action here there is one more muscle here on the posterior aspect we have got posterior ceroid we have got cricothyroid muscle also which is the tensor so the muscle here this is very important the muscle that is causing Abduction of the lens which is causing Abduction of the vocal cord they are posterior ceron very important for the McQ and we have got a VES which has given absolutely the right point about this now we have got sphc action of muscle transfers so we have got sphc action muscle transverse eroid obl eroid and thyro ticus actually this cricothyroid muscle is very important and this has also been asked in McQ which muscle is having tensing effect on the vocal code and the answer is cricothyroid muscle is having tensioning effect on the vocal code so you can see here this is the cricothyroid muscle a very unique muscle having innervation by external lenel KN all the muscles if I talk about all the muscles of the larynx it is getting inovation from recurrent lenal knob except the odd man out is crico thyroid muscle which is getting Innovation from the external lenal knob so I just want everybody to know about the lenel cavity also actually the lenel cavity if I so you can see here this is the arotic fold and iglus so here we have got a false vocal code this is the lower part this is the false vocal cord vestibular fold and lower down we have got a vocal fold so in between this elliptical we have got the glottic compartment above it we have got the sutic compartment lower to it we have got infraglottic compartment so Lal cavity is extending from lenel Inlet to the lower border it get continuous with if we talk about the whole continuation of the laryn so exactly lenal cavity is arising from the lenal inlet to lower down it continues with the trachea it is divided into uh actually uh it is divided in two parts by the vocal fold and the narrow part between the vocal fold is called remag glotus so remag glotus is anal posterior narrow part of the lenal cavity the portion of the larynx which is lying above vocal fold is supraglottic compartment or vestile fold so exactly the portion so exactly what I told you the portion line below the vocal for is infraglottic compartment and that is very important so here you can see the false and the true vocal for this is the glottic compartment this is s for supraglottic and this is I for infraglottic compartment of the larynx and what is very important is to know the narrowest part of the lenal cavity that is the remag glotus and actually in different aspect the shape of remag glotus changes so I just want that you should be aware of this that you should be knowing about the remag glus so exactly it's important to know the remag glotus uh important changes of this so we will talk about Rema glot is important changes how it is changing it's actually remag glottis is an opening between two true vocal cord so exactly you can write this firstly so Rema glotus is opening between between the two true vocal cords anteriorly so it is an opening between the two vocal cord anteriorly and eroid cartilage posteriorly and eroid cartilage posteriorly so actually it is a narrow space it is a part of the laryn it's a narrowest space which is called as NE remag glotis which have got the vocal code anteriorly and posteriorly it is having the aroid cartilage okay it is adding the Aron cartilage so exactly remag glottis is a narrowest part in case of males the remag glotus is approximately 23 to 24 mm and in case of females is slightly more narrow it will be 17 to 18 19 mm that is a range okay so remag glotis is an aperture between two two vocal code anteriorly and it is an aperture between the vocal uh to vocal process of aroid cartilage posteriorly so this is very important for you to understand what is exactly the remag glotus if you want to know exactly the space you can more elaborate it so you can just write on remag glotus is an aperture it's an aperture between it is an aperture between the two true vocal chords anally and the base base and the base and vocal processes of of two aroid cartilage posteriorly two aroid cartilage posterior okay now here uh exactly this is soon and we are knowing the uh uh we are knowing about the uh about this remag glotus sape changes so exactly I just want that during quite respiration the remag glotus sape you can see it's actually a pentagonal type of feature you can see it's a pentagonal during speech it is linear chunk so it is like pentagonal shape the space between the remag is it is like a linear Chunk in Whispering it is actually uh so that spaces is very important so exactly if you talk about exactly normal or quite respiration it is exactly pentagonal type of condition in fored respiration it will be having the forced inspiration you can see funneling is there for the lower aspect as you can see Whispering it is actually like a linear chunk okay so exactly that is important so the saap has been uh shown you you can just go through this now talking about the next part is the nerve Supply nerve Supply as I told you in the larynx case the nerve Supply is all the muscles are supplied by posterior ceroid and so exactly uh if I talk about sensory so I just want to show you this image Superior LEL n is there which divides into internal and external L external lenel will give inovation to CCO thyroid muscle recent lenel n will give inovation to all the muscles of the larynx this internal lingal n will give innervation sensory inovation to upper part of the lenal cavity so it is giving sensory Innovation to upper part of lenal cavity recurent lenal n will give sensory ination to the lower part of lenal cavity so sensory innervation of the glottic and the upper part is where internal lingel L branch of superior lenel external lingel L is having only Motor Supply it gives Innovation to cricothyroid muscle all the muscles of the laryn is inovated by recent lingal nve and rent l nerve is also giving inovation sensory Innovation to the lower part of lenal cavity so this point is highly important for you this point is highly important for you have you understood about the nerve Supply every everyone have you understood about the nerve Supply that means upper part of laryn sensory innervation is via internal lingel L lower part of the lenal cavity below the vocal uh cords it is having internal is having recurent lenal nerve Innovation all the muscles of the larynx is supplied by recurrent lenal nerve except CCO thyroid which is supplied by external LEL yes you are right W is now vascular Supply Superior lenal artery branch of superior thyroid artery and inferior lenal artery branch of inferior thyroid AR is important for the vascular Supply so vascular supply of Ln is from two Superior lenal artery inferior lenal artery Superior lenal artery branch of superior thyroid artery inferior Lal artery branch of inferior thyroid vinous drainage so veins will drain into inferior Lal vein Superior lenel into internal jugular vein and inferior lenel will ultimately drain into left brachos spalc so that means inferior thy so that means Superior lenal vein and inferior lenal vein drain it and they will drain into internal jugular ve clinical correlation I would like to talk about cyy cottoy ma'am uh Vali yes yes yes dear Yes dear yes definitely dear I will take it okay I will take it that also yes dear I will take it croomy is an emergency procedure to make a temporary Airway actually sometime what happen there is failed uh intubation and in that case we can go for CCO thyroid thyroidotomy and exactly if I talk about CCO thyroidotomy it's a procedure of emergency procedure to form a temporary Airway passage so there is a less time and we want to save the patient so it's typically in a situation of any kind of obstruction if there is any kind of obstruction in the for example the obstruction is by foreign body the obstruction is for Ango edema the obstruction is for facial trauma and incubation has become unsuccessful and there is very less time to save the patient then we can go with the procedure of CCO thyroidotomy emergency situation to save the life of the person no it can be done it can be done more easily than intubation so cyod doomy is a technique it is less time dear less time Wes let time it is a procedure in which there is a actually there is incision made to CCO thyroid ligament so exactly it is an incision done for CCO thyroid ligament and if the patient is as is not able to breathe properly and we want to save the patient so and intubation is not successful because of any kind of much large swellings andol then we can go for this Cyro deomi procedure and incision is made in C thyroid ligament a small incision is made in the midline as you can see here the CID ID ligament and incision is made in this case so that we can save the person now I would also like to talk okay I will also like to talk about the vocal code paralysis so if I talk about vocal code paralysis the important vocal code paralysis and the injury of recrent lenal nerve is an important of case so exactly I just want that you should know the approximate uh important condition where there can be the uh there can be uh the Ral lenal nerve injury and this can cause to vocal cord paralysis okay so exactly uh uh uh so uh so exactly you can see the case of ayal if there is a case of aaral cancer so exactly so exactly if we talk about so exactly if I talk about the important uh uh procedures okay so yes if we talk talk about the important cases so exactly the reasons will be ayal lung cancer thyroid cancer ortic Anor cervical lymph adenopathy so these are the conditions okay so exactly yes Vates teach your paly actually 30 minutes and more yeah the whole entire process will be taking 30 40 minutes and all but uh exactly it is a safe procedure okay uh it's a safe procedure and uh if if an emergency condition if the patient is uh is uh just close to the hospital and all the procedures in the case of emergency should be done as fast as all because from starting to the end point yes it is approximately 25 30 to 40 minutes range is there okay so if we use for a case of nle croomy I think it's 40 minutes approxim but you should refer with a uh with a anesthesia doctor I will like that I will not be a better person to give you this answer you should refer to the anes IA faculty okay now these are certain condition where there can be affection or injury to the rine lenal nerve or the inferior thyroid artery is taken out is ligated so exactly this is a respiration process it is quite uh the vocal Cordes are aarts and there is a sufficient air passages there this is with the fation this is unilateral paly and this is the bilateral paly so in case of bilateral R Arin of paralysis you can say it's in adducted position and there is no space for the airway passage so in unilateral case of R LEL knob injury vocal Corde is paralyzed but again the other side vocal Corde is abducted so certain Airway passage is maintained and the patient will have heness of voice the patient will have horseness of voice but in case of bilateral paralysis what happens there is no abduction and the vocal code will be in adducted position paramedian position so I just want you to this is the right vocal code normal this is the left vocal code paralyzed this is the right vocal code normal and the left is so you can see slight space is there because the other side vocal code is not paralyzed and you can see still the there will be slight horseness of voice but it's it can it is not uh uh not so serious condition as this is the case of paralyzed right and the voter so you can see exactly very less space is there and there is no Airway passage and it's a emergency condition if you want to save the patient you have to go with the cyomi or procedure as early as possible so in the situation where the nerves are partially paralyzed the vocal code become paralyzed in full adducted position if it is occurs bilaterally the remag glotus as you can see is in completely closed position and the uh process to restore the airway passage can be done only surgical so surgical procedure has to be done to restore the airway passes so I just want to show you this this so here you can see vocal cord is in abducted vocal cord is in abduct abducted position here the vocal Cod is abducted position so very less Airway passage is maintained between the remag glotus and ultimately to save the patient surgical interventions has to be done so if you want to save the patient you have to go with surgical interventions okay so yes I will actually uh want you to know this that uh my procedures and all uh my Tim tables and all I will come with the next sessions also I will tell you the time table I just want you to give the details of the so let me just check how is the order of the sessions being taken the next will be abdomen and pelvis so abdomen and pelvis then we will have the Torx then we will have the lower limb and then we will have the Upper Limb so this will be the sequence that most of the part is covered up important parts exactly if if we can go topic wise one more important topic this is very conceptual you can just write in the messages the and I will come up with the explanation of that topics only so I hope I was able to complete many of the aspects and just go through this it will be highly beneficial for you all the best and keep studying