Head Neck and Face ª GSE Efferent : General Somatic Efferent ª SVE ª GVE Ú GSE VII, IX, X III ª GVA Afferent ÚGVE ª SVA ª GSA ª SSA : Special Somatic Afferent 06:40 PARASYMPATHETIC GANGLION 1. Ciliary Ganglion 2. Pterygopalatine Ganglion 3. Otic Ganglion 4. Submandibular Ganglion VI VII IX X EWN (Mid Brain) Short Cilliary Nerve Sphincter Pupillae Cilliaris Muscle Best Discount code for All Course of eGurukul/ DBMCI is KUCH40 Superior Salivatory Nucleus (Pons) Inferior Salivatory Nucleus (Pons). 1 0:4 DEEP CERVICAL FASCIA Pre Tracheal Fascia à • Forms false capsule of Thyroid • Ligament of Berry – modification of Pre tracheal Fascia. • In lower part it merges with fibrous pericardium Pre Vertebral Fascia à Once the Brachial Plexus, pushes the sheath into axilla â Forms AXILLARY SHEATH 2 Best Discount code for All Co urse of eGuru kul/DBMCI is K UCH40 Investing layer: Covers Trapezius & Stenocleidomastoid Lower part divides & form Suprasternal space Carotid Sheath: Contributed by all 3 Fascia (IL+PTL+PVL) Common Carotid Artery Internal Carotid Artery Contents Internal Jugular Vein Vagus Nerve Cervical Spinal Nerves comes out b/w Scalenus Anterior & Medius â Forms Branchial Plexus • Phrenic Nerve: Nerve in front of SA & behind PVL • Sympathetic Chain: Nerve in front of PVL & behind Carotid Sheath • Recurrent Laryngeal Nerve: Between Tracheoesophageal Groove 1. Buccopharyngeal Fascia: Covers Buccinator Ms also 2. Alar Fascia: Not seen radiologically 3. Prevertebral Fascia Best Discount code for All Co urse of eGuru kul/DBMCI is K UCH40 3 INVESTING LAYER – follows Rule of 2 • 2 Ms à SCM & Trapezius • 2 Gland à Parotid & Submandibular • 2 Spaces à Suprasternal & Supraclavicular Space • 2 Ligaments à Stylomandibular & Sphenomandibular ligament • 2 Pulleys à Digastric & Omohyoid muscles 4 : Dural venous sinuses Dural folds à • Falx Cerebri • Falx Cerebelli • Tentorium Cerebelli • Diaphragma Sellae Sigmoid Sinus + Internal Jugular Vein Inferior Petrosal Sinus 4 Incoming Channels of Cavernous Sinus From Orbit • Superior & Inferior ophthalmic vein • Central vein of Retina Outgoing channels of Cavernous • Superior Petrosal Sinus • Inferior Petrosal Sinus Superior Ophthalmic Vein â It’s an emissary vein that is without valve From Brain • Superficial Middle Cerebral vein • Inferior Cerebral vein From Meninges • Sphenoparietal Sinus • Middle Meningeal Sinus : Relations of cavernous sinus • Anteriorly : Superior Orbital Fissure • Posteriorly : Apex of Petrous temporal bone 5 Best Discount code for All Course of eGurukul/ DBMCI is KUCH40 6 : 0 MUSCLES OF MASTICATION TEMPORALIS Function: Elevation of Mandible Retraction of Mandible Insertion: Coronoid process of Mandible Origin: Temporalis fossa MASSETER Function : Elevation Protraction Medial Pterygoid Functions : Elevation + Protraction Lateral Pterygoid 2 belly: Superior head Inferior head Insertion: Pterygoid Fovea (Neck of Mandible) Action : Protraction & Depression (Main) (Only muscle) # Medial Pterygoid : Only muscle of mastication supplied by Trunk of V3 nerve Remaining muscle are supplied by Anterior division of Mandibular nerve 6 Best Discount code for All Course of eGurukul/ DBMCI is KUCH40 : 0 Muscles of pharynx • Structures passing Superior & Middle constrictor: Stylopharyngeus & IX nerve • Structures piercing Thyrohyoid membrane (between Middle & Inferior Constrictor) a) Nerve: Internal Laryngeal Nerve Supply above vocal cord b) Vessel: Superior Laryngeal vessel • Structures below Inferior constrictor (In trachea – esophageal groove) 1) Inferior Laryngeal Vessel Supply below vocal cord 2) Recurrent Laryngeal Nerve Pharyngobasilar Fascia / Sinus of Morgagni • Space between Base of skull & Superior constrictor • Present inside the Pharyngeal muscles. (1) Auditory Tube (2) Levator Velli Pallatini (3) Ascending Palatine Artery (4) Palatine branch of Ascending Pharyngeal Artery Killian’s Dehiscence: • Zone of weakness present between TP & CP • It’s site for Zenker’s Diverticulum Upper border of SC + PASSAVANT’S RIDGE Palatopharyngeus 7 Best Discount code for All Course of eGurukul/ DBMCI is KUCH40 94:50 Larynx MUSCLES OF LARYNX Posterior Cricoarytenoid m/s Only Abductor of vocal cord. ? (Safety Muscle of larynx) During whispering : Lateral Cricoarytenoid adduct vocal cords â But there is a space between 2 Arytenoid Cartilage â Air can pass through. INTER ARYTENOID MUSCLE Adduction of vocal cord + Adduction of Arytenoid â Complete closure of Rima Glottidis 8 THYROARYTENOID MUSCLE • From inner surface of Thyroid cartilage to Lateral surface of Arytenoid. • Relaxation of Vocal Cord VOCALIS MUSCLE • Medial to Thyroarytenoid – (It’s a modification) • In Anterior 1/3rd attached to Vocal cord à Causes Tension of Vocal cord • In Posterior 2/3rd not attached to Vocal cord à Causes Relaxation of Vocal cord â \ Called as MODULATOR OF LARYNX CRICOTHYROID à Supplied by External Laryngeal Nerve • Only intrinsic muscle of larynx seen outside • Contraction à Bend Thyroid forward â Tension of Vocal cord à TUNING FORK OF LARYNX Best Discount code for All Co urse of eGuru kul/DBMCI is K UCH40 Aryepiglotticus • Modification of Oblique Arytenoid • Closes inlet of Larynx 9 117:10 Cranial Cavity • OPTIC CANAL:- Optic Nerve + Ophthalmic Artery • SUPERIOR ORBITAL FISSURE:- III, IV, V2, VI Best Discount code for All Course of eGurukul/ DBMCI is KUCH40 Meningeal branch of Lacrimal artery Superior & Inferior Ophthalmic vein • FORAMEN OVALE: Mandibular Nerve Accessory Meningeal Artery Lesser Petrosal Nerve Emissary Vein • FORAMEN SPINOSUM: Middle meningeal Artery + Nervus Spinosum (V3) • FORAMEN LACERUM: ICA + Sympathetic plexus + Greater Petrosal Nerve • INTERNAL AUDITORY CANAL: VI + VII + Labyrinthine Artery (Branch of AICA) • JUGULAR FORAMEN: IX + X + XI Inferior Petrosal Sinus Sigmoid Sinus • HYPOGLOSSAL CANAL: Hypoglossal Nerve 10 :00 TRIANGLES OF NECK Best Discount code for All Course of eGurukul/DBMCI is KUCH40 GREAT AURICULAR NERVE • C2-C3 • Runs with External Jugular Vein • Supplies Lobule of Ear • Angle of Mandible Skin • Lower Parotid region • In Frey’s Syndrome, the regenerating Auriculotemporal nerve accidently fuse with Great Auricular Nerve > Buccal Nerve > Lesser Occipital Nerve (MC) (Supplies behind ear) SPINAL ACCESSORY NERVE • Supplies SCM & Trapezius. • Injury to SAN in Post Triangle à SCM Spared. Involved Trapezius â • Difficult in Shrugging of Shoulder • Middle fibres à Difficulty in retraction of Scapula • T2+ Serratus Ant à Difficulty in overhead Abduction • Mild Winging of Scapula 11 Embryology Paraxial Mesoderm à Somites: • Formed between D20-D30 (aka Somite Period) • Primitive Somites : 42-44 pairs â Definitive Somites : 36-38 pair Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Lateral Plate Mesoderm Somatopleuric LPM (1) All Parietal Layers (2) Dermis of front, Limbs (3) Appendicular Skeleton Splanchnopleuric LPM (1) All visceral layers (2) Smooth muscles + Cardiac muscle @ the cranial end 1 Exceptions of Smooth muscle derived from Splanchnopleuric LPM i. Papillary Muscles – from Neuroectoderm ii. Cilliaris Muscles – from Neural Crest Cells (NCC) iii. Sm of Ascending Aorta, PT & Coronary Artery – from NCC iv. Sm of Sweat gland, Mammary gland, Myoepithelial Cells – from Surface Ectoderm SEPTUM TRANSVERSUM • Undifferentiated LPM @ the cranial end of embryo • Most cranial structure in the embryonic plate before foldings • Derivatives:- Central Tendon of Diaphragm • Fibrous pericardium • Liver stroma including Kupffer cells • Ventral Mesogastrium à Lesser omentum 26:37 Development of Diaphragm DIAPHRAGM DEVELOPMENT A – Body wall mesoderm Muscular part B – Dorsal mesentery of Oesophagus Crura C – Septum transversum Central Tendon D – Pleuroperitoneal membrane Incorporated by muscles Failure of muscle tissue to develop inside Evertration of Diaphragm • Similar to CDH • Not a True Hernia Persistence of Pleuroperitoneal canal â 2 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Bochdalek foramen â Congenital Diaphragmatic Hernia • Common on left side • Complication à left lung Hypoplasia 3 :2 Pharyngeal arches MESODERM 1st Arch: Meckel’s Cartilage à Malleus & Incus 2nd Arch: Stapes + Styloid Process + Stylohyoid ligament + Lesser horn of hyoid & upper body â Except Foot plate – from Otic Capsule 3rd Arch : Lower body & Greater horn of hyoid 4th Arch Laryngeal cartilages 6 Arch th 3 : 3 Development of face & palate FACE DEVELOPMENT i. Mandibular Process from Ist Arch ii. Frontonasal Process • Lower Lip à Mandibular Process • Upper Lip à Maxillary Process + MNP • Ala of Nose à LNP A. Non fusion of both MNP à Midline Cleft Upper Lip B. Non fusion of MNP with maxillary Process à Unilateral Cleft Lip C. Maxillary Process fails to fuse with LNP à Oblique Facial cleft (No NLD) Best Discount code for All Course of eGurukul/DBMCI is KUCH40 4 Limbs 00:10 Brachial plexus BRANCHES FROM ROOTS i. Dorsal Scapular Nerve à Levator Scapulae Rhomboides Major & Minor ii. Long Thoracic Nerve à Serratus Anterior à # Winging of Scapula BRANCHES FROM TRUNK (UPPER TRUNK) i. Supra Scapular Nerve à • Supraspinatus (0-15° of Abduction of shoulder) • Infraspinatus ii. Nerve to Subclavius à Subclavius Muscle < Accessory Phrenic nerve joins with Phrenic Nerve BRANCHES FROM CORDS A) LATERAL CORD • Lateral Root of Median Nerve • Musculocutaneous Nerve à Biceps, Brachialis, Coracobrachialis Skin of Lateral forearm – Lateral cutaneous Nerve of forearm • Lateral Pectoral Nv. à Pierces Clavipectoral Fascia â Supply Pectoralis Major 1 B) POSTERIOR CORD • Upper subscapular nerve à Subscapularis • Lower subscapular nerve à Subscapularis + Teres major • Nerve to Lattismus dorsi • Axillary Nerve à Deltoid, Teres Minor • Radial Nerve C) MEDIAL CORD • Medial Root of Median Nerve • Medial Pectoral Nerve à Pectoralis minor & Pectoralis major • Medial cutaneous Nerve of arm • Medial cutaneous Nerve of forearm • Ulnar Nerve ERB S PALSY - Injury to Upper trunk â Root Nerve involved à C5 + C6 â Axillary Nerve C5-C6 DELTOID â# Adduction \ Spared in Erb’s Corachobrachialis â Musculocutaneous Nerve C5C6C7 BICEPS & BRACHIALIS â# Extended Elbow + Pronated forearm POLCIE MAN’S TIP HAND KLUMPKE S PALSY Injury to Lower Trunk à C8-T1 involved â Median Nerve & Ulnar Nerve Intrinsic Muscle of Hand (Lumbricals & Interossei) â# Hyper extension of MCP & Flexion of IP joint T1 # } CLAW HAND Sympathetic Loss of face à HORNER’S SYNDROME 2 30:17 SCAPULAR ANASTOMOSIS • Anastomosis between 1st part of Subclavian Artery & 3rd part of Axillary Artery 37:08 Clavipectoral fascia 3 • Structures enclosed à o Subclavius o Pectoralis Minor • Continued as à Suspensory ligament of Axilla • Structures piercing i. Vein à Cephalic Vein ii. Artery à Thoracoacromial Trunk iii. Nerve à Lateral Pectoral Nerve iv. Lymphatics à going to Apical L.N :00 Osteology of ul 0:38 Hand-flexor retinaculum SUPERFICIAL RELATIONS: NOTE:- • Ulnar artery forms à Superficial Palmar Arch • Radial artery forms à Deep Palmar Arch 4 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 7: Muscles of Hand THENAR MUSCLES i. Abductor Pollicis Brevis Median Nerve ii. Flexor Pollicis Brevis iii. Opponens Pollicis - Deep muscle - Only thenar muscle attached to 1st Metacarpal Rest are attached to Phalanges â \ Can Rotate MC # of MC à Benet’s # â Opposition of thumb impaired iv. Adductor Pollicis aka Graveyard of Ulnar Nerve Only Thenar muscle supplied by Ulnar Nerve (Supply at the last) 5 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 HYPOTHENAR MUSCLE i. Abductor Digiti minimi ii. Flexor Digiti minimi iii. Opponens Digiti minimi – Deeply placed Ulnar Nerve - Only hypothenar attached to 5th MC â \ Opposition movement. iv. Palmaris Brevis – Subcutaneous muscle Lumbricals (4) L1 L2 L3 L4 Origin : Flexor Digitorum Profundus Unipinnate à Median Nerve Flexion of MCP joint Extension of IP joint Bipinnate à Ulnar Nerve INTEROSSEI à Supplied by Ulnar Nerve PALMAR INTER. • • • • Unippinate Adduction Middle finger devoid of P.I CARD TEST used DORSAL INTER. • • • • Bippinate Abduction D.I absent on Thumb & Little finger Middle finger – double D.I 6 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Nerve 7 :30 Injuries RADIAL NERVE (A) à In Axilla [CRUTCH PALSY] • FLEXED ELBOW • WRIST DROP • FINGER DROP • SENSORY LOSS ON DORSUM OF HAND (B) à In Spiral Groove [SATURDAY NIGHT PALSY] • WEAKNESS IN ELBOW EXTENSION • WRIST DROP • FINGER DROP • SENSORY LOSS ON DORSUM OF HAND (C) à In Front of Lateral Epicondyle # # NO WRIST DROP • • FINGER DROP • SENSORY LOSS ON DORSUM OF HAND (D) à PIN Injury [RADIAL HEAD #] • # NO WRIST DROP • FINGER DROP • # NO SENSORY LOSS 7 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 0:00 MEDIAN NERVE INJURIES (A) à HIGHER INJURY SUPRACONDYLAR # • APE THUMB DEFORMITY (d/t Opponens pollicis) • FDS & Lateral ½ of FDP # • POINTING INDEX FINGER (while making Fist) (B) à LOWER INJURY CARPAL TUNNEL SYNDROME • APE THUMB DEFORMITY • NO POINTING INDEX FINGER • As palmar cutaneous branch is spared • Sensory loss is seen only on fingers & not on palms (C) Anterior Interosseous Nerve Injury • Inability to flex distal IP joint of index finger & IP joint of Thumb â Collapsed ‘OK’ Sign Best Discount code for All Course of eGurukul/DBMCI is KUCH40 8 107:38 ULNAR NV ULNAR PARADOX à due to FDP muscle. Higher # à Less severe claw hand (Distal IP can’t flex due to FDP) Lower # à More severe claw hand 11 : Posterior Abdominal wall POSTERIOR RELATIONS OF KIDNEY à Psoas Major + Quadratus Lumborum + Transverse Abdominis à Subcostal Nerve + Ileohypogastric + Ileoinguinal Nerve 9 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 1 Upper end of femur ANTERIOR VIEW : 0 POSTERIOR VIEW Gluteus Minimus à • Supplied by Superior Gluteal Nerve • Fx: Medial / Internal Rotation of Thigh • Insertion: Anterior surface of Greater Trochanter Gluteus Medius à • Supplied by Superior Gluteal Nerve • Fx: Abduction @ Hip Joint • Insertion: Lateral Surface of Greater Trochanter • TEST: Trendelenburg Test Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Gluteus Maximus à • Supplied by Inferior Gluteal Nerve • Fx: Extention of Hip joint • Insertion: Gluteal Tuberosity Ileopsoas Muscle à • Insertion: Lesser trochanter Pectineus Muscle à • Insertion: Pectineal line 10 • Pudental Nerve Coming from Greater • Interior Pudental Vessels Sciatic notch to lesser • Nerve to Obturator Internus Sciatic notch Greater Sciatic Notch • Muscles : Piriformis • Superior Gluteal nerve & vessels • Inferior Gluteal nerve & vessels • Sciatic Nerve • Posterior Cutaneous Nerve of thigh • Pudental nerve • Internal pudental vessels • Nerve to Obturator Internus Lesser Sciatic Notch • Obturator Internus • Pudental nerve • Internal pudental vessels • Nerve to Obturator Internus \ In Pudental block â We give at Ischial spine Best Discount code for All Course of eGurukul/DBMCI is KUCH40 11 1 Foot :3 ARCHES OF FOOT • Phalanges never participate in Arch formation. NOTE: • Medial Cuneiform à LARGEST • Intermediate Cuneiform à SHORTEST • 2nd Metatarsal à LONGEST \ Easily fracture Talocalcaneonavicular Joint à Main joint for Medial Arch (Ball & Socket Joint) Supported by SPRING Ligament Calcaneocuboid Joint à Main joint for Lateral Arch (Saddle Joint) Supported by Short & Long Plantar Ligament TALUS is the summit for Medial Arch CALCANEUM is the summit for Lateral Arch SLINGS i. Medial arch à INVERTORS • Tibialis Anterior • Tibialis Posterior • Flexor Digitorum Longus ii. Lateral Arch à EVERTORS • Peroneus longus • Peroneus brevis 12 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Lower Limb- Cadaveric Images Discussion Anterior compartment of thigh 00:10 Contents of femoral triangle 05:50 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 1 0 : 0 Adductor muscle AFTER REMOVAL OF ADDUCTOR BREVIS & LONGUS 2 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Medial compartment of thigh 1 : Gluteal region 1 :1 3 NERVES & VESSELS SUPERIOR GLUTEAL NERVE Supplies • GLUTEUS MEDIUS • GLUTEUS MINIMUS • TENSOR FASCIA LATA SCIATIC NERVE & IT’S RELATIONS 4 A STRIN CO ART ENT O LITEAL OSSA Best Discount code for All Course of eGurukul/DBMCI is KUCH40 5 : Posterior compartment of leg 6 : 0 Flexor retinaculum OOT 7 1st layer of sole Best Discount code for All Course of eGurukul/DBMCI is KUCH40 2nd layer of sole (2 tendons + 2 muscles) 8 3rd layer of sole (3 muscles) Interossei 9 2nd DIGIT has 2 DORSAL INTEROSSEI GREAT TOE and LAST TOE are Devoid of INTEROSSEI 5: 5 ANTERIOR COMPARTMENT OF LEG 10 :10 DORSUM OF FOOT 11 Neuro anatomy 00:10 Tracts ASCENDING TRACTS DESCENDING TRACTS Best Discount code for All Course of eGurukul/DBMCI is KUCH40 1 S IN T A A IC TRACT D RSA C N TRACT 2 S IN CERE E AR TRACT RA IDA TRACTS 3 R Spinothalamic Tract • I/L loss of Pain, temperature, Crude Touch & Pressure at the level of lesion • C/L loss of Pain, temperature, crude touch & Pressure below the N SE ERD S NDR E Dorsal Column Tract • Pyramidal Tract I/L loss of Conc. propioception Fine touch, Vibration, Steriognosis at & below the level of lesion. • • I/L Flaccid paralysis at the level of lesion I/L Spastic paralysis below the level of lesion level of lesion. : Brian stem 4 INTER ED NC • AR SSA Contents:1. Infundibulum & Tuber cinerum 2. Mammilary body 3. III nerve 4. Post Perforating substance : Grey matter area perforated by Posterior Cerebral artery. • Ant Perforating Substance • Outside interpeduncular fossa • Perforated by ACA & MCA Nucleus present in floor of IVt h Ventricle i. VIII Nucleus ii. VI Nucleus iii. XII Nucleus iv. X Nucleus # to Facial Colliculs à LMN of VI Nerve Best Discount code for All Course of eGurukul/DBMCI is KUCH40 5 Lateral Lemniscus (Auditory pathway) à # C/L Hearing Loss Spinal Lemniscus à # C/L loss of Pain & temperature from body Trigeminal Lemniscus à # C/L loss of Pain & temperature from face Medial Lemniscus à # Loss of Conscious proprioception, TOUCH, Vibration, Pressure, Stereognosis. : Syndromes Benedict’s Syndrome • • • • # ML à C/L Loss of conscious Proprioception Touch, Vibration Stereognosis # SL à C/L Loss of Pain & Temp (Body) # TL à C/L Loss of Pain & Temp (face) # III nerve à • I/L Ptosis • I/L Divergent Squint • Loss of Light & accommodation Reflux Weber’s Syndrome • • • # III nv: • I/L Ptosis • I/L Divergent Squint • Loss of Light & accommodation reflux # UMN of VIII nerve • C/L Paralysis of Lower face # Pyramidal Tract • C/L Hemiplegia 6 Millard Gubler’s Syndrome Ponto Cerebellar angle Syndrome (Acoustic Neuroma) • VI nerve : I/L Medial squint • VIIth nerve # à I/L Facial Paralysis • VIII nerve # : I/L Facial Paralysis • VIIIth nerve # à I/L Progressive • Pyramidal Tract # : C/L Hemiplegia • Aka Abduscent Alternative deafness • MCP / ICP # à I/L Ataxia Hemiplegia 7 Medial Medullary Syndrome • • • Lateral Medullary Syndrome ML # à C/L loss Conscious proprioception Touch, Vibration, Stereognosis XII nerve # à I/L Tongue paralysis Pyramid # à C/L Hemiplegia • • • • • • Aka Wallenberg Syndrome ICP # : I/L Ataxia Vest. Nu # : Vertigo, Vomiting Nu. Ambigus : I/L Bulbar Paralysis. (IX, X, XI) Spinal Lemniscus : C/L Loss of Pain & temp (body) Spinal Nu of VI nv : I/L Loss of Pain & temp (face) 11 : Cerebellum IST i. G Molecular Layer 9 Stellate cells à inhibitory cells 9 Basket cell à inhibitory cells ii. Purkinje Layer : Large flask shaped cells à inhibitory cells • Only cells forming efferent from cortex Efferent out of cerebellum. • Project to the nuclei – Deep cerebellar nuclei in white matter • Dentate Nu. – Largest – Nu of Neocerebellum • Emboliform Nucleus • Fastigial Nucleus • Globose Nucleus iii. Granular Layer 9 Granule cells à excitatory cells 9 Golgi Cells à inhibitory cells Best Discount code for All Course of eGurukul/DBMCI is KUCH40 8 • Middle cerebellar Peduncle à • Largest Peduncle • Purely Afferent 1 Sagittal section RD : 1 ENTRIC E Best Discount code for All Course of eGurukul/DBMCI is KUCH40 9 1 Transverse section C R NA SECTI N 10 : 0 ATERA ENTRIC E Floor: • Caudate Nucleus • Thalamostriate vein • Choroid Plexus • Fornix : Connecting Hippocampus to Mamillary Body • Thalamus 1 Thalamus :1 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 • Inputs of VL Ú Dentatothalamic Troct Dentatorubrothalamic Tract • Inputs of VA Ú Pallidothalamic tract from Globus Pallidus • Inputs of ATN Ú Mamillothalothalamic Tract from Mamillary body (PAPEZ CIRCUIT) 11 Viscera 00:10 Mediastinal surface of lung • Pulmonary Artery Ú Highest structure in Left Hilum • Eparterial Bronchus Ú Highest structure in Right Hilum 10:13 Pericardial sinuses TRANSVERSE SINUS • Can be used to ligate Great vessels in Cardiac Surgery. 1 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 I UE SINUS • Blind space behind LA for its expansion with out compressing Esophagus. 1 :31 Coronary circulation Small Cardiac Vein: Accompanied by RMA & RC • Largest ventricular branch of RCA Ú Right Marginal Artery • Nodal Artery ü Supply SA Node ü It’s a branch of RCA in 65% cases LCA in 35% cases • Middle Cardiac Vein (MCV) is accompanied by PIVA 2 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 : Liver • Ligamentum Teres: Remanent of Left Umbilical vein • Ligamentum Venosum: Remanent of Ductus venosum Best Discount code for All Course of eGurukul/DBMCI is KUCH40 3 1: Peritoneal cavity • • • • Anterior : PV, HA, BD Posterior : IVC, Right suprarenal Gland, Body of T12 vertebrae Roof: Caudate lobe of Liver Floor: 1st Part of duodenum Best Discount code for All Course of eGurukul/DBMCI is KUCH40 4 • In Supine Position Ú most dependant site Ú Hepatorenal pouch of Morrison • Relations of Lesser Sac i. ii. Anterior: • Caudate lobe of Liver • Lesser Omentum • Stomach • Greater Omentum Posterior: All structures of stomach bed EXCEPT SPLEEN :10 PERINEUM Perineal membrane separates Ú Superficial & Deep Perineal Pouch 5 Best Discount code for All Course of eGurukul/DBMCI is KUCH40 Superficial Perineal Pouch Contents • • • • Ischiocavernous muscle Bulbospongiosus Superficial Transverse Perineal muscle Female = Bartholin’s Gland Deep Perineal Pouch contents • • • • Membranous urethra External Urethral sphincter Male Bulbourethral / Cowper’s Gland Deep Transverse Perineal muscle Ischiorectal fossa Best Discount code for All Course of eGurukul/DBMCI is KUCH40 R NA SE TI N 6 • In the drainage of Ischiorectal Fossa Abscess Ú # to IRN & IRA 3: 0 Vertebrae Body Vert. Foramen Transverse Process Spinous Process : : : : CERVICAL Quadrangular Large & (+) of Foramen Transversarium Short & Bifid THORACIC Heart shaped Small & Circular (+) of Costal Facets Long & Pointing backward & downwards Best Discount code for All Course of eGurukul/DBMCI is KUCH40 7 LUMBAR Kidney Shaped Large & Rudimentary Quadrangular shaped