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Anatomy

2007 Mikey

Clinical Anatomy
SCALP Loose areolar tissue dangerous layer of the scalp due to the presence of emissary vein. Bleeding is profuse due to high vascularity plus the fact that the vessels cannot retract or constrict because of the surrounding fibrous tissue. SKULL Anterior Fontanel former site indicated by bregma. Estimates hydration during infancy. Posterior Fontanel former site indicated by lambda. Pterion contains anterior branch of middle meningeal artery Skull Fractures Linear most frequent Depressed inner table is more fractured than the outer table Basal Skull o Anterior cranial fossa - involves frontal, ethmoidal, and sphenoidal sinuses; bleeding into nose and mouth. CSF leakage from nose (tear in meninges); anosmia loss of smell. o Middle cranial fossa bleeding of CSF from the ear o Posterior fossa cranial nerve damage; bruising over mastoid region. Sutural Landmarks Bregma Lambda Lambdoid Coronal Pterion Metopic

Malocclusion displacement of the bone fragments. Muscles of mastication (TIM) Temporalis, Masseter, Internal Pterygoid. Opponents: External pterygoid, Digastric, Mylohyoid, Geniohyoid. Clonic chattering of teeth, Tonic Trismus, lockjaw Angular vein (at the sides of the nose) dangerous area of the face; external nose. Bells Palsy unable to close their lips and eye on the affected side. Injury to facial nerve. Langers Lines surgical incisions must be made along these lines. Sialolith calcified deposit blocking the parotid duct. NECK Zone I submandibular and submental nodes Zones II IV lymph nodes along jugular vein (deep to the SC, upper, mid, and lower neck) Zones V nodes that lie posterior to the SCM. Commonly enlarged with viral infections. Zone VI between the carotid sheaths; drain larynx and thyroid gland. Thyroid Epithyroideum true capsule Perithyroideum false capsule; opened in thyroidectomy; derived from the pretracheal fascia. External Laryngeal Nerve injury to this nerve causes hoarseness. Monotonous voice due to paralysis of cricothyroid muscle; Closely related to superior thyroid artery. Recurrent Laryngeal Nerve injury causes aphonia (Bilateral); passes near inferior thyroid artery. Enlarged Goiter Dyspnea trachea Dysphagia esophagus Enophthalmus prolonged pressure on adjacent cervical sympathetic chain Thyroid gland moves with swallowing because the suspensory ligament of Berry binds the gland to the sides of the cricoid cartilage.

FACE Common Facial Fractures Le Fort I horizontal fracture of the maxilla; upper jaw becomes movable. Le Fort II entire central part of the face becomes movable. Le Fort III The maxilla and zygomatic bones are separated from the rest of the skull. Antrum of Highmore biggest cavity of maxillary bone. Common Sites of Fracture of the Mandible Coronoid process Neck of the mandible Angle of the mandible Body of the mandible

UPPER EXTREMITIES Flattening shoulder Impacted fracture about anatomical neck Dislocation of the head of humerus from glenoid cavity Atrophy of deltoid muscle Erbs birth palsy Muscular Dystrophy Axillary nerve damage

Clavical Fractures Indirect when one falls and tries to break the fall by extending the upper extremity; inner fragment remains unchanged; outer fragment is pulled downward. Direct fragments are driven inwards; compresses subclavian artery, brachial plexus. Axillary Vessels Formed by the vena comites of the brachial artery and the basilic vein. Adhered to the upper part of the costo-coacoid membrane (prevents its collapse) Close to the heart, inspiratory movement induce air embolism Median Nerve most injured; Musculocutaneous least injured. Brachial Plexus Upper trunk most commonly injured; exposed Erbs Palsy rupture of the upper trunk Klumpkes Paralysis injury of the lower trunk Forcibly pulled outward arm evulsion of roots from the cord Types of Dislocations subglenoid; subcoracoid (most common); subclavicular; subspinous (very rare) Kochers Method very slow external rotation of humerus; a movement directly forward of the elbow; rapid internal rotation. Hippocratic method foot is used as fulcrum. Surgical neck of humerus most commonly fractured. Cephalic vein upper part of arm used in introducing a catheter for determination of central venous pressure. Medial cubital/Median vein intravenous injections because: they are large and prominent; superficial; least movable; least subject to variations. Volkmans Ischemic fibrosis of muscles of the anterior compartment of the forearm from tight bandages over the elbow in the fully flexed position. Colles Fracture compression fracture above the wrist (dinner fork) Ulna is more often fractured by direct violence; hair on the dorsum of the proximal phalanges are directed towards the ulna; Sweat glands are numerous in the palm; rich supply of Pacinian corpuscles Ulnar Nerve C8&T1; muscles paralyzed: flexor carpi ulnaris, medial half of the FDP, medial two lumbricals, all interossei and the adductor pollicis. Hand resembles a claw. Median Nerve inability to approximate the 5 fingers. Compressed at the wrist in Carpal Tunnel Syndrome. Radial Nerve paralysis of triceps, anconeus, extensors of the wrist (wrist drop). Injured if humerus breaks. Failure to extend the digits (Trigger test). Infections: Carbuncles found in dorsum of hand and fingers due to presence of hair follicles and sweat glands Felon infection involving closed spaces of the terminal phalanx (osteomyelitis if not treated early) Paronchia (run around) infection with abscess formation under the root of the nail. Tenosynovitis tendon sheath infection. Usually flexor tendon. Palmar Abscesses mid-palmar = normal concavity of the palm becomes convex. Thenar = normal concave curve between the thumb and index finger is convex.