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Supratrochlear nerve the supratrochlear nerve is the smaller terminal branch of the frontal nerve spasms throughout body azathioprine 50 mg fast delivery. It runs anteromedially in the roof of the orbit, passes above the trochlea, and supplies a descending filament to the infratrochlear branch of the nasociliary nerve. The nerve emerges between the trochlea and the supraorbital foramen at the frontal notch, curves up on the forehead close to the bone with the supratrochlear artery, and supplies the conjunctiva and the skin of the upper eyelid. It then ascends beneath the corrugator and the frontal belly of occipitofrontalis before dividing into branches that pierce these muscles to supply the skin of the lower forehead near the midline. The sensory innervation is primarily from the three divisions of the trigem inal nerve, with smaller contributions from the cervical spinal nerves. Supraorbital nerve the supraorbital nerve is the larger terminal branch of the frontal nerve. It traverses the supraorbital notch or foramen and supplies palpebral filaments to the upper eyelid and conjunctiva. It ascends on the fore head with the supraorbital artery, and divides into medial and lateral branches that supply the skin of the scalp nearly as far back as the lambdoid suture. The medial branch perforates the muscle to reach the skin, while the lateral branch pierces the epicranial aponeurosis. It anastomoses with filaments of the facial 501 cHapTeR 30 Lesser occipital and greater auricular Face and scalp nerve. Occasionally, it is absent, in which case it is replaced by the zygomaticotemporal nerve; the relationship is reciprocal, and when the zygomaticotemporal nerve is absent it is replaced by a branch of the lacrimal nerve. Auriculotemporal nerve Infratrochlear nerve the infratrochlear nerve branches from the nasociliary nerve. It leaves the orbit below the trochlea and supplies the skin of the eyelids, the conjunctiva, lacrimal sac, lacrimal caruncle and the side of the nose above the medial canthus. External nasal nerve the external nasal nerve is the terminal branch of the anterior ethmoi dal nerve. It descends through the lateral wall of the nose and supplies the skin of the nose below the nasal bones, excluding the alar portion around the external nares. The auriculotemporal nerve emerges on to the face behind the tem poromandibular joint within the superior surface of the parotid gland. The cutaneous branches of the auric ulotemporal nerve supply the tragus and part of the adjoining auricle of the ear and the posterior part of the temple. The nerve may be damaged during parotid gland surgery, resulting in impaired sensation of the tragus and temple.

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A further consequence is the underdevelopment of the incisor-bearing part of the maxilla muscle relaxant recreational buy generic azathioprine. These abnormalities, in turn, influence the mucocutaneous tissues, which results in the displacement of the skin of the nostril to the upper part of the lip, retraction of the labial skin and abnormalities of the soft tissues on either side of the mucocutaneous junction. A narrow or incomplete cleft of the hard palate is likely to be due to a growth defect in the palatal shelves and/or a delay in shelf elevation, and/or to failure of fusion of the apposed palatal shelves. A submucous cleft, which may be detected as a median V-shaped notch of the soft palate, can cause speech difficulties. Very rarely, muscle hypoplasia, particularly of the musculus uvulae, causes palatopharyngeal incompetence. Median cleft lip (true hare lip) is also rare, since this is not a line of morphogenetic fusion. Median grooving of the nose occurs with hypertelorism in various frontonasal dysplasias, suggesting a developmentally early broadening of the median region of the face. Formation of the posterior part of the neck is, by this time, well advanced, with cartilaginous cervical vertebrae, muscles, nerves and blood vessels. The anterior neck forms gradually, as relatively rapid growth of the anterior structures, including the trachea, oesophagus, common carotid arteries and jugular veins, takes place. As the extending neck lifts the head to a forward-facing orientation, the angle between the spinal cord and brainstem increases. Myoblasts derived from paraxial mesenchyme invade the second pharyngeal arch as it forms and by this stage are present in the superficial connective tissue beneath the anterior neck skin; these spread out from the underside of the chin to the upper thorax and differentiate to form the platysma (this is the main human remnant of the panniculus carnosus, the muscle that is present throughout the skin of many mammals). The interface between cranial nerve-innervated pharyngeal arch muscles and spinal nerve-innervated trunk muscles occurs at the lower neck and the upper parts of the pectoral girdle. Both the proximal and distal connections of the trapezius muscle, at the nuchal line of the occipital bone and the attachment to the spine of the scapula, are formed from post-otic neural crest cells (Matsuoka et al 2005). The neural crest generates areas of endochondral ossification in the cervical vertebral column and scapula associated with trapezius attachment. Stage 3 (after 29 weeks) is characterized by a gradual increase in the epithelium/colloid ratio and a decrease in follicular size (Bocian-Sobkowska et al 1997). The parafollicular or C cells of the thyroid gland are derived from the ultimobranchial body, a small diverticulum of the fourth pharyngeal pouch. Failure of downgrowth of all or part of the thyroid gland from the pharyngeal floor results in ectopic thyroid tissue within the tongue (lingual thyroid), lying between the foramen caecum and the epiglottis.

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It perforates the deep cervical fascia muscle relaxant 303 order azathioprine toronto, and divides under platysma into ascending and descend ing branches that are distributed to the anterolateral areas of the neck. The ascending branches ascend to the submandibular region, forming a plexus with the cervical branch of the facial nerve beneath platysma. Some branches pierce platysma and are distributed to the skin of the upper anterior areas of the neck. The descending branches pierce platysma and are distributed anterolaterally to the skin of the neck, as low as the sternum. Its apex is at the chin, its base is the body of the hyoid bone and its floor is formed by both mylohyoid muscles. It con tains lymph nodes and small veins that unite to form the anterior jugular vein. The structures within the digastric and submental triangles are described in more detail with the floor of the mouth. Levator scapulae Trapezius Scalenus posterior Inferior belly of omohyoid Sternocleidomastoid Muscular triangle the muscular triangle is bounded anteriorly by the median line of the neck from the hyoid bone to the sternum, inferoposteriorly by the anterior margin of sternocleidomastoid and posterosuperiorly by the superior belly of omohyoid. Scalenus medius Scalenus anterior Carotid triangle the carotid triangle is limited posteriorly by sternocleidomastoid, an teroinferiorly by the superior belly of omohyoid and superiorly by stylohyoid and the posterior belly of digastric. In the living (except the obese), the triangle is usually a small visible triangular depression, sometimes best seen with the head and cervical vertebral column slightly extended and the head contralaterally rotated. The carotid tri angle is covered by the skin, superficial fascia, platysma and deep fascia containing branches of the facial and cutaneous cervical nerves. The hyoid bone forms its anterior angle and adjacent floor; it can be located on simple inspection and verified by palpation. Parts of thyrohyoid, hyoglossus and inferior and middle pharyngeal constrictor muscles form its floor. The carotid triangle contains the upper part of the common carotid artery and its division into external and internal carotid arteries. Overlapped by the anterior margin of sternocleidomas toid, the external carotid artery is first anteromedial, then anterior to the internal carotid artery. Thus the superior thyroid artery runs anteroinferiorly, the lingual artery anteriorly with a characteristic upward loop, the facial artery anterosuperiorly, the occipital artery pos terosuperiorly and the ascending pharyngeal artery medial to the in ternal carotid artery. The superior thyroid, lingual, facial, ascending pharyngeal and sometimes the occipital veins correspond to the branches of the external carotid artery, and all drain into the internal jugular vein. It curves round the origin of the lower sternocleidomastoid branch of the occipital artery, and at this point the superior root of the ansa cervicalis leaves it to descend anteriorly in the carotid sheath. The internal laryngeal nerve and, below it, the external laryngeal nerve lie medial to the external carotid artery below the hyoid bone. More over, some of their subdivisions are easily identified by inspection and palpation, and provide invaluable assistance in surface anatomical and clinical examination.

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The postganglionic axons are distributed mainly to smooth muscle or glands in the walls of the pelvic viscera spasms the movie purchase azathioprine 50 mg visa. Their peripheral processes pass through white rami communicantes and, without synapsing, through one or more sympathetic ganglia to end in the walls of the viscera. Central processes of ganglionic unipolar neurones enter the spinal cord by dorsal roots and synapse on somatic or sympathetic efferent neurones, usually through interneurones, completing reflex paths. Alternatively, they may synapse with other neurones in the spinal or brainstem grey matter that give origin to a variety of ascending tracts. Near the origin of inferior oblique, it turns rostrally along rectus capitis posterior major, where it receives a communicating branch from the third occipital nerve before turning dorsally to pierce semispinalis capitis. It emerges on to the scalp by passing above an aponeurotic sling between trapezius and sternocleidomastoid near their occipital attachments. It ascends with the occipital artery and divides into branches that connect with the third occipital and lesser occipital nerves, and which supply the back of the auricle and the skin of the scalp as far forwards as the coronal suture. The lateral branch of the second cervical dorsal ramus supplies longissimus capitis, semispinalis capitis and splenius capitis, and sends a communicating branch to the lateral branch of the third cervical dorsal ramus. This is usually caused by damage or irritation to the greater occipital nerve but more rarely can result from a similar process in the lesser occipital nerve or both greater and lesser occipital nerves. A similar syndrome may be caused by upper facet joint arthritis involving the second cervical root (Vanelderen et al 2010). An individual intervertebral foramen may contain a duplicated sheath, nerve and roots, which will then be absent at an adjacent level. Thoracic ventral rami run independently and retain a largely segmental distribution. Cervical, lumbar and sacral ventral rami connect near their origins to form plexuses. Dorsal (posterior) primary rami of spinal nerves are usually smaller than the ventral rami and are directed posteriorly. It courses back round the articular pillar of the third cervical vertebra, medial to the posterior intertransverse muscle, and divides into medial and lateral branches. The lateral branch passes dorsally across the surface of semispinalis capitis to supply it and the overlying longissimus capitis and splenius capitis. It receives a communicating branch from the lateral branch of the second cervical dorsal ramus, and sends a similar branch to the lateral branch of the fourth cervical dorsal ramus. The deep medial branch curves dorsally and medially around the waist of the articular pillar before ending in multifidus.

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The submucosa in the posterior half of the hard palate contains minor mucoustype salivary glands muscle relaxant flexeril buy azathioprine 50 mg on line. They secrete via numerous small ducts, which often drain into a larger duct that opens bilaterally at the paired palatine foveae. These depressions, sometimes a few millimetres deep, flank the midline raphe at the posterior border of the hard palate. They provide a useful landmark for the extent of an upper denture; they cause an overextended denture to become unstable when the soft palate moves during deglutition and mastication. The upper surface of the hard palate is the floor of the nasal cavity and is covered by ciliated respiratory epithelium. Actions Geniohyoid elevates the hyoid bone and draws it forwards, and therefore acts partly as an antagonist to stylohyoid. Vascular supply and lymphatic drainage of the hard palate the palate derives its blood supply principally from the greater palatine artery, a branch of the third part of the maxillary artery. The greater palatine artery descends with its accompanying nerve in the palatine canal, where it gives off two or three lesser palatine arteries, which are transmitted through the lesser palatine canals and foramina to supply the soft palate and tonsil, and anastomose with the ascending palatine branch of the facial artery. The greater palatine artery emerges on to the oral surface of the palate at the greater palatine foramen adjacent to the second maxillary molar and runs in a curved groove near the alveolar border of the hard palate to the incisive canal. It ascends this canal and anastomoses with septal branches of the nasopalatine artery to supply the gingivae, palatine glands and mucous membrane. The veins of the hard palate accompany the arteries and drain largely to the pterygoid plexus. The hard palate is bounded in front and at the sides by the toothbearing alveolus of the upper jaw and is continuous posteriorly with the soft palate. In its more lateral regions, it also possesses a submucosa containing the main neurovascular bundle. The mucosa is covered by keratinized stratified squamous epithelium, which shows regional variations and may be ortho or parakeratinized. A narrow ridge, the palatine raphe, devoid of submucosa, runs anteroposteriorly in the midline. An oval prominence, the incisive papilla, lies at the anterior extremity of the raphe. It covers the incisive fossa at the oral opening of the incisive canal and also marks the position of the fetal nasopala tine canal. Irregular transverse ridges or rugae, each containing a core of dense connective tissue, radiate outwards from the palatine raphe in the anterior half of the hard palate; their pattern is unique to the individual. Innervation of the hard palate the sensory nerves of the hard palate are the greater palatine and nasopalatine branches of the maxillary nerve, which all pass through the pterygopalatine ganglion.

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The transverse ligament is stronger than the dens spasms right side of back cheap 50 mg azathioprine amex, which therefore usually fractures before the ligament ruptures. The alar ligaments are weaker, and combined head flexion and rotation may avulse one or both alar ligaments; rupture of one side results in an increase of about one-third in the range of rotation to the opposite side. Pathological softening of the transverse and adjacent ligaments or of the lateral atlanto-axial joints results in atlanto-axial subluxation, which may cause spinal cord injury. Developmental laxity of ligaments may also lead to problems with instability, especially if there is an episode of trauma; this combination is probably responsible for atlanto-axial rotational instability. Laxity of cervical spinal ligaments may be a normal variant in children and lead to diagnostic difficulties. Typical vertebral bodies are united by anterior and posterior longitudinal ligaments and by fibrocartilaginous intervertebral discs between sheets of hyaline cartilage (vertebral end-plates). In the cervical region, from C3 to C7, joints have been described between the uncinate or neurocentral processes of the inferior vertebral body and the bevelled lateral border of the superior body at each level. Articulating surfaces: intervertebral discs the intervertebral discs are the chief bonds between the adjacent surfaces of vertebral bodies from C2 to the sacrum. Except at the sites of the uncovertebral (neurocentral) joints of Luschka, disc outlines correspond with the adjacent bodies. In cervical and lumbar regions the discs are thicker anteriorly, contributing to the anterior convexity of the vertebral column. In the thoracic region they are nearly uniform, and the anterior concavity is largely due to the vertebral bodies. Discs are thinnest in the upper thoracic region and thickest in the lumbar region. They adhere to thin layers of cartilage on the superior and inferior vertebral surfaces, the vertebral end-plates. The latter do not reach the periphery of the vertebral bodies but are encircled by ring apophyses. The fibrocartilaginous component lies nearer to the disc and is sometimes considered not to be part of the end-plate itself. While all discs are attached to the anterior and posterior longitudinal ligaments, discs in the thoracic region are additionally tied laterally, by intraarticular ligaments, to the heads of ribs articulating with adjacent vertebrae. Intervertebral discs form about one-quarter of the length of the postaxial vertebral column; cervical and lumbar regions make a greater contribution than the thoracic and are thus more pliant. Anulus fibrosus the anulus fibrosus has a narrow outer collagenous zone and a wider inner fibrocartilaginous zone.

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Extensive lateral movement is only possible when the jaw is rotated horizontally about one condyle while the other condyle slides backwards and forwards muscle relaxant tincture order 50 mg azathioprine otc. The temporomandibular joint is structurally adapted to accommodate both sliding/translation and rotation/hinging in a sagittal plane. This differential movement results in the disc moving only about half the distance of the condyle. The changes in disc position may become out of phase with the condyle, causing obstruction to smooth mandibular movement. The disc is typically pulled anteromedially by the lateral pterygoid, so preventing forward translation of the condyle. As the force from the condyle on the disc increases, the elastic posterior attachments of the disc are stretched until the resistance to movement is overcome and the disc reduces into a normal relationship with the condyle, which is associated with an audible click (audible to the patient and occasionally to others). This phenomenon is called reciprocal clicking or disc displacement with reduction. If the disc remains completely anterior to the condylar head and does not reduce into a normal relationship with the condyle during opening, the condyle is prevented from further forward translation and mouth opening is restricted. This is a common clinical condition and is known appropriately as closed lock or disc displacement without reduction (see below). Under these conditions, jaw movements and the positions of the condyles are controlled by neuromuscular processes (within the limits of constraints imposed by the articular eminence, the occluding surfaces of the teeth and the presence of food between them). Note that the non-working condyle moves the furthest, and is the most heavily loaded, during the power stroke of mastication. The loads on each joint, balancing and working, drive each condyle more forcefully into its articular eminence. The envelope of motion Eccentric jaw opening Jaw movement during mastication can be divided into three parts: opening, closing and power strokes. Eccentric jaw opening is associated with preparing for the power stroke of mastication. The mandibular condyle on the non-working side slides back and forth during lateral movements associated with the power stroke on the working side. Although the jaw muscles now have the major control over mandibular movements, the temporomandibular and sphenomandibular ligaments keep the condyle firmly against its articular eminence during opening. Eccentric and symmetrical jaw closing During closure of the jaw, the masticatory muscles act in combination to force the joint surfaces together. This compresses the joint tissues and the envelope of motion is the volume of space within which all movements of a point on the mandible have to occur because the limits are set by anatomical features, i. In consciously controlled movement of the jaw from the rest position to the fully opened position, the trajectory of the mandibular incisal edge is two-phased. The first phase is a hinge-like movement during which the condyles are retruded within the mandibular fossae. When the teeth are opened by approximately 25 mm, the second phase of opening occurs by anterior movement or protrusion of the condyles down the articular eminences with further rotation.

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Accommodation allows an increase in refraction of 12 dioptres in youth but this decreases with age spasms while eating azathioprine 50 mg buy with mastercard, being halved at 40 years and reduced to 1 dioptre or less at 60 years (presbyopia). Ball and socket junctions develop in deeper layers; these are subsequently eliminated towards the nucleus, where tongue and groove junctions gradually form. The anterior (a) and posterior (b) triradiate sutures are shown in the fetal lens. Fibres pass from the apex of an arm of one suture to the angle between two arms at the opposite pole, as shown in the coloured segments. The suture pattern becomes much more complex as successive strata are added to the exterior of the growing lens, and the original arms of each triradiate suture show secondary and tertiary dichotomous branchings. Conversely, in hyperopia (long sight), the eye is too short for its refractive power and, when it is relaxed, distant objects are focused behind the retina. A resting focal plane behind the retina results in scleral growth causing axial elongation of the globe until the focused image and the position of the retina are coincident. On the other hand, light focused in front of the retina retards scleral growth, reducing axial length. The causes of refractive errors such as myopia are both genetic and environmental. Not only have several candidate genes been identified, but also factors such as increased near work and lack of outdoor activity have all been linked to myopia (Wallman and Winawer 2004, Flitcroft 2013). This has led to a recent increase in the incidence of myopia to epidemic proportions, with a prevalence of over 80% in the adult population of some East Asian cities (Rose et al 2008). Fortunately, errors of refraction are amenable to correction using spectacle or contact lenses and by various forms of refractive surgery. As noted above, the ability to change the power of the lens through accommodation diminishes during the fifth decade to an extent that neither the corrected ametrope nor the emmetrope is able to focus near objects clearly, and reading spectacles become necessary. Many factors could potentially cause such loss of accommodation, but it seems likely that the main cause is reduced lens elasticity with age. This is offset to a very limited extent by the reduction of the pupil aperture with age, which increases the depth of focus but at the cost of creating the further problem of requiring greater illumination. Other errors of refraction are the concomitants of eye disease, especially those that affect the cornea. Corneal curvature, for example, may be sufficiently altered as a residual defect of past disease to cause irregular astigmatism. In keratoconus, the cornea is thinned and steepened centrally, distorting the refracting surface. Retinal arteries are narrower and lighter in colour, and generally are vitreal to the veins. The avascular centre of the macular region, with its associated macular pigment, can be seen temporal to the disc. The lack of blood vessels at the foveola is even more apparent in a fluorescein angiogram.

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As it ascends muscle spasms zoloft 50 mg azathioprine purchase fast delivery, it gives off several large branches and diminishes rapidly in calibre. In children the external carotid is smaller than the internal carotid, but in adults the two are of almost equal size. At its origin, it is in the carotid triangle and lies anteromedial to the internal carotid artery. At mandibular levels, the styloid process and its attached structures intervene between the vessels; the internal carotid is deep, and the external carotid superficial, to the styloid process. A fingertip placed in the carotid triangle perceives a powerful arterial pulsation, which represents the termination of the common carotid, the origins of external and internal carotids, and the stems of the initial branches of the external carotid. Sternocleidomastoid artery the sternocleidomastoid artery descends laterally across the carotid sheath and supplies the middle region of sternocleidomastoid. Like the parent artery itself, it may arise directly from the external carotid artery. Cricothyroid artery the cricothyroid artery crosses high on the anterior cricothyroid ligament, anastomoses with its fellow of the oppo site side and supplies cricothyroid. Ascending pharyngeal artery Relations the skin and superficial fascia, the loop between the cervi cal branch of the facial nerve and the transverse cutaneous nerve of the neck, the deep cervical fascia and the anterior margin of sternocleido mastoid all lie superficial to the external carotid artery in the carotid triangle. The artery is crossed by the hypoglossal nerve and its vena comitans, and by the lingual, facial and, sometimes, the superior thyroid veins. Leaving the carotid triangle, the external carotid artery is crossed by the posterior belly of digastric and by stylohyoid, and ascends between these muscles and the posteromedial surface of the parotid gland, which it next enters. Within the parotid, the artery lies the ascending pharyngeal artery is the smallest branch of the external carotid. It is a long, slender vessel, which arises from the medial (deep) surface of the external carotid artery near the origin of that artery. It ascends between the internal carotid artery and the pharynx to the base of the cranium. The ascending pharyngeal artery is crossed by styloglos sus and stylopharyngeus, and longus capitis lies posterior to it. It gives off numerous small branches to supply longus capitis and longus colli, the sympathetic trunk, the hypoglossal, glossopharyngeal and vagus nerves, and some of the cervical lymph nodes. It anastomoses with the ascending palatine branch of the facial artery and the ascending cervical branch of the vertebral artery. Pharyngeal artery the pharyngeal artery gives off three or four branches to supply the constrictor muscles of the pharynx and stylo pharyngeus. A variable ramus supplies the palate, and may replace the ascending palatine branch of the facial artery. The artery descends for wards between the superior border of the superior constrictor and levator veli palatini to the soft palate, and also supplies a branch to the palatine tonsil and the pharyngotympanic tube. It descends along the lateral border of thyrohyoid to reach the apex of the lobe of the thyroid gland.

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The cervical vertebrae spasms 14 year old beagle discount azathioprine 50 mg visa, the occipital bone and the atlanto occipital and atlantoaxial joints are described in Chapter 43, and the laryngeal cartilages are described in Chapter 35. Lesser cornua the lesser cornua are two small conical projections at the junctions of the body and greater cornua. At its base, each is connected to the body by fibrous tissue and occasionally to the greater cornu by a synovial joint that occasionally becomes ankylosed. The middle pharyngeal constrictors are attached to the posterior and lateral aspects of the lesser cornua. The stylohyoid ligaments are attached to their apices and are often partly calcified, and the chon droglossi are attached to the medial aspects of their bases. Ossification the hyoid bone develops from cartilages of the second and third pha ryngeal arches, the lesser cornua from the second, the greater cornua from the third, and the body from the fused ventral ends of both. Chondrification begins in the fifth fetal week in these elements and is completed in the third and fourth months. Ossification begins in the greater cornua towards the end of intrauterine life, in the body shortly before or after birth, and in the lesser cornua around puberty. The greater cornual apices remain cartilaginous until the third decade and epiphyses may occur here. Synovial joints between the greater and lesser cornua may be obliterated by ossification in later decades. Its anterior surface is convex, faces anterosuperiorly, and is crossed by a transverse ridge with a slight downward convexity. A vertical median ridge often bisects the upper part of the body but rarely extends to the lower part. The posterior surface is smooth and concave, faces posteroinferiorly, and is separated from the epiglottis by the thyrohyoid membrane and loose areolar tissue. Geniohyoid is attached to most of the anterior surface of the body, above and below the transverse ridge; the medial part of hyoglossus invades the lateral geniohyoid area. The lower anterior surface gives attachment to mylohyoid, the line of attachment lying above sterno hyoid medially and omohyoid laterally. The lowest fibres of genioglos sus, the hyoepiglottic ligament and (most posteriorly) the thyrohyoid membrane are all attached to the rounded superior border. Sterno hyoid is attached to the inferior border medially and omohyoid is attached laterally. Occasionally, the medial fibres of thyrohyoid and, when present, levator glandulae thyroideae, are attached along the inferior border. It curves round the posterior border of sternocleidomas toid near its midpoint and runs obliquely forwards, deep to the external jugular vein, to the anterior border of the muscle. Its base is the inferior border of the mandible and its projec tion to the mastoid process, and its apex is at the manubrium sterni. The roof of the posterior triangle is formed by the investing layer of the deep cervical fascia. The floor of the triangle is formed by the prevertebral fascia overlying splenius capitis, levator scapulae and the scalene muscles.

Innostian, 39 years: Any or all of these muscles may be absent in cleft lip deformities with corresponding functional and aesthetic consequences. In adults, the distance between these tubercles is shorter than the transverse ligament itself, with a mean value of approximately 16 mm.

Benito, 65 years: It may be traced forwards as a separate layer which passes over the masseteric fascia (itself derived from the deep cervical fascia), separated from it by a cel lular layer that contains branches of the facial nerve and the parotid duct. The height to which the apical pleura rises ­ with reference to the first pair of ribs and costal cartilages ­ varies in different individuals according to the obliquity of the thor acic inlet.

Daryl, 24 years: The maxillary branch becomes the infraorbital artery and the mandibular branch forms the inferior alveolar artery. Huang R, Zhi Q, Brand-Saberi B et al 2000 New experimental evidence for somite resegmentation.

Eusebio, 22 years: The fascicles from the seventh to ninth thoracic segments reach the median sacral crest, and those from the tenth and eleventh thoracic segments attach transversely across the posterior surface of the third segment of the sacrum. It is closed above by fusion of the spinal dura with the edge of the foramen magnum, and below by the posterior sacrococcygeal ligament that closes the sacral hiatus.

Will, 48 years: The rough area behind the auricular surface shows two or three marked depressions for the attachment of strong interosseous sacroiliac ligaments. The malleus and incus rotate together around an axis that runs from the short process and posterior ligament of the incus to the anterior ligament of the malleus.

Arokkh, 36 years: The lateral slip is prolonged into the lateral part of the upper lip, where it blends with levator labii superioris and orbicularis oris. It curves upwards and backwards, remains superficial to the temporal fascia, and anastomoses with its contralateral fellow and with the posterior auricular and occipi tal arteries.

Jaffar, 52 years: Acute and complete thrombosis of the superior sagittal sinus is an extremely severe condition causing acute elevation of the intracranial pressure and herniation. The palatovaginal canal transmits pharyngeal branches of the maxillary artery and pterygopalatine ganglion.

Elber, 30 years: Branches of the facial nerve emerge on the face from the anterior margin of this surface. Although individual variations occur, these changes appear in most individuals from 20 years onwards.

Mazin, 21 years: Interestingly, the pharyngeal ridge becomes hypertrophic in an infant with a cleft palate, presumably in an attempt to produce a seal to the nasal airway. All lumbar transverse processes present a vertical ridge on the anterior surface, nearer the tip, which marks the attachment of the anterior layer of the thoracolumbar fascia, and separates the surface into medial and lateral areas for psoas major and quadratus lumborum respectively.

Denpok, 44 years: The root apices of the maxillary cheek teeth are close to, and may even invaginate, the maxillary sinus. Ascending cervical artery the ascending cervical artery is a small branch that arises as the inferior thyroid turns medially behind the carotid sheath and ascends on the anterior tubercles of the cervical transverse processes between scalenus anterior and longus capitis.

Roy, 63 years: The vagus descends vertically in the neck in the carotid sheath, between the internal jugular vein and the internal carotid artery, to the upper border of the thyroid cartilage, and then passes between the vein and the common carotid artery to the root of the neck. Here, the posterior end of the septum is curved laterally to form a pulley, the processus cochleariformis (cochleariform process), which is a surgical landmark for the identification of the geniculate ganglion of the facial nerve.