Surface anatomy head and neck

 Head and Neck

Thyroid gland

First draw the Isthmus. Then the lobes are to be drawn from it.

a) Isthmus

1^st point:  1.25 cm below the cricoid cartilage

2^nd point: 1.25cm below the 1^st point

Draw two 1.25 cm long horizontal lines along the 1^st and 2^nd point.

b) Lobes (Right & Left)

Upper pole is conical:

1^st point: lateral end of upper border of isthmus (upper border of isthmus situated - 1.25cm below the cricoid cartilage)

2^nd point: at the anterior margin of the Sterno- cleidomastoid at the level of the laryngeal prominence.

Joined these point by a line

Lower pole is blunt end

1^st point: lateral end of lower border of isthmus

2^nd point:  just 1.25 cm below from the 1^st point

3^rd point: 2.5 cm lateral from the previous point  

Joined these point by a curve line

For each lobe of thyroid glands: Joined the 2^nd point of upper pole and 3^rd point of lower pole by a curve line directed outward

Related questions

What type of gland it is?

ans: endocrine because it has no duct. Its secretion passes through capillaries

Parts of this gland:

 Parenchyma (glandular portion) and stroma (connective tissue)

Histology:

Thyroid follicles are present. (Each follicle is lined by simple cuboidal epithelium, two types of cells present in each follicle, follicular cells and parafollicular cells)

Each follicle is filled by colloid which contain secretion of thyroid gland

Secretion of thyroid gland: 1. Follicular cells secrete: T3, T4 2.Para-follicular cells secrete:  calcitonin 

Development of glands:

Parenchyma: endodermal in origin (thyroglossal duct which arises from foramen ceacum of tongue) 

Stroma: mesodermal in origin

Follicular cells: endodermal in origin and parafollicular cells: neural crest (from ultimobrochial body)

Facial artery (In the neck)

1) 1^st   point- Just above the greater cornu of the hyoid bone.

2) 2^nd point- On the body of the mandible at the antero-inferior angle of the Masseter.

    Joint the points by a line which runs at first upwards & forwards under cover of the ramus of the mandible terminating above to the 2^nd point.

Facial artery (In the face)

1^st point- On the body of the mandible at the antero-inferior angle of the Masseter.

(This pint is to be taken by clenching the teeth when the Messeter becomes hardened).

2^nd point-1.25 cm  lateral to the angle of the mouth.

3^rd point- at the medial angle of eye

 Joint the 1^st with the 2^nd point by a tortuous line and the  with the 3^rd point by a slight convex line almost nearing the ala of the nose.

Parotid gland 

1^st point- At the upper border of the condyle of the mandible.

 2^nd point- A little above the centre of the Masseter.

  3^rd point: - Just below & behind the angle of the mandible.

4^th point: tip of mastoid process

Joined 1st, 2^nd & 3^rd points.

Joined 1^st and 4^th point by a  curve line  passing just below the external auditory meatus 

Parotid duct:

1^st point: just in front and below the tragus

2^nd point : between the ala of nose and the sharp margin of the upper lip

Join the 1^st and 2^nd point. The middle third of this line is parotid duct

Related questions:What type of gland it is? Ans: exocrine gland (because it has a duct)

According to the nature of secretion: it is pure serous in nature

Parts of this gland: Parenchyma (glandular portion )and stroma (connective tissue)

Histology: Serous acini are present. (Serous acini are darkly stain and cells of acini contain round nuclei)

Duct is present

Development of glands: Parenchyma: endodermal in origin. Stroma: mesodermal in origin

Opening of parotid duct: at the vestibule of mouth opposite the crown of 2^nd molar teeth

Frontal air sinus

1^st point- On the nasion

2^nd point- 2.5 cm above the 1^st point.

3^rd point- At the junction of the medial 1/3 and the lateral 2/3 of the supra- orbital margin.

Join the points.

Related information:

Drainage areas: middle meatus of nasal cavity

Lining epithelium: pseodustratified ciliated columnar epithelium 

Functions of sinus: resonance of voice, lightening the wt of bone 

What is the name of sinus containing bones: pneumatic bone

Maxillary air sinus

1^st point- On the lacrimal tubercle.

2^nd point- On the Zygomatic bone at the junction of the inferior with the lateral margin of the orbit.

3^rd point- On the alveolar process just above the 3^rd moral tooth.

4^th point- On the alveolar process just above the 2^nd premoral tooth.

Join the points.

Related information:

Drainage areas: middle meatus of nasal cavity

Lining epithelium: pseostratified ciliated columnar epithelium 

Functions of sinus: resonance of voice, lightening the wt of bone 

What is the name of sinus containing bones: pneumatic bone

 How hiatus of maxilla is reduce?

 

                

Surface anatomy of lower limb

 

Lower limb:

List of living anatomy by a point

1. Adductor tubercle : it is situated at the upper part of medial epicondyle of femur

Importance of adductor tubercle:

                          I.     It receives the lowest tendon of insertion of the adductor magnus muscle

                        II.     epiphyseal cartilage of lower end of the femur lies at the level of this tubercle

                     III.     femoral artery end and continued as popliteal artery

2. Lateral and medial malleolus
3. Tibial tuberosity
4. Anterior superior iliac spine

Arteria dorsalis pedis :

1^st point: in front of the ankle joint midway between medial and lateral malleolus

2^nd point: at the proximal end of the 1^st intermetatarsal space

Join the points by a straight line

Related informations:

 It is the continuation of anterior tibial artery 

Greater saphenous vein (leg)

1^st point: just in front of the medial malleolus

2^nd point: at the adductor tubercle 

Related information:

It drains blood in to femoral vein

Surface anatomy of superior extremity

 Superior Extremity

Vein of upper limb

Median cubital vein

1^st point : 2.25 cm above from the medial epicondyle

2^nd point : 2.25 cm below from the lateral epicondyle

Join these points by an oblique line

Why median cubital vein choose for intravenous injection?

Ans : it is superficial and fixed on underlying fascia.

Related informations:

Name of the superficial vein of upper limb: cephalic vein, basilic vein, median cubital vein

Name of the deep vein of upper limb: axillary, brachial, ulna and radial vein

Arteries of upper limb

Brachial artery

1)     1^st point- at the junction of anterior 1/3 and posterior 2/3 of the lateral wall of the axilla

2)     2^nd point- 2.5 below and medial to the tendon of the biceps brachii.

Join the points by a straight line.

Related information:  brachial artery is the continuation of axillary artery.

Branches of brachial artery:

1. Profunda Brachii.
2. Superior Ulnar Collateral.
3. Inferior Ulnar Collateral
4. Nutrient
5. Muscular
6. Terminal branches: Radial and ulnar artery

Radial artery

1^st point- 2.5 below and medial to the tendon of the biceps brachii .

2^nd point- In front of the wrist between the tendon of the flexor carpi radialis medially and the lower part of the anterior border of the radius laterally.(Here, practically feel the pulsation of the artery and put the point over it).

   Join the points by a line with slight outwards convexity at the upper part.

Related information s:Branches radial artery : In the Forearm:

1.   Radial Recurrent artery,
2.   Muscular artery 
3.   Superficial Volar artery

 At the Wrist: Dorsal Carpal artery

    In the hand:

1. Princeps Pollicis.
2. Volaris Indicis Radialis.

Ulnar artery

1^st point- 2.5 below and medial to the tendon of the biceps brachii .

2^nd point-  At the junction of the upper 1/3 and the lower 2/3 of the medial border of the forearm.

3^rd point- Just lateral to the pisiform bone.

Join the 1^st with the 2^nd point by a line passing downwards & medially, then the line runs straight to the 3^rd point.

Related informations:

Branches of ulnar artery: In the Forearm   

•        Anterior Recurrent.

•        Posterior Recurrent.

•        Common Interosseous.

•        Muscular

In the Hand:   Superficial Volar Arch.

Superficial palmar arch

1^st point – just lateral to the pisiform bone

2^nd point – middle of the thenar eminence

Join these points by a convex line directed downwards

Related questions:

How superficial palmar arch is formed?

By terminal branch of ulnar artery and superficial palmar branch of the radial artery.

Nerves of upper limb

Median nerve

1^st point- at the junction of anterior 1/3 and posterior 2/3 of the lateral wall of the axilla

2^nd point- 2.5 below and medial to the tendon of the biceps brachii.

3^rd point: in front of wrist over the tendon of palmaris longus

Join these points by a straight line.

  (The line joining the 1^st & 2^nd points represents the Median nerve in the arm and the line joining the 2^nd & 3^rd points represents the Median nerve in the forearm.)

Related informations:

It arises from medial and lateral cord of brachial plexus

Root value: C5-8, T1

 Types of nerves: mixed (both sensory and motor)

It mainly supply muscles of the flexor compartment of forearm

Ulnar nerve

1^st point-. at the junction of anterior 1/3 and posterior 2/3 of the lateral wall of the axilla

2^nd point- at the medial epicondyle .

3^rd point- Just lateral to the pisiform bone.

The line joining the 1^st & 2^nd points represents the ulnar nerve in the arm and 2^nd and 3^rd represents ulnar nerve at the forearm       

Related informations:

It arises from medial cord of brachial plexus

Root value: C8, T1

Types of nerves: mixed (both sensory and motor)

It mainly supplies the hand muscles and few forearm muscle like flexor carpi ulnaris etc. 

Radial nerve (In the arms)

1^st point- at the junction of anterior 1/3 and posterior 2/3 of the lateral wall of the axilla

2^nd point- At the junction of the upper 1/3 and the lower 2/3 of a line joining the deltoid and lateral epicondyle

3^rd point- In front of the lateral epicondyle 1.25  lateral to the tendon of the Biceps brachii

4^th point – at the anatomical snuff box

1^st and 2^nd point are joined across the back of the arm,

2^nd and 3^rd point joined on the front of arm

 3^rd and 4^th points are joined along the lateral border of forearm.

Related informations:

It arises from posterior cord of brachial plexus

Root value: C5-8, T1

Types of nerves: mixed (both sensory and motor)

It mainly supplies posterior (extensor) compartment of arm and forearm muscles. 

List of living anatomy by a point

1. medial and lateral humeral epicondyle
2. styloid and olecranon process of ulna and
3. styloid process of radius
4. acromion and spinous process of scapula
5. inferior angle of scapula
6. Pulsation of brachial and radial artery

Surface anatomy of thorax

 Thorax

Rib counting : 

Heart:

 

1Apex of the   Heart

It is situated in the left 5^th intercostal space just medial to midclavicalar   line.

Related questions:  How it is formed?

Ans: It is formed by only left ventricle of the heart.

2.     Right   border of the Heart

1^st point: On   the upper border   of the right 3^rd costal cartilage about 2.5 cm from the median   plane.

2^nd point: on   the right 6^th costal cartilage about 2.5 cm from the median plane

Join these two points by a convex line towards the right.

SN: (The maximum convexity of which lies at a distance of 3.25am from the median plane in the 4^th intercostal space.)

Related questions:

How it is formed?  Ans: it is formed by right atrium

3. Left Border of Heart

1) 1^st    Point – On the lower border of the left 2^nd costal cartilage about 2.5 cm from the median plane.

2) 2^nd   point- At the apex beat left 5^th intercostal space just medial to mid-clavicular line Join   these two points by line with convexity directed upwards and to the left.

Related questions:

How it is formed? Ans: it is formed by left ventricle of the heart

4. Lower border of the Heart

1^st point: on   the right 6th costal cartilage about 2.5 cm from the median plane

2^nd   point-At the apex beat left 5^th intercostal space just medial to mid-clavicular line

Join these two points with slight notch to the right of the apex of the heart.

Inferior border passes through the xiphisternal junction

 Related questions: How it is formed? Ans: it is formed by mostly by right ventricle and partly by left ventricle

5. Upper border of the Heart

1^st point: On   the upper border   of the right 3^rd costal cartilage about 2.5 cm from the median   plane.

2^nd point: On the lower border of the left 2^nd costal cartilage about 2.5 cm from the median plane.

Join these points.

Related questions: How it is formed? Ans: 1/3 of right atrium and 2/3 of left atrium are formed this border

6. Arch of the Aorta

1) 1^st point –On the right end of the   sternal angle.

2) 2^nd point –On the   centre of the manubrium   sterni

3)3^rd point- sternal end of left 2^nd costal cartilage 

Join the points by a curved line which represents the outer border of the arch of aorta; then the inner   border is drawn   below  &  paralled to it about 2.5 cm apart  .

Importance points :  It is the continuation of ascending aorta and It is continued as descending thoracic aorta

Related questions : What are the branches of arch of aorta?

1.     brachiocephalic artery/ trunk : right common carotid and right subclavian artery

2.   left common carotid artery

3.   left subclavian artery

What is the type of these arteries?  Ans : elastic artery.

Why they known as elastic artery? They contain large numbers of elastic lamina within the tunica media. 

LUNG

1. Apex of the Lung

1^st point – rt/lt  sternoclavicular   joint

 2^nd point –at the junction of medial 1/3 and lateral 2/3 of clavicle

Join these two points & the summit of the curve being situated in the neck about 2.5cm above the medial   third of clavicle.    

by which structure  apex of the lung is covered?

Ans:    The apex of the lung is covered by cervical pleura (part of parietal pleura) and supra-pleural membrane

What is suprapleural membrane?

Ans: it is formed by endothoracic fascia

Attachment : internal border of 1^st rib and transverse process of C7                                                                                                                                                                                                                                                                    

2. Anterior border of the right Lung

1)1^st point-At the apex of the lung (2.5 am above the medial 1/3 of clavicle)

2)2^nd point –On the right sterno- clavicular   joint  

3) 3^rd point –Opposite the centre of the sternal   angle.

4) 4^th point-On the right end of the xiphisternal junction join these four points by a line.

3. Anterior border of   left Lung

 1)1^st   2^nd &   3^rd   point –same as those for right   lung 

2) 4^th point-On the median plane opposite the 4^th costal cartilage.

Join these four points by line. Now   the 4^th point the line goes downwards and to the left for about 1-1/2 and then curves inwards & downwards to a point on the 6^th costal cartilage 3.5cm from the median plane.

Thus, a notch is formed at the lower part of the   anterior border called the cardiac notch  

4.   Posterior border of the Right or Left Lung

Draw a vertical line downwards from a point 2 cm lateral to the 7^th cervical spine to a point 2cm lateral to the10th thoracic spine

5.   Lower border of lung:

1^st point: at xiphisternal joint

2^nd point: 6^th rib in midclavicular line

3^rd point: 8^th rib in midaxillary line

4^th point: 2 cm lateral to the 10^th thoracic spine

List of living anatomy by a point

1.    Tip of the 7^th cervical spine

2.   Tip of coracoid process

3.   sternal angle:

it correspond with lower border of 4^th thoracic vertebra

Importance:

1.    it divide superior mediastinum from inferior mediastinum

2.   it is related with 2^nd costal cartilage so we use it for counting ribs

3.    

4.   jugular notch 

5.   inferior angle of scapula