|PART IV THE SENSE ORGANS
Chapter 1 Introduction
Sense organs are referred to the special receptors of the body, their structures consist of receptor and accessory apparatus, such as visual, auditory and vestibular apparatus.
Receptors are the simple structures which receive the stimulation from the external or internal environment of the body. They may be divided into three kinds, viz. exteroceptors, enteroceptors, proprioceptors, on the bases of the location and the origin of the sense.
Chapter 2 The Visual Apparatus
The visual apparatus receives stimulation of light, and consists of eyeball and accessory apparatus.
Section 1 The Eyeball
The eyeball is embedded in the fat inside the orbit; spherical in shape.
Anterior and posterior poles are referred to the central points of anterior and posterior surface of the eyeball, the line jointing the poles is termed the optic axis. An imaginary line encircling the eyeball, midway between the poles, is the equator. Visual axis joins the centre of the pupil to the central fovea of the retina, and decussate sharply with optic axis.
walls middle tunic ciliary body
eyeball internal tunic blind part
(retina) ciliary part
ⅠThe Wall of the Eyeball
It consists of three tunics, viz. external, middle and internal.
Ⅰ）External Tunic(Fibrous Tunic)
1. Cornea: is the anterior 1/6, transparent, and more convex, nonvascular but rich in numerous sensory nerve terminals.
2. Sclera: is the posterior 5/6, white in colour and opaque, pierced by the optic nerve posteriorly.
Venous sinus of sclera (Sachem’s canal) is a circular canal deep to the junction between the cornea and sclera.
Ⅱ）Middle Tunic(Vascular Tunic)
This layer contains numerous blood vessels and pigment cells and is brown in colour.
1. Choroid: is the posterior 2/3, and covers the inner surface of the sclera.
2. Ciliay body: lies at the inner surface of the junction of the cornea and the sclera, and consists of the ciliary ring, the ciliary processes and the ciliary muscles. The lens is attached to the inner side of the ciliary processes by the ciliary zonule (suspensory ligaments)
3. Iris: is the most anterior coloured part as a circular perforated disc. Near its centre is a round aperture. named pupil.
Iris divide the space between the cornea and the lens into two parts, anterior and posterior chambers. Iridocorneal angle (angle of anterior chamber) is in anterior chamber, at which the cornea meet with the iris.
Iris contains two sets smooth muscles, sphincter m. of pupil and dilator m. of pupil which are arranged circularly and radially respectively.
Ⅲ）Internal Tunic (Retina)
It may be divided into the optic part, the ciliary part and iridial part. The latter two part are known as the blind part, because of lacking light-sensitive elements.
Optic disc is a white, round eminence at which the optic nerve pierces the retina. It is insensitive to light, and termed the “blind spot”. About 3.5mm to the temporal side of the optic disc, there is an oval yellowish area, named the macula lutea, it shows a central depression termed the central fovea, where visual acuity is highest.
Ⅱ. The Contents of the Eyeball.
They include the aqueous humor, the vitreous body, and the lens, which are all transparent and avascular, with the cornea altogether form the refractive media. Each plays a part in refracting the light entering the eye.
It is colourless and transparent water fluid, and fills the chambers of the eye. The circulating route of aqueous humor is as follows.
Secreted by the ciliary bodyposterior chamberpupilanterior chamberiridocorneal anglevenous sinus of scleraanterior ciliary v. the veins of eye.
It lies between the iris and the vitreous body. It is a transparent and elastic, biconvex body lacking vessels and nerves.
Suspensory ligament connects the ciliary process to the capsule of the lens which encloses the lens.
During near visionhe ciliary m.contractsciliary zonule relaxconvexity of lens increasesindex of refracting increasebringing near objects into sharp focus on retina
It is a transparent, jelly-like substance which fills the space between the lens and the retina.
Section 2 The Accessory Apparatus of the Eyeball
The accessory apparatus of the eyeball includes the eyelid, the conjunctiva, the lacrimal apparatus, the extraocular muscle and the fasciae, the adipose corpus of orbit, et al.
Ⅰ. Eyelids or Palpebrae
Upper eyelid medial canthus
Lower eyelid lateral canthus
From outside inwards, each eyelid includes: skin, subcutaneous tissue, orbicularis oculi m. tarsus and conjunctiva.
It is a thin and transparent mucous membrane.
conjunctival fornices superior conjunctival fornix
inferior conjunctival fornix
Ⅲ. The Lacrimal Apparatus
Ⅰ）Composition and Opening
(superior and inferior)
lacrimal passages lacrimal sac
lateral wall of inferior nasal meatus.
1. Lacrimal gland: lies in the lacrimal fossa situated in superolateral portion of orbit.
2. Lacrimal sac: is lodged in the fossa of lacrimal sac situated in the medial wall of the orbit.
Ⅳ. The Extraocular Muscles
Which include the levator palpebral superioris, the four rectus and two oblique muscles.
name action nerve supply
superior rectus turn eye upward, inward Ⅲ
inferior rectus turn eye downward, inward Ⅲ
medial rectus turn eye inward Ⅲ
lateral rectus turn eye outward Ⅵ
superior oblique turn eye downward, outward Ⅳ
inferior oblique turn eye upward, outward Ⅲ
superior palpebral levator elevates upper eyelid Ⅲ
Section 3 The Blood Vessels of the Eye
Ⅰ. The Arteries of the Eye
internal carotid a.
ophthalmic a. superior nasal a.
↓ inferiorior nasal a.
central retinal a.------- superior temporal a. inner layer of retina
inferior temporal a.
Ⅱ. The veins of the Eye
They are two in number, the superior and inferior ophthalmic veins and are devoid of valves.
Chapter 3 The Auditory and Vestibular Apparatus
The auditory and vestibular apparatus is divided into three parts: the external, middle, and internal ears. The external and middle ears are a sound collecting and transmitting apparatus. The internal ear is such an organ that can receive the stimulaton of both sound waves and changes of the position of the head.
external ear external acoustic meatus
middle ear auditory tube(pharyngotympanic tube)
mastoid air cells
osseous labyrinth vestibule
internal ear bony semicircular canals
membranous labyrinth utricle and saccule
membranous semicircular ducts
Section 1 The External Ear
Ⅰ. Auricle: projects from the side 0f the head．Auricular lobule ties below the auricle, and is composed of fibrous and adipose tissue.
Ⅱ. External Acoustic Meatus: extends from the external acoustic porus to tympanic membrane.
The lateral l／3 is cartilaginous, and the medial 2／3 is osseous. It is a curved tube．From outside inwards, first it runs forwards and upwards. then backwards，and finally forwards and downwards.
In childhood, the external acoustic meatus is shorter and more narrow, the tympanic membrane is more horizontal.
Section 2 The Middle Ear
This part is between the external and inner ear.
Ⅰ. Tympanic Cavity
It is an irregular air-filled．space within the temporal bone, and contains auditory ossicles ligaments, muscles, vessels and nerves. It communicates anteriorly with the nasopharynx through the auditory tube, and posteriorly with the mastoid air cells through the mastoid antrum.
Ⅰ）The Wall of the Tympanic Cavity
1. Superior wail (Tegmental wall)
It is a thin plate separating the middle cranial fossa from the tympanic cavity.
2. Inferior wall (Jugular wall)
It separates the tympanic cavity from the jugular fossa.
3. Anterior wall (Carotid wall)
It is close to internal carotid artery. There are two parallel canals on this wall, semicanal for tensor tympani and semicanal for auditory tube.
4. Posterior wail (Mastoid wall)
On the upper part, here is an opening of mastoid antrum, which passes to mastoid air cells through mastoid antrum, On the lower part, the pyramidal eminence and prominence of facial canal exist.
5. Lateral wail (Membranous wall)
It is almost entirely formed by the tympanic membrane, only the superior part of this wall is formed by the lateral wall of the epitympanic recess.
Tympanic membrane is oval and semi-transparent, lies obliquely between tympanic cavity and external acoustic meatus. Umbo is formed by the traction of the terminal point of the handle of the malleus. It also has two parts:
flaccid part: upper 1/4
tense part: lower 3/4, cone of light
6. Medial wall (labyrinthine wall)
It is the lateral wall of the inner ear.
promontory: on the middle of this wall.
vestibular window: posterosuperior to promontory.
cochlear window: posteroinferior to promontory, closed by the secondary
(fenestra rotunda) tympanic membrane in vivo
prominence of facial nerve canal: posterosuperior to vestibular window.
Ⅱ）The Auditory Ossicles
The tympanic cavity contains a chain of three ossicles: the malleus incus, and stapes, which connects the tympanic membrane and the fenestra vestibule.
Ⅱ. The Auditory Tube
Lateral1/3--bony partpharyngeal orifice of auditory tubenasopharynx
Medial 2/3--cartilaginous partorifice of tympanic cavity of auditory tubetympanic cavity
The auditory tube is shorter，wider and horizontal in infant, therefore the pharyngeal inflammation may along the auditory tube spread into the tympanic cavity.
Ⅲ. The Mastoid Ant rum and Mastoid Ai r Cells
The mastoid antrum is air-filled space between the tympanic cavity and the mastoid air cells.
Mastoid air cellsmastoid antrumtympanic cavity
(posterior) (middle) (anterior)
Section 3 The Internal Ear
The internal ear lies between the tympanic cavity and the base of the internal acoustic meatus, viz. in the petrous part of the temporal bone.
Osseous labyrinth perilymph
Membranous labyrinth endolymph
Ⅰ. The Osseous Labyrinth
It includes the cochlea, the vestibule and the semicircular canals, from before backwards along the long axis of the petrous part of the temporal body.
posterior: five openingsemicircular canal
anterior: one openingcochlear
Ⅱ）Bony semicircular Canals
ampullar crus(bony ampulla)
anterior semicircular canal
posterior semicircular canal
ampullar crus(bony ampulla)
lateral semicircular canal single crus
(horizontal semicircular canal) ampullar crus(bony ampulla)
It resembles the shell of a snail. It is composed of the bony canal of cochlea winding spirally for 5/2~11/4 turns around the central modiolus which projects the osseous spiral lamina. The bony canal is divided into two parts by this lamina and the basilar membrane of the cochlear duct.
scala vestibule-------upper part
two parts (vestibular scale) communicating through helicotrema
scala tympani-------lower part
cochlear apex--------toward anterolateral
apex and base (cochlear cupula)
cochlear base--------toward bottom of internal acoustic meatus
Ⅱ. The membranous Labyrinth
It is a series of membranous canal and sacs which lie within the bony labyrinth. From before backwards, it includes: the cochlear duct, the utricle and saccule, and the membranous semicircular ducts.
Ⅰ）The Utricle and Saccule
-----------------------membranous semicircular duct
utricle------posterosuperior part: macula of utricle
∣ utriculosaccular duct static balance organs
saccule------anteroinferior part: macula of saccule
Ⅱ）The Membranous Semicircular Ducts
They lie within the bony semicircular canal, and are similar to them in shape and names.
On the wall of membranous ampulla, there are the ampular crests which are the organs of kinetic balance.
Ⅲ）The Cochlear Duct
It lies in the bony canal of the cochlea.
A transverse section through the cochlea shows that this canal is divided into three separated channels, namely, the tympanic scale, the vestibular scale and the cochlear duct. The cochlear duct is triangular on the transverse section, and has three walls.
superior wall: vestibular membrane
lateral wall: the thickened endosteum
osseous spinal lamina
inferior wall: basilar membrane tympanic scale
(spiral membrane) cochlear duct
The spiral organ is the receptor for auditory sensation, situated on the basilar membrane.
Ⅲ. The Internal Acoustic Meatus.
It is a short canal within the petrous part of the temporal bone.
Liu Zhiyu (刘执玉)
PART Ⅴ THE NERVOUS SYSTEM
Chapter 1 Introduction
The nervous system is a master system in the living body, it regulates and intergrates the activities of all the other bodily systems for the benefit of the organism as a whole:
Ⅰ. Subdivision of Nervous System
The nervous system may be divided into the following parts:
central nervous cerebellum midbrain
system﹙CNS﹚ brain stem pons
peripheral cranial nerves (12 pairs)
nervous spinal nerves (31 pairs)
system (PNS) visceral sensory n.
visceral n. sympathetic n
visceral motor n.
Ⅱ. The Activity Mode of Nervous System
The functional unit of the nervous system is the reflex arc, a linkage of afferent and efferent neurons
2. afferent n. (sensory n.)
reflex arc 3. center
4. efferent n. (sensory n.)
Ⅲ. The Basic Terminology in Nervous System
Ⅰ）Terms in CNS
1. Grey matter----collections of cell bodies and dendrites.
2. White matter----collections of nerve fibres.
3. Cortex----a mantle of grey matter on the brain,such as cerebral cortex.
4. Nucleus----a group of cell bodies which have the same shape and function.
5. Tracts----In white matter, a bundle of nerve fibres which have the same origin, terminaion, passway and function。
Ⅱ）Terms in PNS
1. Ganglion----collections of cell bodies。
2. Nerve----collections of nerve fibres held together by connective tissue sheath。
Chapter 2 The Peripheral Nervous System
The peripheral nervous system ( PNS ) is the nervous structures out-side the brain and spinal cord. It is composed of nerves and ganglia, and usually divided into three portion: ① cranial nerve attaching to the brain. ② spinal nerve attaching to the spinal cord. ③visceral nerve innervating the viscera, heart and vessels, and gland.
Section 1 The Spinal Nerves
There are thiry-one pairs of spinal nerves, each of them arises from two roots attached to the cord, an anerior root (motor fibres ) and a posterior root (sensor fibres). Two roots unite o form the spinal nerve at the intervertebral foramen. The spinal ganglion is an enlargement of the posterior root near the intervertebral foramen.
cervucak n. ----8 pairs
thoracic n. ----12 pairs
Spinal n. (31 pair) lumbar n. ----5 pairs
sacral n. ----5 pairs
coccygeal n. ----1 pairs
The spinal nerves are mixed nerves which contain two kinds of fibres.
somaic sensory fibres-supplying skin, skele-tal m., tendon and joint.
Sensory nerve fibres visceral sensor fibres-supplying viscera, heart and vessels, and gland.
somaic motor fibres-innervating skeletal m.
Motor nerve fibres visceral motor fibres-innervating cardiac m.
smooh m. and gland.
The trunk og spinal nerve is short and gives off two major branches,
①larger mixed n.
anterior ramus ②suppling the skin and muscles of anterolateral region of the body (venral ramus ) and upper and lower extremities.
③forming plexus: cervixal, brachial, lumbar and sacralplexuses, except ventral rami of thoracic n.
①smaller mixed n.
posterir ramus ②supplying the skin and muscle of dorsal region of the body
(dorsal ramus) ③segmental distribution
Ⅰ. The Cervical Plexus
It is frmed by the anterior rami of the four upper cervical n. (C1-4).
It is situated deeply in the upper part of the neck, covered by the upper part of the sternocleidomastoid m., and anterior to the levator scapulae and scalenus medius muscles.
1. Superficial (cutanous) branches
They emerge near the middle point of the posterior border of the sternocleiddomastoid m. and have a fan-shaped distribution.
lesser occipital n.
great auricular n.
transverse cervical n.
2. Deep (muscular) branches
The most important branch of the cervical plexus is phrenic nerve, a mixed nerve.
Anterior rami of cervical n. 3～5phrenic n. laeral border of anterior scalene m.
inlet of thorax
aterior, medial to the m. between subclavian a. and v. -----------------------thoracic cavityin front of the root of lung between pericardium and mediastinal pleuradiaphragm.
pleurac, pericardium, peritoncum.
right phrenic n. liver,gallbadder, and bile duct.
Ⅱ. The Brachial Plexus
It is formed by anterior rami of nerver C5～8 and T1. It is situated in the supeoposterior side of subclvian a., behind the clavicle, and in axillary fossa.
Five rootsthree trunks (upper, moddle and lower) two divisions (anterior, posterior) three cords (lateral ,medial and posterior) severn important branches.
1. Long thoracic n. supplying the anterior seratus m.
2. thoracodorsal n. supplying latissimus dorsi m.
3. Axillary n.
Posterior cordaxillary n. quadrilateral pacewinding round surgical neck of humerusdeep to detoid m.
Muscular branchesdeltoid m., teres minor m.
Cutancous branches skin on shoulder and superolateral part of arm.
4. Musculocutaneous n.
Lateral cord musculocutaneous n. piecing coracobrachialis m. between bieceps branchi and branchialis m.
Muscular branches the three m. above.
Cutanous branches (lateral antebrachial cutanous n.) skin of lateral side of forcarm.
5. Median n.
Two roots of medial cord and lateral cordembracing axillary a. median n. medial to biceps brachii m. in armcrossing branchial a. cubital fossapiercing pronator teres m.
Muscular branchesm. in front of forearm except brachioradialis m. flexor carpi ulnaris m. and ulnar half of flexor digitorum pro-fundus m.; m. of thenar eminence except adductor pollicis m. 1～2 lumbricalis m.
Cutanous branchesradial half of palm ;pslmar surface of radial 31／2 fingers.
6. Ulnar n.
Medial cordulnar n. medial to axillary a. piercing medial intermuscular septumback of armulnar grooveforearm, wrist, hand.
flexor carpi ulnaris m.
ulnar half of flexor digitorum profundus m.
muscular branches adductor pollicis m.
interosseous m. (palmar, dorsal)
3～4 lumbricalis m.
cutanous branchesskin on ulnar side of hand;palmar and dorsal surface of ulnar 11/2and 21/2fingers.
7. Radial n.
Posterior cordradial n. behind axillary a. between long and medial head of triceps m.
radial groove lateral superfical branch
---------------------lateral side of arm----------------------------
epicondyle of humberus deep branch
extensors of arm and forearm.
skin on dorsal surface of arm and forearm
skin on dorsal surface of lateral half of hand and lateral 21/2
Ⅱ. The Ventral Rami of the Thoracic Nervers
They are twelve pairs: the uuper eleven are called intercosal n., which pass into intercosal space and run between internal and exteral intercostals m. along costal groove; the twelfth is called subcostal n. They supply muscles and skin of the thoracic and abdominal wall.
The distribution of the anterior branches of the thoracic nerves is segmental. On the anterior surface of trunk, they present about the level of:
T2——the sternal angle
T6——the xiohoid process
T8——the costal arch
T12——the midpoint between umbilicus and symphysis pubis (or anterior superior iliac spine)
Ⅳ. The lumbar Plexus
It is derived from anterior rami of nerver T12, L1-4 and coverd by the psoas major m.