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W. Ortega, M.A., M.D., M.P.H.

Associate Professor, Rush Medical College

As it crosses the knee, the tibial collateral ligament is firmly attached on its deep side to the articular capsule and to the medial meniscus, an important factor when considering knee injuries. In the fully extended knee position, both collateral ligaments are taut (tight), thus serving to stabilize and support the extended knee and preventing side-to-side or rotational motions between the femur and tibia. The articular capsule of the posterior knee is thickened by intrinsic ligaments that help to resist knee hyperextension. Inside the knee are two intracapsular ligaments, the anterior cruciate ligament and posterior cruciate ligament. These ligaments are anchored inferiorly to the tibia at the intercondylar eminence, the roughened area between the tibial condyles. The cruciate ligaments are named for whether they are attached anteriorly or posteriorly to this tibial region. Each ligament runs diagonally upward to attach to the inner aspect of a femoral condyle. The cruciate ligaments are named for the X-shape formed as they pass each other (cruciate means "cross"). It serves to support the knee when it is flexed and weight bearing, as when walking downhill. In this position, the posterior cruciate ligament prevents the femur from sliding anteriorly off the top of the tibia. The anterior cruciate ligament becomes tight when the knee is extended, and thus resists hyperextension. The medial and lateral menisci provide padding and support between the femoral condyles and tibial condyles. It consists of the articulations between the talus bone of the foot and the distal ends of the tibia and fibula of the leg (crural = "leg"). The superior aspect of the talus bone is square-shaped and has three areas of articulation. This is the portion of the ankle joint that carries the body weight between the leg and foot. The sides of the talus are firmly held in position by the articulations with the medial malleolus of the tibia and the lateral malleolus of the fibula, which prevent any side-to-side motion of the talus. The ankle is thus a uniaxial hinge joint that allows only for dorsiflexion and plantar flexion of the foot. Additional joints between the tarsal bones of the posterior foot allow for the movements of foot inversion and eversion. Most important for these movements is the subtalar joint, located between the talus and calcaneus bones. The joints between the talus and navicular bones and the calcaneus and cuboid bones are also important contributors to these movements. Together, the small motions that take place at these joints all contribute to the production of inversion and eversion foot motions. Like the hinge joints of the elbow and knee, the talocrural joint of the ankle is supported by several strong ligaments located on the sides of the joint. These ligaments extend from the medial malleolus of the tibia or lateral malleolus of the fibula and anchor to the talus and calcaneus bones. Since they are located on the sides of the ankle joint, they allow for dorsiflexion and plantar flexion of the foot. They also prevent abnormal sideto-side and twisting movements of the talus and calcaneus bones during eversion and inversion of the foot. The deltoid ligament supports the ankle joint and also resists excessive eversion of the foot. These include the anterior talofibular ligament and the posterior talofibular ligament, both of which span between the talus bone and the lateral malleolus of the fibula, and the calcaneofibular ligament, located between the calcaneus bone and fibula. The talocrural (ankle) joint is a uniaxial hinge joint that only allows for dorsiflexion or plantar flexion of the foot. Movements at the subtalar joint, between the talus and calcaneus bones, combined with motions at other intertarsal joints, enables eversion/inversion movements of the foot. Ligaments that unite the medial or lateral malleolus with the talus and calcaneus bones serve to support the talocrural joint and to resist excess eversion or inversion of the foot.

Syndromes

• Head injury
• Wakes you up from sleep
• Facial, tongue, or throat swelling
• Blood in the stool
• You have breathing problems.
• Acute inflammation
• Eat some high-potassium foods, such as bananas, potatoes without the skin, and watered-down fruit juices.
• Shock
• See how far cancer has spread
• Confusion

Inferior cervical sympathetic ganglion the postganglionic fibers run along the perivascular coat to the gland. The gland develops during the 4th month of intrauterine life as an endodermal outgrowth from the anterior wall of the primitive pharynx Head, Neck and Face 417 ii. The endodermal outgrowth begins as a localized thickening on the ventral wall of the pharynx opposite the median plane. Goiter: Any enlargement of the thyroid gland is known as the goiter, which moves with deglutition, may be associated with the hyperfunctions or hypofunctions of the gland. Benign tumor of the gland may displace and even compress the surrounding structures. If the enlarge gland gives pressure on the trachea causes cough and pressure on the recurrent laryngeal nerves results hoarseness of voice. Thyroglossal duct: If it is present may form cysts and fistula, cysts are usually near or within the body of the hyoid bone and form swelling in the anterior part of the neck. During removal of the thyroid gland posterior part of the lateral lobes should not remove because of risk of removal of parathyroid glands. During operation of the gland, the superior thyroid artery is ligated near the gland to save the external laryngeal nerves and the inferior thyroid artery is ligated away from the gland to save the recurrent laryngeal nerves. Sometimes thyroid gland remains in its embryonic origin in the base of the tongue resulting in lingual thyroid gland ii. Or thyroid gland incomplete descent results in thyroid gland lies high in the neck at or just below the hyoid bone. Although this tissue may be functional but it is of small size to maintain normal function if the thyroid gland is removed iv. In surgical removal of the gland, the gland is removed along with true capsule and along with venous plexus which is situated deep to the true capsule to avoid excessive hemorrhage. Between the posterior border of the ramus of the mandible in front and the mastoid process behind iii. Usually this anterior extended part of the gland detached and lies between the zygomatic arch above and the parotid duct below which is known as accessoria or social parotidis. Coverings/Capsules True Capsule It is formed by the condensation of the fibrous stroma of the gland. Styloid process and its attached structures Parts Apex It is directed downwards, overlaps the posterior belly of digastric muscle and appears in the carotid triangle. Surfaces Superior Surface/base It is small and concave and forms the upper end of the gland. Medial Border It separates the anteromedial surface from the posteromedial surface. It is a thin border separates the superficial surface from the anteromedial surface ii. Posterior Border It separates the superficial surface from the posteromedial surface. Arteries External carotid artery It enters the gland through its posteromedial surface and divides into maxillary and superficial temporal arteries. Superficial temporal artery It gives transverse facial branch in the gland then emerges through the upper surface of the gland. Posterior auricular artery It may arise within the gland from the external medial surface. It is formed within the gland by the union of superficial temporal and maxillary veins 420 Human Anatomy for Students A B C Figs 9. At the lower part of the gland, the vein divides into anterior and posterior divisions which emerge through the apex of the gland Nerves Facial nerve with its branches i. Its branches leave the gland through its antero medial surface medial to the anterior border. Inflammatory swelling of the parotid gland is very painful due to the tight fibrous capsule, the pain is more during mastication. Parotiditis or parotitis: It is a condition of the inflammation of the parotid gland.

The lining of the nasal cavities is a mucous membrane, which contains many blood vessels that bring heat and moisture to it. It is better to breath through the nose than through the mouth because of changes produced in the air as it comes in contact with the lining of the nose: 1. Foreign bodies, such as dust particles and pathogens, are filtered out by the hairs of the nostrils or caught in the surface mucus. Air is moistened by the liquid secretion 295 Human Anatomy and Physiology the sinuses are small cavities lined with mucous membrane in the bones of the skull. The sinuses communicate with the nasal cavities, and they are highly susceptible to infection. Diagram of external respiration showing the diffusion of gas molecules through the cell membranes and throughout the capillary blood and air in the alveolus. The upper portion located immediately behind the nasal cavity is called the nasopharynx, the middle section located behind the mouth is called the oropharynx, and the lowest portion is 296 Human Anatomy and Physiology called the laryngeal pharynx. This last section opens into the larynx toward the front and into the oesophagus toward the back. At the upper end of the larynx are the vocal cords, which serve in the production of speech. The nasal cavities, the sinuses, and the pharynx all serve as resonating chambers for speech, just as the cabinet does for a stereo speaker. The space between these two vocal cords is called the glottis, and the little leaf-shaped cartilage that covers the larynx during swallowing is called the epiglottis. As the larynx moves upward and forward during swallowing, the epiglottis moves downward, covering the opening into the 297 Human Anatomy and Physiology larynx. You can feel the larynx move upward toward the epiglottis during this process by placing the flat ends of your fingers on your larynx as you swallow. The cilia trap dust and other particles, moving them upward to the pharynx to be expelled by coughing, sneezing, or blowing the nose. The Trachea (Windpipe) the trachea is a tube that extends from the lower edge of the larynx to the upper part of the chest above the heart. These cartilages, shaped somewhat like a tiny horseshoe or the letter C, are found along the entire length of the trachea. All the open sections of these cartilages are at the back so that the esophagus can bulge into this section during swallowing. The Bronchi and Bronchioles the trachea divides into two bronchi which enter the lungs. The right bronchus is considerably larger in diameter than the left and extends downward in a more vertical direction. Each bronchus enters the lung at a notch or 298 Human Anatomy and Physiology depression called the hilus or hilum. The Lungs the lungs are the organs in which external respiration takes place through the extremely thin and delicate lung tissues. The two lungs, set side by side in the thoracic cavity, are constructed in the following manner: Each bronchus enters the lung at the hilus and immediately subdivides. Because the subdivision of the bronchi resembles the branches of a tree, they have been given the common name bronchial tree. The bronchi subdivide again and again, forming progressively smaller divisions, the smallest of which are called bronchioles. The bronchi contain small bits of cartilage, which give firmness to the walls and serve to hold 299 Human Anatomy and Physiology Figure 10-2. In the bronchioles there is no cartilage at all; what remains is mostly smoothly muscle, which is under the control of the autonomic nervous system. At the end of each of the smallest subdivisions of the bronchial tree, called terminal bronchioles, is a cluster of air sacs, resembling a bunch of grapes. This very thin wall provides easy passage for the gases entering and leaving the blood as it circulates through millions of tiny capillaries of the alveoli. Certain cells in the alveolar wall produce surfactant, a substance that prevents the alveoli from collapsing by reducing the surface tension ("pull") of the fluids that line them.

Diseases

• Linear nevus syndrome
• Gollop syndrome
• Chromosome 14 trisomy
• Schindler disease
• B?b? Collodion syndrome
• Michels Caskey syndrome
• Large B-cell diffuse lymphoma
• Pointer syndrome