MARIAN DIAMOND: Facial bones.
Let's continue with
the maxilla, all right?
Maxilla-- oops.
Did we disconnect?
All of a sudden, I
couldn't hear it.
There we go.
All right, maxilla, as you
know, is the upper jaw.
It's called the
keystone of the face.
Remember, the sphenoid
was the keystone
of the base of the skull.
The maxilla is the keystone
of the facial bones.
And by this, we mean that
all facial bones are touching
the maxilla except one.
All facial bones
touch maxilla but one.
Which one is that?
STUDENT: The mandible.
MARIAN DIAMOND:
The mandible, sure.
And that's the mandible.
Now, there are two maxilla.
Let's continue on and name
these other bones of the face
quickly and just become
familiar with them
because, as I said
before, we're going
to bring in muscle attachments.
So the maxilla
was the upper jaw,
and it has a protrusion that
comes off from it, which
is called a zygomatic process.
It has a zygomatic
process, which
we'll come back to in a moment.
And it also has a role in
forming the roof of the mouth.
So the anterior roof of mouth
is formed by the maxilla.
So the next bone--
we'll take the nasal bones.
There are two nasal bones.
What do they form?
They form the bridge.
Those of us who are
wearing glasses,
our glasses are sitting
on our nasal bones,
so they form the
bridge of the nose.
And then we have what are
called the lacrimal bones.
There are two lacrimal.
We'll understand those when
we discuss the tear formation.
And these will be on the
medial portion of the orbit,
but it's the inferior
medial orbit.
And then if we come
across from our nasal
to our lacrimal
and move laterally,
we'll have the zygomatic bones,
so that's a separate bone.
We have then two
zygomatic bones,
and this will form the middle
aspect of the cheek bone.
So, this will form middle
aspect of cheek bone.
So, now, you've had all the
components of the cheek bone.
You just had the zygomatic
process of the maxilla,
you have the
maxilla, and then you
had another zygomatic process.
Where was it coming from?
STUDENT: Temporal.
MARIAN DIAMOND: Temporal, right.
So your whole cheek bone
is made up of three bones.
You have the zygomatic process,
which just [INAUDIBLE]..
Zygomatic process of maxilla.
You had the zygomatic bone
and the zygomatic process
of the temporal bone.
So you just have to pretend that
you're an orthopedic surgeon,
and somebody has been run
into the windshield, right?
Everything is mashed.
You have to put it
back together again.
So it gives you a reason why
it's important to know these.
So, as we move down then,
let's have two palatine bones,
and they will form the posterior
portion of your hard palate.
This is posterior roof of mouth.
So, now, you've had two
bones that are forming
the roof of the mouth, right?
The roof of the mouth is
called the hard palate.
So anterior, we had
the maxillary bone.
You can call it either maxilla
as a noun or maxillary bone
and as an adjective.
Hard palate, anteriorly.
Posteriorly, you'll
have the palatine bones.
Now, where do we want to go?
Let's go to the nose,
the lateral nose.
We'll have the inferior conch.
A-E is plural.
This is in the lateral--
it's inferior
lateral nasal cavity.
We get this all again when
we get to respiration.
We've got to start
through the nasal cavity.
You have to learn
how it's built,
so this is just giving
us our skeleton.
And now, where shall we go?
Let's go to the vomer.
You have two inferior conchs.
You have one vomer.
Excuse me, I have a
cough, I apologize,
but I will have to
cough occasionally.
One vomer on the
medial nasal cavity.
What's a common
term for this bone?
What's forming the medial
portion of your nasal cavity?
Septum?
Have you heard of septum?
Sometimes, people have deviated
ones-- they go sideways.
All right, we'll come
to that later though.
So, now, how are we coming?
You've got the vomer.
Have we've forgotten
any of these?
Does anybody see
one we've forgotten?
No, we're fine.
Then we want to give the last
one, which we have mentioned,
but we want to give
more detail to it
because it forms the only
movable joint of the skull
and that's the mandible.
Only movable joint of skull.
You have to be ready
when you go out
and teach other
people because when
you're teaching little
kids and they say,
well, we have another
movable joint,
and you ask them
which one it is--
teeth.
And they'll show you
that their teeth wiggle,
but you have to let them
know that teeth aren't bones.
And the only movable
joint is this one.
So, let's look at what
the mandible is offering.
It has a process that comes out
like this and one that comes up
like this and around.
So, This one--
I wonder if I have one here
that's loose or just attached.
No, it's attached too.
I don't know that
you can see it,
but you have the
condyloid process.
This process here is the
condyloid and it forms
the TM joint--
your temporal mandibular
joint that we had before.
This is the coronoid process.
Coronoid process and we'll see--
right now, it has a metal
spring attached to it,
but in your head, it will have
a major muscle coming down
for you to close your mouth.
So we need to know where
the coronoid process is
versus the condoloid.
Then the other just
names that define
the angle and the bony
portion back here--
ramus.
Ramus means branch.
Doesn't make much sense right
there but that's its name.
Then the angle, see, and
you can feel the angle.
Feel the angle.
It's quite sharp there, right?
We're going to use that because
we're going to use a pressure
point from it later when we
start the arterial system,
so you need to know where these
bones are on you so you'll
be able to find them in the case
of emergency on somebody else.
So here is the body
of the mandible.
So this gives us then just
a brief outline, once again,
of our facial bones,
and now we want
to move on for more
of our axial skeleton
and pick up the hyoid
bone as we continue down
the axis of the body.
How many have heard of
your hyoid bone before?
Quite a few, all right.
We're still axial skeleton
so we'll just put hyoid here.
It's a little bone that many
people haven't heard of.
It's u-shaped and you find it
in the anterior of your neck--
anterior of neck.
It will be inferior
to the mandible.
So you know where your mandible
is now, so you know roughly
where you're going to be.
Inferior to mandible and
superior to your larynx.
What's the part of the larynx
that you could feel right here?
What's it called?
Adam's apple, right?
While I'm talking now,
mine's going up and down.
So swallow and you'll
feel yours go up and down.
That's the larynx.
So somewhere between
here and here,
you have this little
u-shaped bone,
and most skeletons
don't have it because it
doesn't have a bony attachment.
It's just in this position
here with the u-shaped.
This would be anterior
this is posterior,
but you can pick it up.
If you allow your head to sort
of be soft and your neck soft,
you can get the
two arms of the U
and make it go back and forth.
It has no bony attachments--
no bony attachments, only
muscles and ligaments.
All right, next, let's
go look at the vertebra
so that we're getting those
in the line of our whole--
come this far.
Turn it around
and pick up these,
which are in the center
axis specifically,
and see how they are designed
to carry out their functions.
So, the vertebral
column is next.
We have 33 bones in
the vertebral column.
We'll have 7 cervical.
What does cervical mean?
STUDENT: The neck.
MARIAN DIAMOND: Neck.
We'll have 12 thoracic, and
these are movable vertebra.
A little bit twisted here.
Get it around.
So these are all flexible.
We come down to the--
we should put in
our five lumbar here
because they're flexible too,
or movable, if you prefer.
And then, we have
the immovable--
the sacral-- five sacral
and four coccygeal.
Coccygeal.
When you speak of the
coccyx, it's the same thing,
and these are immovable.
Now, we can say that
this is a column.
When you look at it
posteriorly, it is a column,
but when we look at it
laterally, we have curves.
So, if we have a head and we're
posterior, we have a column.
If we have a head
and we're laterally,
we're going to first
have a curve this way,
then we're going to
have a curve this way,
then we're going to have a curve
this way, then on this way,
and one down here.
So this will be
our cervical curve.
This will be our thoracic
curve, our lumbar curve,
our sacral curve, and
our coccygeal down here.
So you can see that they're
normally just slightly curved.
But you can have
abnormal curves,
and the abnormal curves
have specific names.
What do we commonly call an
accentuated thoracic curve?
Accentuated thoracic
curve, what do we call it?
STUDENT: Hunchback.
MARIAN DIAMOND: Hunchback.
Have you heard of the
Hunchback of Notre Dame?
Did you see the picture?
No?
But it's very accentuated,
so it's called a hunchback.
But the scientific
name is kyphosis.
Kyphosis.
What do we call an
accentuated lumbar curve?
STUDENT: Swayback.
MARIAN DIAMOND: Swayback.
Accentuated lumbar
curve is a swayback.
What's the technical term?
Lordosis, lordosis.
It's easy to remember because
lumbar begins with an L
and lordosis begins with an L.
Now, we also have a
deviated lateral curve,
so if this is my column--
this is posterior--
I can have a curve
that's going this way.
So it's a lateral,
accentuated lateral curve,
and it's usually in
the thoracic area.
Does anybody know
what it's called?
Scoliosis, a lot
of know that one.
Scoliosis.
And what's characteristic
of scoliosis?
It's more frequent in
females than males,
and it frequently
appears during puberty.
Has anybody had scoliosis?
Several of you, right, so
that's why you know scoliosis.
So, it's a lateral deviation
and occurs more frequently
in females and
appears at puberty.
Many may have just
a slight deviation
when you get your physical.
You know, your physician usually
runs the hand down the spine--
doesn't?
Nope, maybe just looks.
But the point is that if they
find just a slight deviation,
they'll just announce it,
but if it's accentuated,
then you may have to
get a brace and get
some help so that you
get the full support
of a vertebral column.
So that's scoliosis.
Those are some of
the abnormal curves.
Let's continue then and see what
a typical vertebra looks like.
We're going to see
deviations from the norm,
but we'll also look
at a typical one.
So this is our typical vertebra,
and it will look something
like this.
We'll have a spine coming up,
have a process coming out,
the body down here, the
vertebral canal in here.
We'll name these in a moment.
So, let's just start with this.
This is posterior, anterior.
This is called a
spinous process.
Spinous process.
This area in here is
called a lamina, lamina.
This process is a transverse.
It's running transverse.
Remember that term,
transverse process.
All of these are for
muscular attachments
to be able to do all
the activities you do.
And then we come down
to the vertebral canal.
This is the vertebral canal.
What do we find in
the vertebral canal?
STUDENT: Spinal cord.
MARIAN DIAMOND:
Spinal cord, right.
So, it's protecting
the spinal cord.
And then you have
this large body,
which we'll see has
different arrangements
and different vertebrae
depending on function.
This is the body.
And we need for the vertebra
to communicate with each other,
so we're going to
need an articular
process so one can fit against
the other so they can move.
Articular process.
It's difficult to draw
them in two dimensions,
but they're coming up here.
We'll just sort of
do them like this.
These will be
articular processes.
And we'll have a process on
the thoracic ones for the rubs
so we'll have a
costal facet here.
A costal facet for ribs and that
will be in the thoracic area
because we see that the
ribs are coming around.
They're articulating with
the transverse process
here as a costal facet.
So that gives us a basic
vertebra, a typical vertebra.
Let me just mention something
that's of interest here.
Occasionally, we find
a student who's had it.
Say that you have a tumor
on your thoracic cord,
and the orthopedic surgeon
has to get into it.
It's all surrounded by bone.
What's he going to do-- or she?
You're going to do what's
called a laminectomy.
You cut through the lamina.
We'll make this in
green so you can see it.
We're defining a
laminectomy now.
It allows us to get to the cord.
You cut through
the lamina to cord.
So, you can see when you
do that, you can just
lift off the spine and
you'll have the cord exposed.
So I've done a
laminectomy in green.
Does anybody know
which area of the cord
is more prone to
tumor formation?
Has anybody had a
tumor on the cord?
No?
I had a student once--
she had it and they kept taking
it off, kept taking it off.
It kept coming back.
She didn't live too long.
It was very unfortunate, but
she understood a laminectomy.
But the thoracic area is most
common, most common sight
for tumor formation.
So, it's important to know them.
Know your spinal cord.
Now, what are alterations
of the vertebra
that will differ from this
basic typical vertebra?
Well, let's start with
C1, first cervical.
It's already different.
Let's just take C1.
Does anybody know
what it's called?
STUDENT: The atlas?
MARIAN DIAMOND: The atlas, sure.
This is the atlas
holding up the skull.
We've said that before.
So, it's going to
be articulating
with what skull bone?
What's that part of the
skull just immediately
superior to the atlas?
Occipital, right?
Sure.
There's the back of
the skull, it's easy.
Here's occipital, here's
the atlas vertebra.
So it articulates with
occipital bone and with C2
but it's characteristic--
you might see it all
by itself and you say,
but that's no vertebra.
Can you see it?
Those in front can, I'm sorry.
It's just a ring.
There there's no body.
First cervical
vertebra has no body.
We saw how big it
was on our typical.
So it's a ring.
It'll have a little spine,
little transverse process,
something like this.
This is the vertebral
canal, looks very different.
How about C2?
C2 two looks different because
it has this tooth-like process.
This is C2 and it's got a
tooth-like process sticking up
there.
What does that represent?
That's the body
of the first fused
to the body of the second.
So C2 differs because the body
of C1 fuses to body of C2.
I remember a PhD exam
not too long ago,
bioengineers,
engineers, the engineers
hadn't had their anatomy,
the bioengineers had.
So they knew the
function of this process.
It looks like a tooth, so it's
called the odontoid process.
Odontoid process is what is
formed when C1 body forms
to C2 body, but
it's very important
because you have this
little projection coming.
Best way for you to do
it is to use your hands,
and you can make a C1 vertebra
like this and use your thumb.
This would be C2 and that--
turn it this way--
goes into here, and so
it allows you to do this.
You're rotating around
that odontoid process.
So those are two unusual
characteristics for a vertebra.
Then, the thoracic vertebra
have to have facets for ribs.
The other vertebrae
don't have them.
Let's see, we want thoracic.
They have facets for ribs.
They also have
very large spines.
You can see that
they're longer spines,
but they're lying sort of
flat so longer spines then
the adjacent vertebra.
And then the lumbar, since
they're weight bearing,
they have the largest bodies--
very different on a test.
All you have to do is give
you a C1 versus the lumbar.
See that huge body?
I don't know.
Can he pick it up?
Maybe not.
I'll see if I can do it.
You all see that huge body?
All of that is body,
whereas that is one.
Now, you can see the
odontoid process,
so you can see how that goes up.
All right, those are just some
important characteristics,
which will allow you
to identify which
vertebra you're dealing with.
So, the lumbar has a
large body, and then we
had the fused sacrum
and the fused coccyx.
So what have we got between
the vertebrae to cushion them?
Here are the bodies
from the front view,
and you can see the
cushions between them.
What do we call those cushions?
Intervertebral discs,
intervertebral discs.
So, between the bodies
of the vertebrae--
between the bodies of vertebrae
equal the intervertebral discs.
What are they made of?
They're made of rings of
cartilage, rings of-- we're
going to learn different
types of cartilage
because we have different
kinds for different purposes.
These have to be very strong so
rings of fibro, fibrocartilage.
So, what are we
going to call them?
Here's my ring.
If I were to take it
out from between--
take this out, hold it up--
this would be my ring
of fibrocartilage.
So, it's called an annulus ring,
annulus fibrosis, fibrosis.
And it has a soft,
gelatinous center.
It's a soft gelatinous
center, a nucleus pulposus.
Nucleus pulposus.
That was our core.
So, now, what is a slipped disc?
Well, it sounds like a
slipped disc would just
be that that fibrous
cartilage just slips out
from between the vertebrae,
but, in reality, a slipped disc
is the following.
Since it's called an
intervertebral disc--
this is called a slipped disc--
and I have my outer
annulus fibrosis
intact except for one area.
So what is slipping out
is the nucleus pulposus.
So, it will come out and this is
referred to as a slipped disk.
Anybody had one?
Pretty painful, isn't it?
Yes, it's supposed to
be exceedingly painful.
There are certain
conditions, which
are exceedingly painful, but
you can see why it is because--
here is my disk.
Here are the nerve
roots coming out,
so you get that slippage
pressing on nerve roots.
We have too much chalk today.
I keep dropping it.
Pressing on a slipped disk--
exceedingly painful.
We'll find there are certain
parts of the body that I
can tell you that are also
exceedingly painful as we
go along, but, fortunately,
only one in the whole class
has had one.
How is it now?
STUDENT: Better.
MARIAN DIAMOND: Better.
Was bed rest still--
STUDENT: No surgery.
MARIAN DIAMOND: Yes,
they say that's the best
thing for it is bed rest.
With all modern technology,
sounds pretty good.
All right, so now, let's go
on to our thoracic cavity.
What are the constituents
of our thoracic cavity?
Oh, my gosh.
Class has gone by already,
did you know that?
Do you feel that you've
been sitting there?
All right, we'll just
go through this quickly.
What are the constituents
of our thoracic cavity?
Lower sternum, the costal
cartilages, the ribs,
and what's posterior?
Sternum, the brown are your
costal cartilages, ribs, ribs,
ribs.
What's posterior?
I just told you.
[LAUGHTER]
What do the ribs
articulate with?
STUDENT: Vertebral column.
MARIAN DIAMOND: What
part of vertebral column?
STUDENT: Thoracic.
MARIAN DIAMOND: Thoracic, right.
So, the bodies of
thoracic vertebrae.
All right, I'm almost tempted
to just keep going and then show
slides next time
so I get further.
Do you want slides?
Yeah, OK.
All right, we'll do
slides but I'm slow today.
Did it seem slow to you?
I thought I was
moving right along.
Where did the hour go?
I've got to go through the
whole rest of the appendix.
Strange.
All right, let's move along--
at least get our skull here.
We talked about the
upper jaw, the maxilla,
the zygomatic process coming
out of the maxilla here.
Inside here on the medial wall,
we'll have the lacrimal bone.
Here's the nasal bone forming
the bridge of the nose,
and then we would have
the zygomatic bone
so that the whole arch is
formed by the zygomatic process
of the maxilla, the zygomatic
bone, and the zygomatic process
of the temporal bone.
And we can see
very clearly here,
This is the vomer
forming the septum.
You'll see, you have
lots of projections
inside to increase the
surface area to prepare
your air for breathing.
So the lowest one,
the inferior conch,
is here coming in
from the lateral wall.
It looks like a shell.
That's why it was called a
conch, which we have a medial.
You'll have a superior
when we get along further.
And the next one.
And now, as we
can see, the cheek
bone clearly here,
the maxillary part
of the zygomatic,
the temporal part.
Here, what is this
called back here?
STUDENT: Mastoid process.
MARIAN DIAMOND: Pardon?
STUDENT: Mastoid process.
MARIAN DIAMOND: Mastoid process.
Remember that?
But we want the hard palate.
The anterior part of the
hard palate is the maxilla.
The posterior part is
your palatine bone.
What would happen if I
drilled right through here?
What would I encounter
if I go between 46 and 43
into the floor of the skull?
STUDENT: Pituitary.
MARIAN DIAMOND: That's
right, good for you.
That's how they reach it.
Come up through the pharynx
and come in through the floor,
drill, then there's
the pituitary.
Good for you.
I'm pleased for you.
Next one.
And here, you can
see your mandible,
the condoloid process, which
will be your TM joint here.
This is all temporal.
This is squamous temporal,
this is zygomatic temporal,
this is mastoid temporal,
and this is the TM joint
with the condoloid process.
Here's the coronoid process.
It's going to have a big muscle
that's going to fit in here
and come down, and
when it contracts,
it'll close your jaw.
This is the ramus, this is the
angle, and this is the body.
Next one.
Here, it shows it's separate.
I don't think we get
anything different from this.
See all the teeth
in the mandible?
Teeth in the maxilla?
Next one.
Here are vertebrae as
we see it as a column
with our flexible vertebrae
down to the sacrum, five
fused sacral, and
four coccygeal.
We see the curve-- cervical,
thoracic, lumbar, and back
to the sacral.
Intervertebral discs between the
bodies of the vertebra and you
get that nucleus
pulposus exuding out,
and it will impinge
on the nerves that are
coming in to the spinal cord.
But you learn whether it's
at C5 or if it's at T12 or T4
up here or C3.
So, you learn your
vertebral column
when you're in
professional schools.
And the next one.
And this stuff shows
progressive muscular dystrophy
affecting the shoulder
and pelvic girdles.
Shoulder girdle was the
one pectoral up here.
We're just getting to
it but you see the--
what do we call this curvature?
STUDENT: Lordosis.
MARIAN DIAMOND: Pardon?
STUDENT: Lordosis.
MARIAN DIAMOND: Lordosis, right.
We didn't get to the
scapula, but it's just
showing the wasting of the
upper arm in muscular dystrophy.
So you can see the
scapula showing here.
But why you get to know these?
So that you can treat people
when they are defective.
And the next one.
And we didn't get
to the scapula,
but this is the spine, the
acromion, the coracoid process.
We're going to have
structures, muscles attached
to the whole scapula, but we'll
continue with that next time.
