1. Q1: Larynx OR triangles of neck, carotid triangle, facial venous drainage
2. Q2: Danger area of face, cavernous sinus thrombosis, extra-ocular muscle nerve supply
3. Q3: Diagrams of thyroid histology and layers of scalp
4. Q4: Differences: tongue parts; parotid vs submandibular gland
5. Q5: Applied anatomy: nasal regurgitation in soft-palate paralysis; otitis media in children
6. Q6: Temporomandibular joint and muscles of mastication
7. Q7: Pharynx and palatine tonsil blood supply

1. Q1: larynx / neck triangles / facial venous drainage
2. Q2: facial infection and extra-ocular muscles
3. Q3: thyroid histology and scalp diagram labels
4. Q4: paired anatomical differences
5. Q5: applied anatomy explanations
6. Q6: TMJ and mastication
7. Q7: pharynx and tonsil blood supply

1. Q1: Larynx OR triangles of neck, carotid triangle, facial venous drainage
2. Q2: Danger area of face, cavernous sinus thrombosis, extra-ocular muscle nerve supply
3. Q3: Diagrams of thyroid histology and layers of scalp
4. Q4: Differences: tongue parts; parotid vs submandibular gland
5. Q5: Applied anatomy: nasal regurgitation in soft-palate paralysis; otitis media in children
6. Q6: Temporomandibular joint and muscles of mastication
7. Q7: Pharynx and palatine tonsil blood supply

1. Q1: larynx / neck triangles / facial venous drainage
2. Q2: facial infection and extra-ocular muscles
3. Q3: thyroid histology and scalp diagram labels
4. Q4: paired anatomical differences
5. Q5: applied anatomy explanations
6. Q6: TMJ and mastication
7. Q7: pharynx and tonsil blood supply

1. (a) Interior of the larynx

1. Laryngeal vestibule
   • From laryngeal inlet to vestibular folds.
   • Lateral walls show aryepiglottic folds.
2. Middle part
   • Between vestibular folds and vocal folds.
   • Contains:
     • Vestibular folds or false vocal cords
     • Vocal folds or true vocal cords
     • Laryngeal ventricle, a recess between the two folds
     • Saccule, upward extension of ventricle
3. Infraglottic cavity
   • From vocal folds to lower border of cricoid cartilage.
   • Narrow above and wider below.
   • Continuous with trachea.

1. (b) Vocal cord as a watershed line

• Supraglottic region, above vocal cord, drains mainly to upper deep cervical lymph nodes, especially jugulodigastric nodes.
• Subglottic region, below vocal cord, drains to prelaryngeal, pretracheal, paratracheal, and lower deep cervical lymph nodes.
• The true vocal cords have very few lymphatic vessels.

1. (c) Why unilateral recurrent laryngeal nerve injury causes hoarseness

• Unilateral injury paralyzes muscles of one vocal fold.
• The affected vocal cord lies in a paramedian position and cannot abduct or adduct properly.
• During phonation, the two vocal cords cannot come together completely.
• Air escapes through the gap, causing a weak, breathy, hoarse voice.

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Alternative Question 1

1. (a) Division of side of neck into triangles

1. Anterior triangle

• Anteriorly: midline of neck
• Posteriorly: anterior border of sternocleidomastoid
• Superiorly: lower border of mandible

1. Submental triangle
2. Submandibular or digastric triangle
3. Carotid triangle
4. Muscular triangle

2. Posterior triangle

• Anteriorly: posterior border of sternocleidomastoid
• Posteriorly: anterior border of trapezius
• Inferiorly: middle third of clavicle

1. Occipital triangle
2. Supraclavicular or subclavian triangle

1. (b) Carotid triangle: boundaries and contents

Boundaries

• Anterosuperior: posterior belly of digastric
• Anteroinferior: superior belly of omohyoid
• Posterior: anterior border of sternocleidomastoid

Contents

• Common carotid artery and its bifurcation
• Internal carotid artery
• External carotid artery and its branches
• Internal jugular vein
• Vagus nerve
• Hypoglossal nerve
• Ansa cervicalis
• Superior laryngeal nerve
• Carotid sinus and carotid body
• Deep cervical lymph nodes

1. (c) Venous drainage of face

• Facial vein begins as angular vein at medial angle of eye.
• Angular vein is formed by union of supratrochlear and supraorbital veins.
• Facial vein descends across face, crosses lower border of mandible, and joins anterior division of retromandibular vein to form common facial vein.
• Common facial vein drains into internal jugular vein.

Communications of facial vein

1. Angular vein → superior ophthalmic vein → cavernous sinus
2. Deep facial vein → pterygoid venous plexus → emissary veins → cavernous sinus

Supratrochlear + Supraorbital veins
                ↓
           Angular vein
          ↙             ↘
Facial vein              Superior ophthalmic vein
     ↓                         ↓
Common facial vein          Cavernous sinus
     ↓
Internal jugular vein

Facial vein → Deep facial vein → Pterygoid plexus → Cavernous sinus

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2. Clinical case

2. (a) Likely clinical condition

2. (b) How pustular acne affects eye muscles

Upper lip pustule
      ↓
Facial vein
      ↓
Angular vein
      ↓
Superior ophthalmic vein
      ↓
Cavernous sinus

2. (c) Motor nerve supply of extra-ocular muscles

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3. Draw and label

3. (a) Light microscopic structure of thyroid gland

1. Thyroid follicles
2. Colloid in follicular lumen
3. Follicular cells, simple cuboidal epithelium
4. Basement membrane
5. Interfollicular connective tissue
6. Rich blood capillaries
7. Parafollicular or C cells

       Blood capillary
             ↓
    -------------------
   /                   \
  |  Follicular cells   |
  |     Colloid         |  = Thyroid follicle
  |       in lumen      |
   \___________________/
        ↑
   Basement membrane

C cells lie between follicles / near follicular epithelium.

3. (b) Layers of scalp

1. Skin
2. Connective tissue, dense
3. Aponeurosis, epicranial aponeurosis
4. Loose areolar tissue
5. Pericranium

Skin
↓
Dense connective tissue
↓
Epicranial aponeurosis
↓
Loose areolar tissue - dangerous area of scalp
↓
Pericranium
↓
Skull bones

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4. Differentiate

4. (a) Anterior two-thirds and posterior one-third of tongue

4. (b) Parotid gland and submandibular gland

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5. Applied anatomy

5. (a) Soft palate paralysis causes nasal regurgitation

• Palatal muscles cannot elevate the soft palate.
• Nasopharynx remains open during swallowing.
• Food or fluid enters nasal cavity.
• This produces nasal regurgitation and a nasal quality of voice.

5. (b) Middle-ear infection is more common in children

1. Shorter
2. Wider
3. More horizontal
4. More easily obstructed by enlarged adenoids
5. More easily infected from nasopharyngeal infections

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6. Temporomandibular joint and muscles of mastication

6. (a) Formative elements, type, and movements of TMJ

Formative elements

• Head of mandible
• Mandibular fossa of temporal bone
• Articular tubercle of temporal bone
• Articular disc
• Fibrous capsule
• Synovial membrane
• Lateral temporomandibular ligament

Type

• Synovial joint
• Modified hinge joint
• Bicondylar joint
• Contains an articular disc, dividing it into upper and lower compartments

Movements

1. Elevation of mandible
2. Depression of mandible
3. Protrusion
4. Retraction
5. Side-to-side or grinding movements

6. (b) Principal muscles of mastication with innervation

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7. Pharynx and palatine tonsil

7. (a) Parts of pharynx with their extent

7. (b) Blood supply of palatine tonsil

Arterial supply

1. Tonsillar branch of facial artery, chief supply
2. Ascending palatine branch of facial artery
3. Dorsal lingual branches of lingual artery
4. Ascending pharyngeal artery
5. Lesser palatine branch of descending palatine artery

Venous drainage

• Peritonsillar venous plexus
• Drains into facial vein, pharyngeal venous plexus, and internal jugular vein.