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Dentistry

Medicine

Basic Sciences

Surgery

Nursing

MBBS Curriculum

Pre-Clinical

Para Clinical

Two Semesters (1 st & 2 nd Anatomy, Physiology, Biochemistry

Clinical

Three Semesters (3 rd ,4 th & 5 th ) Community Medicine, Forensic Medicine, Pathology, Pharmacology, Microbiology, Clinical postings in wards, OPDs begin here

Four Semesters (6 th ,7 th ,8 th & 9 th )

Medicine & allied subjects - Psychiatry, Dermatology; Obst. Gynae.; Pediatrics; Surgery & allied subjects (Anesthesiology, E.N.T., Ophtha.,Ortho); Clinical postings

New Curriculum highlights:

• Early clinical exposure starting from the first year of the MBBS course. • Competency based learning. • Integration of ethics, attitudes and professionalism into all phases of learning.

Pre-Clinical - Anatomy

Anatomy is the science of the structure of the body and the relation of its parts.

Teaching hours are approximately 580

Prof Exam : Total – 200 marks

Theory – 100 marks

Practicals- 100 marks

Titles in Anatomy

Author

Title

Year

Price Target

Audience

AGUR

Grant’s Atlas of Anatomy, 13/e

2012 1595.00

UG's UG's

BRIJESH KUMAR

Histology: Text & Atlas

2013

495.00

EROSCHENKO difiore’s Atlas of Histology with Functional Correlations, 12/e

2012

795.00

UG's UG's UG's UG's UG's UG's UG's UG's PG's PG's PG's

MOORE

Clinical Oriented Anatomy 7/e

2013 2250.00

PAL

Illustrated Text Book of Neuroanatomy Langman’s Medical Embryology, 12/e

2013 2013

595.00 795.00

SADLER

SNELL SNELL

Clinical Anatomy by Regions 9/e

2012 2095.00 2009 1250.00

Clinical Neuroanatomy, 7/e

STEDMAN'S

Stedman’s Pocket Medical Dictionary

2009 2012 2010 2010 2009 2014 2013

365.00 650.00 695.00 695.00 695.00

TANK

Grant’s Dissector, 15/e

Dudek

BRS Embryology

Gartner

BRS Cell Biology and Histology

Dudek

BRS Genetics

Neuroanatomy, IE 9/e (Special Price) Tentative Price shown Barr's The Human Nervous System: An Anatomical Viewpoint 10/e Essential Clinical Anatomy, International Edition, 5/e Tentative Histology: A Text and Atlas, International Edition 6/e (Special Price)

$ 45.00T Reference $71.95 Reference

HAINES

KIERNAN

$ 35.00T) Reference $62.00 Reference

MOORE

2014 2010

ROSS

* Focus titles are highlighted

Grant’s Atlas of Anatomy 13/e

880 Pages ● 1600 illustrations ● 79 Tables ● Paperback ● Pub Year 2012 ● Rs. 1595.00

Anne M Agur B.Sc. (OT), M.Sc., PH.D, Professor, Division of Anatomy, Department of Surgery, Faculty of Medicine

Primary Market : MBBS Students (1 st Prof ) Secondary Market: Aspiring PG Students

USPs:

• Known for realistic dissection illustrations, detailed surface anatomy photos, clinical images and comments, and quick-reference muscle tables • Additional clinical images (CTs, MRIs (100)) help students apply the laboratory experience to clinical rotations • Color surface anatomy photographs combine with hallmark anatomical illustrations for the most complete atlas available

More Key features:

• A cornerstone of gross anatomy since 1943 •

Renowned for its accuracy, pedagogy, and clinical relevance, this classic atlas boasts significant enhancements, including updated artwork, new conceptual diagrams, and vibrantly re-colored illustrations • Updated/additional clinical comments now appear in blue text for quick identification (Page no. 4, 5) • Grant’s classic illustrations have been updated/replaced for feature enhanced colorization • Schematic and orientation drawings have been updated or replaced to better facilitate understanding of structures and relationships • Streamlined interior design and layout facilitate comprehension of complex, detailed information • Concise, interpretive legends present important observations and comments • Diagnostic images, with sections at the end of each chapter, feature clinically relevant MRIs, CT scans, and ultrasounds (Page no. 90, 91…) • Tables provide an overview of muscles, nerves, and arteries (Page no. 23…)

Resources: thePoint -

Interactive Question Bank,

- Interactive Atlas (Student Edition), and AclandAnatomy.com video Clips - Image Bank for Faculty - Powerpoint Slides with select dissection images - Interactive Atlas (Instructor Edition)

Adductor pollicis

1st dorsal interosseous

Dorsalis indicis artery

Perforating vein

Dorsalis pollicis artery

Subtendinous bursa of extensor carpi radialis brevis Extensor carpi radialis brevis Dorsal carpal branch Extensor pollicis longus Extensor carpi radialis longus

Radial artery in snuff box

Cephalic vein of forearm

Abductor pollicis longus

Extensor pollicis brevis

Tributaries of cephalic vein of forearm

Radial nerve, superficial branch

A

B

Lateral Views

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EPL

1st dorsal interosseous

EPB

Adductor pollicis (1)

Extensor (dorsal) expansion

1

Extensor digitorum (6)

2

1st metacarpal

1st dorsal interosseous (2)

Extensor pollicis brevis (5)

Radial artery

6

APL

Opponens pollicis

6

Abductor pollicis longus (4)

Extensor pollicis longus (3)

Joint capsule of 1st carpometacarpal joint

3

Midcarpal joint

5

Extensor carpi radialis brevis

Anatomical snuff box

Scaphoid bone

Wrist joint

Extensor carpi radialis longus

Styloid process of radius

6

Radial artery

4

Extensor digitorum (6)

D. Lateral View

Flexor carpi radialis

Distal Extents of:

EPL EPB APL

Extensor pollicis longus Extensor pollicis brevis Abductor pollicis longus

Brachioradialis

C. Lateral View

Agur_Chap06.indd 593

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Distal phalanx of 2nd digit

Extensor pollicis longus

1st dorsal interosseous

Adductor pollicis

Extensor pollicis brevis

Proximal phalanx of thumb

1st dorsal interosseous

1st metacarpal

1st metacarpal

Extensor carpi radialis longus

Trapezium Abductor pollicis longus

Thenar eminence

Hypothenar eminence

Trapezoid

Trapezium

Scaphoid

Scaphoid

Styloid process

Lunate

Grooves for:

Dorsal tubercle of radius

Abductor pollicis longus Extensor pollicis brevis

Groove for extensor pollicis longus

Extensor carpi radialis longus Extensor carpi radialis brevis

Radius

E

F

Lateral Views, Right Hand

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Frontal (metopic) suture

Frontal eminence

Frontal bone

Anterior fontanelle

Coronal suture

Key for B, E and F

A B C

Angle of mandible Body of mandible Coronal suture Frontal bone Lambdoid suture Mandibular symphysis Occipital bone Parietal eminence Sagittal suture Sphenoid Temporal bone Maxilla

Sagittal suture

F L M O

Parietal eminence

P S SP

Parietal bone

Mastoid process Zygomatic bone T X Y Z Arrowheads = Membranous outline of parietal bone

Posterior fontanelle

Lambdoid suture

D. Superior View

Occipital bone

C

F

P

L

SP

T

O

X

Z

X

Y

A

A

B

E. Lateral View

F. Lateral View

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Competition Matrix

Netters Atlas of Human Anatomy, 5/e

Atlas of Anatomy 2/e

Grant's Atlas of Anatomy 13/e

Author / Editor

Frank Netter, MD

Gilroy

Anne M. R. Agur

Product Data

960 Pages, Paperback, Elsevier, 2010

704 Pages, 2200 illustrations, 170 Tables, Paperback, Thieme, 2012 • New sectional anatomy spreads at the end of units build familiarity with 2D views of anatomic regions • Exquisite full-color illustrations with clear, thorough labeling and descriptive captions Even more clinical correlations help students make the connection between anatomy and medicine • Coverage of each region intuitively arranged to simplify learning: beginning with the skeletal framework, then adding muscles, organs, vasculature, and nerves, and concluding with topographic illustrations that put it all together • Innovative, user-friendly format in which each two-page spread is a self-contained guide to a topic • Surface anatomy spreads now include regions and reference lines or planes in addition to landmarks and palpable structures to develop physical exam skills Muscle Fact spreads ideal for memorization, reference, and review organize the essentials about muscles, including origin, insertion, innervation, and action

888 Pages, 1600 illust., 79 Tables, Paperback, WK, 2012

Contents

• Stronger clinical focus with new diafgnostic imaging examples - making it easier to correlate anatomy with practice. • Netter's has clearer pictures and better detail.

• Cornerstone of Gross Anatomy since 1943. • Renowed for its accuracy, pedagogy and clinical references • Additional clinical images (CTs, MRIs (100)) • Updated/additional clinical comments now appear in blue text for quick identification (Page no. 4, 5…) • Color surface anatomy photographs combine with hallmark anatomical illustrations for the most complete atlas available • Concise, interpretive legends present important observations and comments • Diagnostic images, with sections at the end of each chapter, feature clinically relevant MRIs, CT scans, and ultrasounds (Page no. 90, 91…) • Tables provide an overview of muscles, nerves, and arteries (Page no. 23…) • Quick reference muscle tables •Terminology conforms with Terminologica Anatomica, the standard for anatomical nomenclature

Resources

Student Consult online access includes supplementary learning resources

Access to WinkingSkull.com PLUS, with over 500 images from the book for labels-on and labels-off review and timed self-tests for exam preparation

For instructors: Image Bank, Powerpoint Slides + images, Interactive Atlas (Instructor Edition) For students: Figure Labeling Exercises, Flash cards, Interactive Question Bank, Interactive Atlas (Student Edition), and AclandAnatomy.com video clips

Price

Rs.1475.00

Rs.1495.00

Rs.1595.00

Clinically Oriented Anatomy 7/e 1248 Pages ● 1988 illustrations ● Paperback ● 2013 ● Price: Rs,2250

Keith L. Moore MSc PhD FIAC FRSM FAAA (American Association of Anatomy: Distinguish Educator Award 2007) (American Association of Clinical Anatomists: Honored Member Award 1994)

Primary Market: MBBS Students (1 st Prof) Secondary Market: Aspiring PG students

USPs: • The best-selling clinical anatomy textbook on the market •

CLINICAL BLUE BOXES, supported by photos and illustrations, help students understand the practical value of anatomy. Each clinical correlation is classified by the type of clinical information it contains: Anatomical Variation, Trauma, Surgical Procedure, Diagnostic Procedure, Life Cycle, and Pathology (659-661) • EXTENSIVE MEDICAL AND DIAGNOSTIC IMAGING reflects the increasing importance it plays in diagnosis and treatment(930-934) More Key features • NEW-AND-IMPROVED ART PROGRAM: All illustrations have been redrawn and updated for consistency in style and color as well as anatomical accuracy • ILLUSTRATED TABLES organize complex information about veins, arteries, nerves, and other structures • BOTTOM LINES summarize key study points for students • SURFACE ANATOMY photos clearly demonstrate anatomy’s relationship to physical examination and diagnosis

Resources Resource: thePoint -

Entire Content of the book fully searchable - Over 100 USMLE –style Questions with detailed explanation - 145 Interactive case studies - “Blue Box” Video Podcast

Also Available:

Essential Clinical Anatomy 5/e Master core anatomical concepts and prepare for course and board exams. Concise and easy-to-read, this bestselling text includes student-favorite Clinical Boxes, hundreds of striking illustrations, and up-to-date coverage of surface anatomy and medical imaging. Acclaimed for the relevance of its clinical correlations, the text emphasizes anatomy that is important in physical diagnosis for primary care, interpretation of diagnostic imaging, and understanding the anatomical basis of emergency medicine and general surgery. 9781451187496 ● Paperback ● 736 Pages ● $ 35.00 (T) ● 2013

Chapter 5 • Lower Limb

660

blood supply to the femoral head and in post-traumatic avascu- lar necrosis of the head of the femur. As a result, incongruity of the joint surfaces develops, and growth at the epiphysis is retarded. Such conditions, most common in children 3–9 years of age, produce hip pain that may radiate to the knee.

FIGURE B5.29.

Dislocation of Hip Joint

Congenital dislocation of the hip joint is common, occurring in approximately 1.5 per 1000 neonates; it is bilateral in approximately half the cases. Girls are affected at least eight times more often than boys (Salter, 1999). Dislocation occurs when the femoral head is not prop- erly located in the acetabulum. Inability to abduct the thigh is characteristic of congenital dislocation. In addition, the affected limb appears (and functions as if it is) shorter because the dislocated femoral head is more superior than on the normal side, resulting in a positive Trendelenburg sign (hip appears to drop on one side during walking). Approximately 25% of all cases of arthritis of the hip in adults are the direct result of residual defects from congenital dis- location of the hip. Acquired dislocation of the hip joint is uncommon because this articulation is so strong and stable. Nevertheless, disloca- tion may occur during an automobile accident when the hip is flexed, adducted, and medially rotated, the usual position of the lower limb when a person is riding in a car. Posterior dislocations of the hip joint are most common. A head-on collision that causes the knee to strike the dashboard

maintaining the femoral head; consequently, the fragment may undergo aseptic vascular necrosis (tissue death) .

Surgical Hip Replacement

Although the hip joint is strong and stable, it is sub- ject to severe traumatic injury and degenerative disease. Osteoarthritis of the hip joint, character- ized by pain, edema, limitation of motion, and erosion of articular cartilage, is a common cause of disability (Fig. B5.30A). During hip replacement, a metal prosthesis anchored to the person’s femur by bone cement replaces the femoral head and neck (Fig. B5.30B). A plastic socket cemented to the hip bone replaces the acetabulum.

Cartilage Hip bone

Cartilage

Femur

Normal hip

Osteophytes and eroded

articular cartilage

(A)

(B) Hip prosthesis

(A) Hip with moderate arthritis

FIGURE B5.30.

Head of femur is driven posteriorly, out of acetabulum

Necrosis of Femoral Head in Children In children, traumatic dislocations of the hip joint disrupt the artery to the head of the femur. Fractures that result in separation of the superior femoral epiphysis (the growth plate between the femoral head and neck) are also likely to result in an inadequate

(B)

Posterior dislocation of the right hip joint

FIGURE B5.31.

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Chapter 5 • Lower Limb

661

may dislocate the hip when the femoral head is forced out of the acetabulum (Fig. B5.31A). The joint capsule ruptures inferiorly and posteriorly, allowing the femoral head to pass through the tear in the capsule, and over the posterior mar- gin of the acetabulum onto the lateral surface of the ilium, shortening and medial rotating the limb (Fig. B5.31B). Because of the close relationship of the sciatic nerve to the hip joint (Fig. 5.80A), it may be injured (stretched and/or com- pressed) during posterior dislocations or fracture–dislocations of the hip joint. This kind of injury may result in paralysis of the hamstrings and muscles distal to the knee supplied by the sciatic nerve. Sensory changes may also occur in the skin over the posterolateral aspects of the leg and over much of the foot because of injury to sensory branches of the sciatic nerve. Anterior dislocation of the hip joint results from a violent injury that forces the hip into extension, abduction, and lateral rotation (e.g., catching a ski tip when snow skiing). In these cases, the femoral head is inferior to the acetabulum. Often, the acetabular margin fractures, producing a fracture–dislocation of the hip joint. When the femoral head dislocates, it usually carries the acetabular bone fragment and acetabular labrum with it. These injuries also occur with posterior dislocations. The femur is placed diagonally within the thigh, whereas the tibia is almost vertical within the leg, creating an angle at the knee between the long axes of the bones (Fig. B5.32A). The angle between the two bones, referred to clinically as the Q-angle, is assessed by drawing a line from the ASIS to the middle of the patella and extrap- olating a second (vertical) line passing through the middle of the patella and tibial tuberosity (Fig. 5.84). The Q-angle is typically greater in adult females, owing to their wider pelves. When normal, the angle of the femur within the thigh places Genu Valgum and Genu Varum

the middle of the knee joint directly inferior to the head of the femur when standing, centering the weight-bearing line in the intercondylar region of the knee (Fig. B5.32A). A medial angulation of the leg in relation to the thigh, in which the femur is abnormally vertical and the Q-angle is small, is a deformity called genu varum (bowleg) that causes unequal weight-bearing: The line of weight-bearing falls medial to the center of the knee (Fig. B5.32B). Excess pres- sure is placed on the medial aspect of the knee joint, which results in arthrosis (destruction of knee cartilages), and the fibular collateral ligament is overstressed (Fig. B.32D). A lateral angulation of the leg (large Q-angle, >17°) in relation to the thigh (exaggeration of the knee angle) is called genu valgum (knock-knee) (Fig. B5.32C). Because of the exagger- ated knee angle in genu valgum, the weight-bearing line falls lateral to the center of the knee. Consequently, the tibial col- lateral ligament is overstretched, and there is excess stress on the lateral meniscus and cartilages of the lateral femoral and tibial condyles. The patella, normally pulled laterally by the tendon of the vastus lateralis, is pulled even farther laterally when the leg is extended in the presence of genu valgum so that its articulation with the femur is abnormal. Children commonly appear bowlegged for 1–2 years after starting to walk, and knock-knees are frequently observed in children 2–4 years of age. Persistence of these abnormal knee angles in late childhood usually means congenital deformities exist that may require correction. Any irregularity of a joint eventually leads towear and tear (arthrosis) of the articular carti- lages and degenerative joint changes ( osteoarthritis [arthrosis] ).

Patellar Dislocation

When the patella is dislocated, it nearly always dis- locates laterally. Patellar dislocation is more com- mon in women, presumably because of their greater

ASIS

Line of gravity

Normal Q-angle

Q-angle

Q-angle

(A) Normal alignment

(B) Genu varum

(C) Genu valgum

(D) Osteoarthritis (arthrosis)

FIGURE B5.32.

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Chapter 7 • Head

930

Labial mucosa

Vestibular (mucolabial) fold

Alveolar mucosa

Labial frenulum

Superior labial gingiva

I1 I2

C

PM

M

Vermilion border of lip

(A)

M

PM

PM

I1 I2 C

Inferior labial gingiva (gingiva proper) Alveolar mucosa (unattached gingiva)

Vestibular (mucolabial) fold

Labial mucosa

(B)

FIGURE 7.78. Oral vestibule and gingivae. A. The vestibule and gingivae of the maxilla are shown. B. The vestibule and gingivae of the mandible are shown. As the alveolar mucosa approaches the necks of the teeth, it changes in texture and color to become the gingiva proper. (Courtesy of Dr. B. Liebgott, Professor, Division of Anatomy, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.)

pink, stippled, and keratinizing. The alveolar mucosa (unattached gingiva) is normally shiny red and non-keratin- izing. The nerves and vessels supplying the gingiva, underly- ing alveolar bone, and periodontium (which surrounds the root[s] of a tooth, anchoring it to the tooth socket), are pre- sented in Fig. 7.79A & C. Teeth The chief functions of teeth are to: • Incise (cut), reduce, and mix food material with saliva during mastication (chewing). • Help sustain themselves in the tooth sockets by assisting the development and protection of the tissues that sup- port them. • Participate in articulation (distinct connected speech). The teeth are set in the tooth sockets and are used in mastica- tion and in assisting in articulation. A tooth is identified and described on the basis of whether it is deciduous (primary)

The principal muscles of the cheeks are the buccinators (Figs. 7.76). Numerous small buccal glands lie between the mucous membrane and the buccinators (Fig. 7.74A). Super- ficial to the buccinators are encapsulated collections of fat; these buccal fat-pads are proportionately much larger in infants, presumably to reinforce the cheeks and keep them from collapsing during sucking. The cheeks are supplied by buccal branches of the maxillary artery and innervated by buccal branches of the mandibular nerve. GINGIVAE The gingivae (gums) are composed of fibrous tissue covered with mucous membrane. The gingiva proper (attached gin- giva) is firmly attached to the alveolar processes of the man- dible and maxilla and the necks of the teeth (Figs. 7.76 and 7.78). The gingiva proper adjacent to the tongue is the supe- rior and inferior lingual gingivae, and that adjacent to the lips and cheeks is the maxillary and mandibular labial or buccal gingiva, respectively. The gingiva proper is normally

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Chapter 7 • Head

931

Trigeminal nerve (CN V)

Maxillary nerve (CN V 2 )

Trigeminal ganglion

Infra-orbital nerve (CN V 2 )

Posterior Middle Anterior

Superior alveolar nerves (CN V 2 )

Mandibular nerve (CN V 3 )

Inferior alveolar nerve (CN V 3 ) Lingual nerve (CN V 3 )

Site of mandibular foramen

Buccal branch of CN V 3

Mental branch (CN V 3 )

Mandibular canal

Incisive branch of inferior alveolar nerve (CN V 3 )

Dental branches of inferior alveolar nerve (CN V 3 )

(A) Lateral view

Innervates right and left Teeth/tooth pulp Periodontal ligament Alveolar process

Occlusal surface

Innervates right and left vestibular (buccal, labial) gingiva

Contact surfaces

Innervates superior lingual gingiva

L ING U A L ( P AL AT A L )

Anterior superior alveolar and Infra-orbital

Anterior superior alveolar

D IST AL

8 7

9 10

6

11

N a s o p a l a t i n e

Infra-orbital and Middle superior alveolar

12

5

L ABIAL (V EST IBUL A R )

Middle superior alveolar

MESI AL

MAXILLARY, inferior view MANDIBULAR, superior view G r e a t e r p a l a t i n e G r e a t e r p a l a t i n e PALATE 13 14 4 3 2

CN V 2

Posterior superior alveolar

INCISOR TOOTH

Posterior superior alveolar

15

1

16

Occlusal surface

Contact surfaces

32

17

FLOOR OF MOUTH

Lingual

31

LI NG U AL ( P AL ATA L )

18

Buccal branch

DISTAL

30

Lingual 19

Dental branches of inferior alveolar

29

20

B U CCAL ( V EST IBU LAR )

CN V 3

21

28

MESIAL

27

Mental branch of inferior alveolar

26 2524 23 22

Incisive branch of inferior alveolar

MOLAR TOOTH

(B)

Floor of mouth and inferior lingual gingiva and anterior 2/3 of tongue (general sensory)

(C)

FIGURE 7.79. Innervation of teeth and gingiva. A. Superior and inferior alveolar nerves. B. Surfaces of an incisor and molar tooth. C. Innervation of the mouth and teeth.

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Chapter 7 • Head

932

in clinical (dental) practice, the mesial surface of a tooth is directed toward the median plane of the facial part of the cra- nium. The distal surface is directed away from this plane; both mesial and distal surfaces are contact surfaces —that is, surfaces that contact adjacent teeth. The masticatory surface is the occlusal surface. PARTS AND STRUCTURE OF TEETH A tooth has a crown, neck, and root (Fig. 7.82). The crown projects from the gingiva. The neck is between the crown and root. The root is fixed in the tooth socket by the peri- odontium (connective tissue surrounding roots) ; the number of roots varies. Most of the tooth is composed of dentine (L. dentinium ), which is covered by enamel over the crown

or permanent (secondary), the type of tooth, and its prox- imity to the midline or front of the mouth (e.g., medial and lateral incisors; the 1st molar is anterior to the 2nd). Children have 20 deciduous teeth; adults normally have 32 permanent teeth (Fig. 7.80A & C). The usual ages of the eruption (“cutting”) of these teeth are demonstrated in Figure 7.81 and listed in Table 7.13. Before eruption, the developing teeth reside in the alveolar arches as tooth buds (Fig. 7.80B). The types of teeth are identified by their characteristics: incisors, thin cutting edges; canines, single prominent cones; premolars (bicuspids), two cusps; and molars, three or more cusps (Fig. 7.80A & C). The vestibular surface (labial or buccal) of each tooth is directed outwardly, and the lingual surface is directed inwardly (Fig. 7.79B). As used

Maxillary alveolar process

PM

*

I

I

C

PM M1

M3

M2 M1 PM PM

I

C

I

M3

I

I

C

PM

M2

PM PM M1

PM

M2 M1

M3

M1 PM PMCI I

M2

M3

PM PM M1

Mandibular alveolar process

(A) Right anterolateral view

(B) Left anterolateral view

M3 M2 M1 PM PM C I I M3 M2 M1 PM PM C I I 1 2 3 4 5 6 7 8

16

9 10 11 12 13 14 15

18 19 20 21 22 23 24 25 26 27 28 29 30 31 32

(C) Panoramic view

FIGURE 7.80. Secondary dentition. A. The teeth are shown in occlusion. There is a supernumerary midline tooth (mesiodens) in this specimen (*). B. Maxillary and mandibular jaws of a child acquiring secondary dentition are shown. The alveolar processes are carved to reveal the roots of the teeth and tooth buds. C. A pantomographic radiograph of an adult mandible and maxilla is shown. The left lower 3rd molar is not present. I, incisor; C, canine; PM, premolar; M1, M2, and M3, 1st, 2nd, and 3rd molars. (Part C courtesy of M. J. Pharoah, Associate Professor of Dental Radiology, Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada.)

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Chapter 7 • Head

933

TABLE 7.13A. DECIDUOUS TEETH

Deciduous Teeth Central Incisor Lateral Incisor Canine 1st Molar 2nd Molar

Eruption (months) a

6–8

8–10

16–20 12–16

20–24

Shedding (years)

6–7

7–8

10–12 9–11

10–12

a In some normal infants, the first teeth (medial incisors) may not erupt until 12–13 months of age.

M1

M2

Interradicular septa of tooth socket

Socket for M1

C

Interalveolar septum

Central and lateral incisors

C

M1

M2

Molar M = Pm = Premolar

M1

Permanent teeth Deciduous teeth

M2

(A)

(B)

Primary dentition, < 2 years

M3 M2

M3 M2

M2

M1

M1

M1

Pm2 Pm1

M2

M2

M1

M1

Canine

Canine

Canine

Incisors

Incisor 1 Incisor 2

Central incisors Lateral incisors

Canine

Canine

Canine

M1

Pm2 Pm1

M1

M2

M2

M1

M1

M1

M2

M3 M2

M2

(E)

(C)

(D)

M3

Age: 6–7 years

Age: 12 years

Age: 8 years

FIGURE 7.81. Primary dentition (deciduous teeth) and eruption of permanent teeth.

TABLE 7.13B. PERMANENT TEETH

1st Premolar

2nd Premolar 1st Molar 2nd Molar 3rd Molar

Permanent Teeth Central Incisor Lateral Incisor Canine

Eruption (years)

7–8

8–9

10–12 10–11

11–12

6–7

12

13–25

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Chapter 7 • Head

934

variable amount of trabeculated bone. The labial wall of the socket is particularly thin over the incisor teeth; the reverse is true for the molars, where the lingual wall is thinner. Thus the labial surface commonly is broken to extract incisors and the lingual surface is broken to extract molars. The roots of the teeth are connected to the bone of the alve- olus by a springy suspension forming a special type of fibrous joint called a dento-alveolar syndesmosis or gomphosis. The periodontium (periodontal membrane) is composed of collagenous fibers that extend between the cement of the root and the periosteum of the alveolus. It is abundantly supplied with tactile, pressoreceptive nerve endings, lymph capillaries, and glomerular blood vessels that act as hydraulic cushioning to curb axial masticatory pressure. Pressoreceptive nerve end- ings are capable of receiving changes in pressure as stimuli. VASCULATURE OF TEETH The superior and inferior alveolar arteries, branches of the maxillary artery, supply the maxillary and mandibular teeth, respectively (Figs. 7.73 and 7.74A; Table 7.12). The alveolar veins have the same names and distribution accompany the arteries. Lymphatic vessels from the teeth and gingivae pass mainly to the submandibular lymph nodes (Fig. 7.77). INNERVATION OF TEETH The nerves supplying the teeth are illustrated in Figure 7.79A. The named branches of the superior (CN V 2 ) and inferior (CN V 3 ) alveolar nerves give rise to dental plexuses that supply the maxillary and mandibular teeth. Palate The palate forms the arched roof of the mouth and the floor of the nasal cavities (Fig. 7.83). It separates the oral cavity from the nasal cavities and the nasopharynx, the part of the pharynx superior to the soft palate. The superior (nasal) sur- face of the palate is covered with respiratory mucosa, and the inferior (oral) surface is covered with oral mucosa, densely packed with glands. The palate consists of two regions: the hard palate anteriorly and the soft palate posteriorly. HARD PALATE The hard palate is vaulted (concave); this space is mostly filled by the tongue when it is at rest. The anterior two thirds of the palate has a bony skeleton formed by the palatine processes of the maxillae and the horizontal plates of the palatine bones (Fig. 7.84A). The incisive fossa is a depression in the midline of the bony palate posterior to the central incisor teeth into which the incisive canals open. The nasopalatine nerves pass from the nose through a variable number of incisive canals and foramina that open into the incisive fossa (Fig. 7.87B). Medial to the 3rd molar tooth, the greater palatine fora- men pierces the lateral border of the bony palate (Fig. 7.84A). The greater palatine vessels and nerve emerge from this

Enamel

Crown

Crown

Dentine

Neck

Pulp cavity (tooth cavity)

Neck

Cement

Root

Root

Root canal

Apical foramen (root foramen)

Incisor tooth

Molar tooth

(A) Longitudinal section

5

1 1

2 2 3

4

7

8

7

6

(B) Lateral radiograph

1 Enamel 4 Root canal

2 Dentine 5 Buccal cusp

3 Pulp cavity 6 Root apex

7 Interalveolar septa (alveolar bone) 8 Interradicular septum (alveolar bone)

and cement (L. cementum ) over the root. The pulp cavity contains connective tissue, blood vessels, and nerves. The root canal (pulp canal) transmits the nerves and vessels to and from the pulp cavity through the apical foramen. The tooth sockets are in the alveolar processes of the maxillae and mandible (Fig. 7.80A); they are the skeletal features that display the greatest change during a lifetime (Fig. 7.81B). Adjacent sockets are separated by interalveo- lar septa; within the socket, the roots of teeth with more than one root are separated by interradicular septa (Figs. 7.81B and 7.82B). The bone of the socket has a thin cortex separated from the adjacent labial and lingual cortices by a FIGURE 7.82. Sections of teeth. A. An incisor and a molar are shown. In living people, the pulp cavity is a hollow space within the crown and neck of the tooth containing connective tissue, blood vessels, and nerves. The cavity narrows down to the root canal in a single-rooted tooth or to one canal per root of a multirooted tooth. The vessels and nerves enter or leave through the apical foramen. B. Bite-wing radiograph of maxillary premolar and molar teeth demonstrating features shown and described in part A.

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Competition Matrix

Netter's Clinical Anatomy: with Online Access, 2/e Clinically Oriented Anatomy 7/e

Hansen

Moore

Author / Editor

? Pages, Paperback, Elsevier, 2009

1248 Pages, 1988 illust., Paperback, WK, 2013

Product Data

• Presents nearly 6 beautifully colored illustrations which provide essential depictions of anatomy, embryology, and pathology to help you understand their clinical relevance. • Features Clinical Focus boxes throughout that present hundreds of well-illustrated clinical correlations which bridge anatomy to pathophysiology • Characteristics boxes that explain the relation between structure and function. • Includes Muscle/Ligament/Joint Tables that summarize attachment points, actions, and other key information related to each structure, providing a quick overview of the MSK system. • Offers short-answer review questions at the end of each chapter to help you gauge your mastery of the material and assess areas in need of further study.

• The best-selling clinical anatomy textbook on the market • NEW-AND-IMPROVED ART PROGRAM: All illustrations have been redrawn and updated for consistency in style and color as well as anatomical accuracy • CLINICAL BLUE BOXES, supported by photos and illustrations, help students understand the practical value of anatomy. Each clinical correlation is classified by the type of clinical information it contains: Anatomical Variation, Trauma, Surgical Procedure, Diagnostic Procedure, Life Cycle, and Pathology • ILLUSTRATED TABLES organize complex information about veins, arteries, nerves, and other structures • BOTTOM LINES summarize key study points for students • INTRODUCTION CHAPTER covers important systemic information and concepts basic to the understanding of the anatomy presented in the subsequent regional chapters • EXTENSIVE MEDICAL AND DIAGNOSTIC IMAGING reflects the increasing importance it plays in diagnosis and treatment • SURFACE ANATOMY photos clearly demonstrate anatomy’s relationship to physical examination and diagnosis • Online CASE STUDIES AND BOARD REVIEW-STYLE QUESTIONS provide interactive, convenient, and comprehensive self-testing and review to prepare for course and licensing exams • TERMINOLOGY fully adheres to the most current Terminologia Anatomica approved by the Federative International Committee on Anatomical Terminology

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Clinical Anatomy by Regions 9/e

9788184736588 ● 800 Pages ● 599 illustraƟons ● Paperback ● Pub Year 2012 ● Rs. 1995.00

Richard S. Snell MD, PhD , Emeritus Professor of Anatomy, George Washington University School of Medicine and Health Science, Washington, DC

Primary Market: MBBS Student (1 st and 3 rd Prof) Secondary Market: Aspiring PG student

Features:

• Widely praised for its clear and consistent organization, abundant illustrations, and emphasis on clinical applications. • Each chapter of Clinical anatomy is constructed in a similar manner. This gives students ready access to material and facilitates moving from one part of the book to another. Each chapter is divided into the following categories: - Clinical Examples - Chapter Objectives - Basic Clinical Anatomy - Surface Anatomy - Clinical Problem solving and Review questions (thePoint) • Updated design and layout allow for a shorter, more focused text. • Basic Clinical Anatomy sections provide essential information on gross anatomic structures of clinical significance. (Page No. 6) • Clinical Examples open each chapter and dramatize the relevance of anatomy in medicine. (Page no. 31) • Clinical Objectives sections in each chapter focus the student on material most important to their preparedness’ for the patient encounter. (Page No. 1) • Embryologic notes provide anatomical insights into developmental anatomy. (Page No. 33) • Full-color illustrations. • Numerous examples of clinical images support the text. (Page no. 69) • Surface Anatomy sections explain surface landmarks of important anatomic structures. (Page No. 50)

Resources for Student & Faculty thePoint

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Online eBook

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158 CHAPTER 5 The Abdomen: Part II—The Abdominal Cavity

esophagus diaphragm

liver

stomach

gallbladder

left colic flexure

right colic flexure

duodenum transverse colon

descending colon

ascending colon

jejunum

ileocecal junction

cecum

ileum

appendix

sigmoid colon

rectum

anal canal

anus

FIGURE 5.1 General arrangement of abdominal viscera.

umbilical regions, and much of it lies under cover of the ribs. Its long axis passes downward and forward to the right and then backward and slightly upward. Small Intestine The small intestine is divided into three regions: duode- num, jejunum, and ileum. The duodenum is the first part of the small intestine, and most of it is deeply placed on the posterior abdominal wall. It is situated in the epigastric and umbilical regions. It is a C-shaped tube that extends from the stomach around the head of the pancreas to join the jejunum (Fig. 5.1). About halfway down its length, the small intestine receives the bile and the pancreatic ducts. The jejunum and ileum together measure about 20 ft (6 m) long; the upper two fifths of this length make up the jejunum. The jejunum begins at the duodenojeju- nal junction, and the ileum ends at the ileocecal junction (Fig. 5.1). The coils of jejunum occupy the upper left part of the abdominal cavity, whereas the ileum tends to occupy the lower right part of the abdominal cavity and the pelvic cavity (Fig. 5.3). Large Intestine The large intestine is divided into the cecum, appen- dix, ascending colon, transverse colon, descending colon,

sigmoid colon, rectum, and anal canal (Fig. 5.1). The large intestine arches around and encloses the coils of the small intestine (Fig. 5.3) and tends to be more fixed than the small intestine.

stomach

liver

gastroepiploic vessels

gallbladder falciform ligament

greater omentum

FIGURE 5.2 Abdominal organs in situ. Note that the greater omentum hangs down in front of the small and large intestines.

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Basic Anatomy 159

the right lower and upper quadrants (Figs. 5.1 and 5.3). On reaching the liver, it bends to the left, forming the right colic flexure. The transverse colon crosses the abdomen in the umbil- ical region from the right colic flexure to the left colic flex- ure (Figs. 5.1 and 5.3). It forms a wide U-shaped curve. In the erect position, the lower part of the Umay extend down into the pelvis. The transverse colon, on reaching the region of the spleen, bends downward, forming the left colic flex- ure to become the descending colon. The descending colon extends from the left colic flexure to the pelvis below (Figs. 5.1 and 5.3). It occupies the left upper and lower quadrants. The sigmoid colon begins at the pelvic inlet, where it is a continuation of the descending colon (Fig. 5.1). It hangs down into the pelvic cavity in the form of a loop. It joins the rectum in front of the sacrum. The rectum occupies the posterior part of the pelvic cavity (Fig. 5.1). It is continuous above with the sigmoid colon and descends in front of the sacrum to leave the pel- vis by piercing the pelvic floor. Here, it becomes continuous with the anal canal in the perineum. Pancreas The pancreas is a soft, lobulated organ that stretches obliquely across the posterior abdominal wall in the epi- gastric region (Fig. 5.4). It is situated behind the stomach and extends from the duodenum to the spleen. Spleen The spleen is a soft mass of lymphatic tissue that occupies the left upper part of the abdomen between the stomach

greater omentum

transverse colon

coils of jejunum

ascending colon

descending colon

appendix

coils of ileum cecum

The cecum is a blind-ended sac that projects down- ward in the right iliac region below the ileocecal junction (Figs. 5.1 and 5.3). The appendix is a worm-shaped tube that arises from its medial side (Fig. 5.1). The ascending colon extends upward from the cecum to the inferior surface of the right lobe of the liver, occupying FIGURE 5.3 Abdominal contents after the greater omentum has been reflected upward. Coils of small intestine occupy the central part of the abdominal cavity, whereas ascending, transverse, and descending parts of the colon are located at the periphery.

central tendon of diaphragm

phrenic artery

left suprarenal gland

inferior vena cava

spleen

right suprarenal gland

left kidney

portal vein

phrenicocolic ligament

right kidney

bile duct hepatic artery

splenic artery pancreas

gastroduodenal artery

descending colon

transverse colon

ascending colon

superior pancreaticoduodenal artery

FIGURE 5.4 Structures situated on the posterior abdominal wall behind the stomach.

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68 CHAPTER 3 The Thorax: Part II—The Thoracic Cavity

esophagus

trachea

right subclavian vein

right vagus

right internal jugular vein

rami communicantes

right brachiocephalic vein

sympathetic trunk

right phrenic nerve superior vena cava

azygos vein

right bronchi

ascending aorta

pulmonary arteries

right atrium covered by pericardium

pulmonary veins

pericardium

greater splanchnic nerve

diaphragm

lesser splanchnic nerve

inferior vena cava

A

thoracic duct

sympathetic trunk

left phrenic nerve left vagus nerve arch of aorta

left brachiocephalic vein

left recurrent laryngeal nerve ligamentum arteriosum

left pulmonary artery

left bronchi

left ventricle covered by pericardium

left pulmonary veins

descending aorta

pericardium

greater splanchnic nerve diaphragm

B

esophagus

FIGURE 3.15 A. Right side of the mediastinum. B. Left side of the mediastinum.

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Basic Anatomy 69

right subclavian vein

right clavicle

sympathetic trunk

right subclavius muscle

cut rib

internal thoracic artery

azygos vein

superior vena cava

intercostal nerve

ascending aorta

right bronchi

right phrenic nerve

pulmonary veins

right atrium

greater splanchnic nerve

right ventricle

cut costal cartilage

inferior vena cava

right cupola of diaphragm

ANTERIOR

cut costal cartilage

FIGURE 3.16 Dissection of the right side of the mediastinum; the right lung and the pericardium have been removed. The costal parietal pleura has also been removed.

sympathetic trunk left vagus nerve descending aorta left auricle

left subclavian artery

left common carotid artery

arch of aorta

pulmonary trunk

right ventricle

left phrenic nerve

ANTERIOR

left ventricle

left cupola of diaphragm

apex of heart

FIGURE 3.17 Dissection of the left side of the mediastinum; the left lung and the pericardium have been removed. The costal parietal pleura has also been removed.

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Gray's Anatomy for Students, 2/e IE

BD Chaurasia's Human Anatomy 6/e 3 Vol Set

Clinical Anatomy by Regions 9/e

Drake

Chaurasia

Snell

Author / Editor

1150 Pages, 350+ illust., Paperback, Elsevier, 2009 Vol 1-311 Pages, Vol 2-463 Pages,Vol 3-493 Pages,Paperback, CBS, 2013

800 Pages, 599 illust., Paperback, WK, 2012

Product Data

Emphasizes the practical applications of anatomy with clinical correlations throughout. • Discusses the relevance of surface anatomy to clinical procedures and physical examination techniques. • Relates regional anatomy to systemic function. • Features beautiful full-color anatomic illustrations as well as radiologic images. • Presents a review tool for course exams as well as the USMLE Step 1 that lets you study your way based on your own personal study habits.

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• The best-selling clinical anatomy textbook on the market • South Asian Advisory Panel (12 from India and 3 from Pakistan) • NEW: Clinical Blue Boxes now have categorizations such as Health, Clinical Procedures, Physical Examination, and Development and are indexed at the front of the book for easy navigation. (Page no. 35) • BOTTOM LINE SECTIONS (in Yellow Boxes): Ensure that primary concepts do not become lost in the many details. (Page no. 36, 43, 56…) • CLINICAL CORRELATIONS: The popular BLUE BOXES are supported by photographs and/or dynamic color illustrations to help students understand the practical value of anatomy (Page no. 19, 23, 37…) also (Separate TOC for Clinical Blue boxes) • FUNCTIONAL ANATOMY: Includes a more realistic approach to the musculoskeletal system emphasizing the action and use of muscles and muscle groups in daily activities (Page 899. *Eye Lid) • INTRODUCTION CHAPTER: This thorough and unique chapter covers important systemic information and concepts basic to the understanding of the anatomy presented in the subsequent regional chapters (Page no. 1) professionals who need to be familiar with imaging (Page no. 456, 458…)

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DVD

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