Anatomi Sistem Indera

Anatomy of Special Senses

Sasanthy Kusumaningtyas I Deswaty Furqonita Department of Anatomy

FMUI

Organs of special senses

Anatomy of the eye and vision

Anatomy of the ear

Anatomy of the olfac@on and taste

EYE

The orbit

Accessory structure of the eye

The eye ball

Pathways

The Orbit

•  Pyramidal shape ( a base, 4 walls, an apex). •  Loca@on: below the anterior cranial fossa and anterior to the middle cranial fossa.

•  8 bones contribute to the framework of the orbit.

•  Contains the eyeball, nerves and vessels, extra ocular muscles, lacrimal apparatus, adipose @ssue and fascia

The Orbit

Keith L. Moore, Arthur F. Dalley & Anne M. Agur. Clinically oriented Anatomy. 7th ed. LippincoS Williams & Wilkins. 2015

The Orbit

•  The orbit are lined by periorbita, and con@nuous with: –  The periosteal layer of duramater at the op@c canal and superior orbital fissure.

–  Covering the external surface of the cranium (pericranium) at the orbital margins and through the inferior orbital fissure.

–  The orbital septa at the orbital margins. –  The fascial sheaths of the extra-‐ocular muscles. –  The orbital fascia that forms the fascia sheath of the eyeball.

The Orbit

The Orbit

Opening: fissura & foramina

The Orbit Nerves of orbit: N.II, III, IV, VI, V1

The Orbit

Source:. Richard L Drake, Wayne Vogl & Adam W.M. Mitchell. Gray’s Anatomy for students. Elsevier. 2007.

Vasculature of orbit

EYE

The orbit


The eye ball

Pathways

Accessory Structures of the Eye

Eyebrows

Eyelids and eyelashes

Conjunc@va

Lacrimal apparatus

Extrinsic eye muscles

(Chantus)

Source: Moore & Agur. Essen@al clinical anatomy. 3rd ed. LippincoS Williams & Wilkins. 2007




The upper and lower eyelids (superior and inferior palpebrae): •  Palpebral fissure •  Eyelids contains, A to P: skin, subcutaneous @ssue, orbicularis oculi muscle, the orbital septum, the tarsus (with tarsal glands), and conjunc@va (bulbar & palpebral).

•  The upper and lower eyelids are basically similar in structure except for the addi@on of levator palpebra superioris and superior tarsal muscles in the upper eyelid.

Eyelids

Tarsal glands secrete an oily substance that increases the viscosity of the tears and decreases the rate of evapora@on of tears from the surface of the eyeball.

Source:. Richard L Drake, Wayne Vogl & Adam W.M. Mitchell.; Gray’s Anatomy for students. Elsevier. 2007.

Eyelids Vessels and innervaAon

The arterial supply: branches of the superficial temporal artery (branch of external caro@d artery)

Innerva@on: •  Sensory: branches of N.V •  Motor: N.VII, N.III •  Symphate@c: innervate superior tarsal

muscle

Eyelids

•  Loss of innerva@on of the orbicularis oculi by the facial nerve [VII] causes an inability to close the eyelids @ghtly and the lower eyelid droops away, resul@ng in a spillage of tears.

•  Complete ptosis: loss of innerva@on of the levator palpebrae superioris by the oculomotor nerve à inability to open the superior eyelid voluntarily.

•  ParAal ptosis: loss of innerva@on of the superior tarsal muscle by sympathe@c fibers.


Eyebrows

Eyelids (palpebra) and eyelashes (cilia)

Conjunc@va

Lacrimal apparatus


The lacrimal apparatus

The lacrimal apparatus is involved in the produc@on, movement, and drainage of fluid from the surface of the eyeball. •  Lacrimal glands: secrete lacrimal fluid •  Lacrimal duct: convey lacrimal fluid from the lacrimal glands to the conjunc@val sac

•  Lacrimal canaliculi •  Nasolacrimal duct, conveys the lacrimal fluid to the nasal cavity




Innerva@on: •  Sensory: lacrimal branch of the ophthalmic nerve [V1].

•  Secretomotor (parasympathe1c) •  Sympathe1c Vasculature: •  ophthalmic vessels and its branches.

Innerva@on of lacrimal gland

/secretomotor(NVII)

(NV2)

(NV1)



Eyebrows

Eyelids (palpebra) and eyelashes (cilia)

Conjunc@va

Lacrimal apparatus



•  Rectus muscles (superior, inferior, medial, lateral). – Originate from the common tendinous ring ( Annulus of Zinn)

•  2 oblique muscles (superior and inferior oblique). – Arise from the body of sphenoid (posterior of orbit).

– Arise from the medial side of floor of orbit.


Extrinsic Eye Muscles

The axis: •  Orbit: laterally •  Visual axis: anteriorly •  Consequences: some muscles has mul@ple ac@on, while others has

single ac@on

Movements of the eye ball

Movements of the eye ball •  Occur as rota@ons around three axes. •  The direc@on of movement of the pupil from the primary

posi@on.

Source: Keith L. Moore, Arthur F. Dalley & Anne M. Agur. 2010. Clinically oriented Anatomy. 6th ed. LippincoS Williams & Wilkins


Single ac@on: •  Lateral rectus •  Medial rectus


Mul@ple ac@on: •  Superior rectus •  Inferior rectus


Mul@ple ac@on: •  Superior oblique •  Inferior oblique

Movements of eye ball:

clinical tes@ng

LR LR

Movements of the eye ball:

clinical tes@ng

MR MR

Movements of eye ball: clinical tes@ng


Movements of eye ball

Binocular movement (version/conjugate): yoke muscle

Extrinsic Eye Muscles Mnemonic: LR6(SO4)3

Eye movement Complete oculomotor nerve palsy affects most of the ocular muscles, the levator palpebrae superioris, and the sphincter pupillae. The pupil is fully abducted and depressed (“down and out”) because of the unopposed ac@vity of the lateral rectus and superior oblique, respec@vely.

The CN VI palsy: paralyze of the lateral rectus, the individual cannot abduct the pupil on the affected side. The pupil is fully adducted by the unopposed pull of the medial rectus.

EYE

The orbit


The eyeball

Pathways

Eyeball •  Globe-‐shaped. •  Occupies the anterior part of the orbit. •  Outward projec@on represents about one-‐sixth of the total area of

the eyeball and is the transparent cornea. •  Posterior to the cornea and in order from front to back are: –  the anterior chamber –  the iris and pupil –  the posterior chamber –  the lens –  the postremal (vitreous) chamber, filled with gela@nous substance, vitreus humor.

•  Aqueous humor: supply nutri@on to the lens and cornea, also maintains the intraoccular pressure.

Eye ball

a.centralis re@nae


pupil

Walls of the eyeball

Consist of three layers: •  The outer fibrous layer consists of the sclera posteriorly and the cornea anteriorly.

•  The middle vascular layer consists of the choroid posteriorly and is con@nuous with the ciliary body and iris anteriorly (=uvea).

•  The inner layer consists of the op@c part of the reAna posteriorly and the nonvisual re@na that covers the internal surface of the ciliary body and iris anteriorly.

The circula@on of aqueous humor

The circula@on of aqueous humor

•  Glaucoma: a condi@on of increased pressure within the eye ball. – Decreasing of ouolow of the aquous humor.


The middle vascular layer: choroid, ciliary body and iris. Intrinsic muscle of the eyeball Zonular fibers: suspensory ligament of the lens

Intrinsic muscle of the eyeball

Muscle LocaAon InnervaAon FuncAon Ciliary Muscle fibers in

the ciliary body Parasymphate@cs from the occulomotor nerve [III]

Constrics ciliary body, relaxes tension on the lens, lens become rounded

Sphincter pupillae Circularly arranged fibers in the iris

Parasymphate@cs from the occulomotor nerve [III]

Constrics pupil

Dilator pupillae Radially arranged fibers in the iris

Symphate@cs form the superior cervical ganglion (T1)

Dilates pupil

Intrinsic muscle of the eyeball

Intrinsic muscles of the eyeball



Intrinsic muscles of the eyeball


The inner layer: re@na •  OpAc part of the re@na (posterior part of the eyeball) – Pigmented layer : firmly aSached to the cornea – Neural layer: aSached to the pigmented layer around the op@c nerve and ora serrata

•  Nonvisual part (covers the internal surface of the ciliary body and iris)

•  Ora serrata: junc@on between op@c and nonvisual part of the re@na.

Source: Marieb & Mallat. Human Anatomy. 3rd ed. Benjamin Cummings.2001

Ophthalmoscopic view of posterior chamber of the eye

Vasculature of the eyeball

•  The arterial supply: mainly form the ophthalmic artery –  The short posterior ciliary artery –  The long posterior ciliary artery –  The anterior ciliary artery –  The central re@nal artery

•  Venous drainage: primarily related to drainage of the choroid layer. Four large veins (the vorAcose veins) are involved in this process.

Visual pathway The fibers of the op@c tract crossed and uncrossed at the op@c chiasm. •  Fibers of the medial root: –  Superior colliculus, provide for automa@c scanning (reading).

–  Relayed from the superior colliculus to the pulvinar of the thalamus (the extra-‐geniculate pathway) to the visual associa@on cortex.

–  Pretectal nucleus and serve the pupillary light reflex •  Fibers of the lateral root: –  Lateral geniculate body (LGB) of thalamus à opAc radiaAon (geniculocalcarine tract) àprimary visual cortex

Visual pathway

Visual pathway

Geniculocalcarine tract

Duane E. Haines. Fundamental Neuroscience for Basic and Clinical Applica@ons. 4th ed. Saunders. 2013

Visual pathway

Visual defects following various lesions of the visual pathways

Visual pathways

Accomoda@on reflex: focusing on a near or distance object LGB

Op@c tract

Visual pathways

Direct and consensual light reflex: constric@on of the pupil LGB

Op@c tract

Visual pathways Corneal reflex, light touching of the cornea or conjunc@va results in blinking of both side of the eyelids

Medial longitudinal fasciculus

The ear

• Auricula • Canal (external acous@c meatus) that extends from the auricle to the tympanic membrane

External ear

• cavity in the petrous part of the temporal bone (tympanic cavity and epitympanic recess)

Middle ear

• contains hearing receptors and receptors that detect mo@on and posi@on

Internal ear

The ear

Round window

Oval window

Source: Richard S Snell, Wayne Vogl, Adam W.M. Mitchell. 2007. Grey’s Anatomy for Students.Elsevier.

The external ear Auricle: the auricle is on the side of the head and assists in capturing sound. It consists of car@lage (except the lobule), covered with skin and arranged in a paSern of various eleva@ons and depressions. Innerva@on: mainly from great auricular and auriculotemporal nerves. Arterial supply: mainly from posterior auricular and superficial temporal arteries; venous drainage is through vessels following the arteries. Func@on: to collect sound.

(consists of fat, blood vessels & fibrous @ssue)

The external ear •  External acousAc meatus: is a

canal that leads inward through the tympanic part of the temporal bone from the auricle to the tympanic membrane.

•  In adults of 2 to 3 cm. •  The lateral 1/3: slightly S-‐

shaped canal à car@laginous and lined with skin, con@nuous with the skin of the auricle.

•  The medial 2/3: bony and lined with thin skin that is con@nuous with the external layer of the tympanic membrane.

•  The ceruminous and sebaceous glands produce cerumen.

•  For examina1on purposes, observa1on of the external acous1c meatus and tympanic membrane can be improved by pulling the ear superiorly, posteriorly, and slightly laterally.

Source: Dynamic Human Anatomy, 2.0.

The external ear: tympanic membrane

The tympanic membrane is sloping medially from top to boSom and posteriorly to anteriorly. Its lateral surface therefore faces inferiorly and anteriorly. It consists of a connec@ve @ssue core lined with skin on the outside and mucous membrane on the inside.


Sensory innerva@on: •  The skin on the outer surface of the tympanic membrane:

primarily by the trigeminal nerve [V] with addi@onal par@cipa@on of the facial [VII] and vagus [X] nerves

•  The mucous membrane on the inner surface of the tympanic membrane: by the glossopharyngeal [IX] nerve.


incisions to release pus from a middle ear abscess (myringotomy): below the upper 1/3 of the tympanic membrane (the chorda tympani runs in that loca@on). The standard surgical approach in the posterior inferior aspect.

Keith L. Moore, Arthur F. Dalley & Anne M. Agur. Essen@al Clinical Anatomy. 4th ed. LippincoS Williams & Wilkins

√

The middle ear Consist of the tympanic cavity and epitympanic recess. Func@on: transmit vibra@ons of the tympanic membrane across the cavity of the middle ear to the internal ear.

The middle ear

2. Lateral (membranous wall)

4. Roof (tegmental wall)

5. Floor (inferior/ jugular wall)

3. Posterior (mastoid wall) 1.   Anterior

(caroAd wall)

(1A)

(1B)

(1C)

(2A)

(2B)

(2C) (3A)

(3B)

(4A)

(5A)

Source: Dynamic Human Anatomy, 2.0

Boundaries

The middle ear

•  Func@on: equalizes pressure on both sides of the tympanic membrane.

•  It consists of: a bony part (1/3 part) and a carAlaginous part (2/3 part).

•  Opened by the contrac@on of the levator veli pala@ni and tensor veli pala@ni muscles

•  Arterial supply: from the branches of the external caro@d and maxillary arteries.

•  Innerva@on: tympanic plexus

The rela@onship between the middle ear and the pharyngotympanic tube

Keith L. Moore, Arthur F. Dalley & Anne M. Agur. Clinically oriented Anatomy. 7th ed. LippincoS Williams & Wilkins. 2015

The middle ear Ossicles and muscles of the middle ear Tensor tympani: •  Contrac@on pulls

handle of malleus medially, tensing tympanic membrane to reduce the force of vibra@ons in response to loud noises

Stapedius: •  Contrac@on, usually in

response to loud noises, pulls the stapes posteriorly and prevents excessive oscilla@on

The middle ear

Vessels: •  Arterial supply: tympanic branch of the maxillary artery and the mastoid branch of the occipital or posterior auricular arteries; branches from the internal caro@d artery.

•  Venous drainage: to the pterygoid plexus of veins and the superior petrosal sinus.

Innerva@on: tympanic plexus

The middle ear •  O@@s media: inflama@on of the middle ear. Inflama@on and swelling of the mucus membrane lining tympanic cavity. And produce bulging and redness of the tympanic membrne may cause par@al or complete blockage of the pharyngotympanic tube.

•  Mastoidi@s: infec@on of the mastoid antrum and mastoid cells result fro a middle ear infec@on à inflama@on of the mastoid process.

•  Paralysis of the stapedius: lesion of the N.VII à hyperacusia

The internal ear

Hearing and balance It consist of bony labyrinth and membranous labyrinth. •  The labyrinth consist of vesAbule, semicircular canals, and the cochlea These bony cavi@es are lined with periosteum and contain a clear fluid (the perilymph).

•  The membranous labyrinth is suspended within the perilymph of the bony labyrinth. It consist of the semicircular ducts, the cochlear duct, and two sacs (the utricle and the saccule). These membranous spaces are filled with endolymph.

The internal ear

Keith L. Moore, Arthur F. Dalley & Anne M. Agur. Essen@al Clinical Anatomy. 4th ed. LippincoS Williams & Wilkins

à endolymph

à perilymph

(communicates with the cochlea and semicircular canals)

The internal ear

Organs of balance: •  Sensory receptors – Macula of utricle: responds to centrifugal and ver@cal accelera@on

– Macula of saccule: responds to linear accelera@on. – Crista ampularis: responds to movement in any direc@on.

The internal ear

The internal ear

Organs of hearing: •  Cochlea, a bony structure that twists on itself two and one-‐half to two and three-‐quarter @mes around a central column of bone (the modiolus)

•  It consist of three canals: – Scala tympani and scala ves@buli (on the bony labyrinth) and the cochlear duct (membranous labyrinth)

•  The sensory receptor: organ Cor@

N.VII & N.VIII

Source: Richard S Snell. Clinical Anatomy. 7th ed. LippincoS Williams & Wilkins. 2010


Ves@bular nerve Source: Clinical Neuroanatomy. Richard S Snell

Source: Richard S Snell. Clinical Anatomy. 7th ed. LippincoS Williams & Wilkins. 2010

Source: Van De Graaf. Human Anatomy. 6th ed. Mc Graw Hill Companies. 2001.

Olfac@on

Olfactory receptors: •  Found in the olfactory mucosa and covers the olfactrory ephitelium

Olfac@on

The major efferent projec@ons of the olfactory bulb. Direct projec@on (blue) and indirect interbulbar connec@on via anterior olfactory nucleus (red)


Olfac@on


Source: Saladin. Anatomy & Physiology. Mc Graw Hill Companies. 2003.

(Emo@onal responses)

Olfac@on

•  Anosmia, the lost of smell •  Hyposmia (olfactory hypesthesia), decreased sensi@vity to odorants – Can be assosiated with nasal polyp

•  Rhini@s, may block the access of odorants to the olfactory epithelium.

Source: Marieb & Mallat. Human Anatomy. 3rd ed. Benjamin Cummings.2001

Taste buds ài N VII,IX, X à solitary nucleus à 1)hypothalamus & amygdala (autonomic reflex, saliva@on. 2) thalamus

Gustatory pathway

References •  Dynamic Human Anatomy 2.0 •  Duane E. Haines. Fundamental Neuroscience for Basic and Clinical Applica@ons. 4th ed.

Saunders. 2013 •  Elaine n Marieb & Jon Mallat. Human Anatomy. 3rd ed. Benjamin Cummings. 2001. •  Keith L. Moore, Arthur F. Dalley & Anne M. Agur. Essen@al Clinical Anatomy. 4th ed.

LippincoS Williams & Wilkins. •  Keith L. Moore, Arthur F. Dalley & Anne M. Agur. Clinically oriented Anatomy. 7th ed.

LippincoS Williams & Wilkins. 2015 •  MJ Turlough FitzGerald, Gregory Gruener and Estomih Mtui. Clinical Neuroanatomy &

Neuroscience. 6th ed. Elsevier. 2012 •  Richard S Snell. Clinical neuroanatomy for Medical Students. 7th ed. LippincoS Williams &

Wilkins. 2010 •  Richard S Snell, Wayne Vogl, Adam W.M. Mitchell. Grey’s Anatomy for Students.3rd ed.

Elsevier. 2015. •  Saladin.Anatomy and Physiology:The unity of form and func@on. 3rd ed. The Mc Graw Hill

Companies. 2003 •  Van De Graaff. 2001. Human Anatomy. 6th ed. McGraw-‐Hill Company.

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