Objectives:- INTRODUCTION COMONENT MOVEMENTS VASCULAR SUPPLY INNERVATION AGE CHANGES SURGICAL ANATOMY REFERENCES

Objectives INTRODUCTION COMONENT MOVEMENTS VASCULAR SUPPLY INNERVATION AGE CHANGES SURGICAL ANATOMY REFERENCES

Introduction The right and left TMJ form a bicondylar articulation and ellipsoid variety of the synovial joint. The most important function of the TMJ mastication speech and great intrest to dentist,orthodontist,clinician and radilogist

The right and left TMJ form a bicondylar articulation and ellipsoid variety of the synovial joints

Peculiarity of TMJ l.Bilateral diarthrosis 2.Articular surface covered by fibrocartilage 3. TMJ is last joint to start develop 4.Develop from two distinct blastema

4.TMJ is last joint to start develop 5.Develop from two distict blastema.

Componenents o Mandibular condyle articular surface of temporal bone capsule articular disc ligaments muscular components

Mandibular condyle articular surface of temporal bone capsule articular disc ligaments muscular components

THE MANDIBULAR CONDYLE It’s the articular surface of the mandible. It is convex in all directions but wider latero-medially(15-20mm)than antero-posteriorly(8- 10mm)

It has lateral and medial poles

Articular surface of Temporal bone The articular surface of the temporal bone is situated on the inferior aspect of temporal bone anterior to tympanic plate.

Articular eminence: this is the entire transverse bony bar that form the anterior root of zygoma.this articular surface is most heavily traveled by the condyle and diskk as the ride forward and backward in normal jaw function.

Articular tubercle:-this is a small raised rough bony knob on the outer end of the articular eminance. It project below the level of the articular surface and serve to attached the lateral collateral ligament the joint. () Preglenoid plane: this is the slightly hollowed,almost horzontal articular surface continuing anteriorly from the height of the articular eminance.

Articular Disc

It is a biconcave fibrocartilagenous structure located between the mendibular condyle and the temporal bone component of the joint. Its function to accommodate a hinging action as well as the gliding action between the temporal and mandibular articular bone.

The articular disc is a roughly oval,firm, fibrous plate anterior band=2mm in thickness posterior band=3mm thick intermediate band=1mm and thin it is a shaped like apeaked cap that divides the joints into alarge upper compartment and smaller lower compartment.

ANATOMICAL BASIS OF ABDOMINAL SURGICAL INCISIONS DR.PRASHANT PRASAD P.G.(1 st YEAR) Department of Anatomy AIIMS (RISHIKESH) DR.PRASHANT PRASAD P.G. Department of Anatomy AIIMS (Rishikesh)

ANATOMY OF ABDOMEN

BOUNDARIES OF ABDOMEN ROOFFLOOR ANTERIOR WALL POSTERIOR WALL

LANGER’S LINE

NEUROVASCULATURE OF ABDOMINAL WALL

DERMATOMES OF ABDOMINAL WALL

REGIONS OF THE ABDOMEN

ANATOMICAL BASIS OF SURGICAL INCISIONS ELEMENTSPREPARATIONS 1.Accessibility1.Prophylactic antibiotics 2.Extensibility2.Surgical site marking 3.Preservation of function3.Skin preparation 4.Security4.Lighting

HISTORICAL BACKGROUND

TYPES OF INCISIONS VERTICALOBLIQUETRANSVERSE

Anatomy – A midline laparotomy can run anywhere from the xiphoid process to the pubic symphysis, passing around the umbilicus. The incision will cut through the skin, subcutaneous tissue, and fascia, the linea alba and tranversalis fascia, and the peritoneum before reaching the abdominal cavity. Discussion – As well as obtaining significant exposure of the viscera, this incision causes minimal blood loss or nerve damage, and can be used for emergency procedures. Its positioning however does make it susceptible to significant scars.

Anatomy – The incision runs 2-5cm away from the midline, cutting through the skin, subcutaneous tissue, and the anterior rectus sheath. – The anterior rectus is separated from the fascia and moved laterally, before the excision is continued through the posterior rectus sheath (if above the arcuate line) and the transversalis fascia, reaching the peritoneum and abdominal cavity. Discussion – The incision will take a long time and is difficult, however it does prevent any division of the rectus muscle and provides access to lateral structures. A paramedian incision can damage the muscles’ lateral blood and nerve supply, which may result in the atrophy of the muscle medial to the incision.

MCBURNEY’S INCISION

ROCKEY-DAVIS INCISION

SUBCOSTAL INCISION

The incision is made to run parallel to the costal margin, starting below the xiphoid and extending laterally. The incision will then pass through the all the rectus sheath and rectus muscle, internal oblique and transversus abdominus, before passing through the transversalis fascia and then peritoneum to enter the abdominal cavity. Two modifications and extensions of the Kocher incision are possible: Chevron / rooftop incision or modification ④ – the extension of the incision to the other side of the abdomen. This may be used for oesophagectomy, gastrectomy, bilateral adrenalectomy, hepatic resections, or liver transplantation Mercedes Benz incision or modification ⑤ – the Chevron incision with a vertical incision and break through the xiphisternum. This may be used for the same indications as the Chevron incision, however classically seen in liver transplantation. Whilst open procedures that come with inherent drawbacks, all these subcoastal incisions provide the surgeon with good exposure to the abdominal viscera and tend to heal well

FLANK INCISION

LUMBOTOMY INCISION

TRANSVERSE INCISIONS Abdominal Cavity PELVIC CAVITY 1.Flank incision1.Pfannenstiel’s incision 2.Lumbotomy2.Cherney’s incisions 3.Maylard’s incision 4.Kustner’s incision 5.Turner-Warwick’s incisions

PFANNENSTIEL’S INCISION

INCISIONS IN LAPROSCOPIC SURGERY