ANATOMYS MODUL

TH
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LABORATORY ANATOMY
MEDICAL FACULTY
MUHAMADIYYAH UNIVERSITY OF PURWOKERTO
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2016

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 Anatomy Lab

ASMA 2013

ASMA 2014:

I. Rosmayda Ria Julianti (1413010002)

II. Mahidin (1413010006)
III. Tyas Ratna Pangestika (1413010030)
IV. Nadya Ratu Aziza Fuady (1413010031)
V. Dewandaru Istighfaris Agadinanta Bramanti (1413010044)

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AURIS
1. Auris externa
a. Pinna auricula (earlobe)
to capture the sound , consisting of
Helix
Antihelix
Tragus
Antitragus
Lobules auricularis
b. Meatus acusticus externus (ear canal)
It is a winding tube , connecting auricula and membrane tympanica
There is the hair , sebaceous glands and glands ceruminosa to prevent the entry of
foreign bends and slows the growth of bacteria
Frame outer third constituent : elastic cartilage , 2/3 in : os temporal
c. Membrana tympanica
It is the boundary between the auris externa and media
Pars
Pars flaccida (soft)
Pars tensa (hard)
Quadran
I :anterosuperior
II :anteroinferior
III :posteroinferior
IV :posterosuperior

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2. Auris media
a. Ossicula auditivus
Malleus
Facial
Caput mallei - (M

Collura mallei
Manubrium mallei
Processus anterior

Processus lateralis
Incus
- Corpus incudis
Crus langum

- Crus brevis
Stapes
Figure 10. Ossicula auiditivus
Caput stapedis

Crus anterior
Crus posterir
Basis

b. Tuba auditiva/eustachii/pharyngotympanica
Linking auris media with nasopharynx
Function :
Drainage discharge from the middle ear to mouth
Ventilation pressure setting of middle ear pads
Protection : preventing the entry of microorganisms and food
from the mouth to the ear

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3. Auris interns
Consists of several layers , generally from outside to inside terdid above:
a. Labyrinthus osseus
Consists of 3 parts
Vestibulum
Nerve fibers forming n . vestibular ( balance set )
Canalis semicircularis
Consisting of 3 canal semicircularis :
- Canalis semicircularis anterior
- Canalis semicircularis posterior
- Canalis semicircularis lateral
Cochlea
- Inside are ductus cochlearis which has serabutserabut auditory nerve ,
the nerve fibers forming n . cochlearis
N. cochlearis and n . vestibular will form Vestibulocochlearis N. ( N.
VIII )
b. Perilymphe
Fluid ads in osseous labyrinthus
c. Labyrinthus membranaceus
Consists of several parts in the osseous labyrinthus
Sacculus dan utriculus (in the vestibule)
Ductus semicurcularis (in the canal semicircularis)
Ductus cochlearis (in the cochlea)
d . Endolymphe

clinical applications
a. Balance the pressure outside and inside
b. otitis Media

Figure 11. The structure of the inner ear

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Osteology related :
Pars petrosa os temporalis
Meatus acusticus internus
Canalis auditorius externus
Cavum tympani
Anthrum mastoideum, processes mastoideus, cellulae
mastoidea

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 Nasal
On the nasal, the air is filtered, humidified and adjusted the temperature to
bodys temperature. Nasal starting from the anterior nares to the posterior nares.
a. Boundary of nasal and oral cavity are:
Palatum durum

Palatum molle

b. The structure of nasal:

1) Nares anterior / nares externa
2) Dorsum nasi
3) Vestibulum nasi
4) Cavum nasi / nasal cavity
There are three concha:

a) Concha nasalis superior

b) Concha nasalis media
c) Concha nasalis inferior
There are three meatus:

a) Meatus nasalis superior

b) Meatus nasalis media
c) Meatus nasalis inferior

Vascul ari sat i ons : P lexus Keiselbach often have bl e edi ng

5) Nares Posterior (Choana) / Nares Interna
6) Sinus Paranasal, such as:
Sinus maxillaris

Sinus frontalis

Sinus sphenoidalis

Sinus ethmoidalis

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3. Innervation
The parts
Ms. Olfactorii - > olfactory receptor cells ; above the cavity rice on the
superior nasal concha ; the mucosa olfactorius
Bulbus olfactorius
Tractus olfactorius
Travel olfactory N.
Nn . Olfactorius ( sensory / afferent ) - ) runs through the lamina cribiformis
os ethmoidalis - > bulb olfactorius - > tractus olfactorius - > synapse in the
thalamus - > cerebral cortex area olfactorius

Clinical Applications : anosmia

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Pharynx
There are three parts, there are:
a. Nasopharynx
Ostium Pharyngeum Tuba Auditiva (OFTA)
Tonsilla pharyngea

b. Oropharynx
Fauces
Tonsilla palatina
c. Laryngopharynx
Adytus laryngeus

Compiler of Waldayers Ring:

a. Tonsilla pharyngea
b. Tonsilla palatina
c. Tonsilla lingualis

Structure:
Glotis
Cartilago cricoidea
Cartilago epiglottis
Ligamentum vestibularis
L i g a men tu m v o ca l i s
Plica vestibularis
Plica vocalis

Larynx
a. Three single cartilage:
Cartilage thyroidea
There is prominentia laryngeal (jakun)
Cartilage cricoidea
Epiglottis
b. Three pairs cartilage
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 Cartilage arytenoidea
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 Cartilage cuneiforme
Cartilage corniculata
c. Plica vestibularis
d. Plica vocalis

Laryngeal function, are:

As the airway / lower respiratory tract
Protect the airway and foreign objects or food
Producing sound

Clinical Application
1. Nasal

A. Nasal Polyp
a. Definition
Nasal polyps are small bags of fluid and mucus that protrude into the nasal
cavity from the side wall of the nose. These harmless growths that come through
the sinus openings into the nose have a narrow stalk at their base, hence the term
polyp. There may be a single polyp or multiple polyps.
b. Etilogy
The basic cause is allergic rhinitis (hay fever), which is an allergic reaction of
the nose to irritating particles in the atmosphere. This causes irritation and
inflammation of the mucous membrane lining the sinuses and nasal cavity. This
results in overproduction of fluid in the cells of the membrane so that it becomes
swollen and engorged with fluid. This is referred to as oedema. These bags of
fluid can enlarge and pop out through the sinus openings into the nasal cavity.

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 c. Symptoms
The main symptom is a sense of obstruction or blockage in the affected side or
sides of the nose. The degree of blockage depends on the size of the polyp or
polyps. Other symptoms include itchiness and an impaired sense of smell.
Occasionally pain in the face and headaches can be experienced if the sinus
opening is blocked. (Metin, 2010)
B. Sinusitis
Sinusitis is an inflammation of the sinuses. It is often caused by bacterial
(germ) infection. Sometimes, viruses and fungi (molds) cause it. People with weak
immune systems are more likely to develop bacterial or fungal sinusitis. Some
people with allergies can have "allergic fungal sinusitis."
Acute sinus disease lasts three to eight weeks. Sinus disease lasting longer than
eight weeks is considered chronic.
The sinuses are air-filled cavities. They are located:

Within the bony structure of the cheeks

Behind the forehead and eyebrows

On either side of the bridge of the nose

Behind the nose directly in front of the brain

An infection of the sinus cavity close to the brain can be life threatening, if
not treated. In rare cases, it can spread to the brain. Normal sinuses are lined with a
thin layer of mucus that traps dust, germs and other particles in the air. Tiny hair-like
projections in the sinuses sweep the mucus (and whatever is trapped in it) towards
openings that lead to the back of the throat. From there, it slides down to the
stomach. This continual process is a normal body function.

Sinus disease stops the normal flow of mucus from the sinuses to the back of
the throat. The tiny hair-like "sweepers" become blocked when infections or allergies
cause tiny nasal tissues to swell. The swelling traps mucus in the sinuses.

Some people have bodily defects that contribute to sinus disease. The most
common of these defects are:

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Deformity of the bony partition between the two nasal passages
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Nasal polyps (benign nasal growths that contain mucus)

A narrowing of the sinus openings (Pete, 2015)

C. Epistaxis
Definition
Nosebleeds (also called epistaxis) are very common. They can occur at
any age but are twice as common in children. Most nosebleeds are harmless
and do not require treatment. Nosebleeds usually happen when a small blood
vessel inside the nose lining bursts and bleeds. The lining of the nose has lots
of tiny blood vessels, which warm the air as it enters the nose. This lining is
very fragile and may break easily, causing bleeding.
Etiology
A range of factors can cause a nosebleed. The common ones include:
fragile blood vessels that bleed easily, mostly in warm to hot, dry weather
an infection of the lining of the nostrils, sinuses or adenoids
colds, flu, allergy or hay fever
bumps or falls
an object pushed up the nostril
nose-picking
constipation causing straining
medications such as warfarin, aspirin, clopidogrel (also known as
blood thinners) and anti-inflammatory tablets
a bleeding or clotting disorder. This is rare. (Meton, 2010)

2. Pharynx
A. Pharyngitis
Pharyngitis is defined as an infection or irritation of the pharynx and/or tonsils.
The etiology is usually infectious, with most cases being of viral origin. These
cases are benign and self-limiting for the most part. Bacterial causes of
pharyngitis are also self-limiting, but are concerning because of suppurative and
nonsuppurative complications. Other causes include allergy, trauma, toxins, and
neoplasia. (Alcaide AL, 2006)
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B. Laryngitis

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 Laryngitis is one of the most common conditions identified in the larynx.
Laryngitis, an inflammation of the larynx, manifests in both acute and chronic
forms.Acute laryngitis has an abrupt onset and is usually self-limited. If a patient
has symptoms of laryngitis for more than 3 weeks, the condition is classified as
chronic laryngitis. The etiology of acute laryngitis includes vocal misuse,
exposure to noxious agents, or infectious agents leading to upper respiratory
tract infections. The infectious agents are most often viral but sometimes
bacterial. (Bhattacharyya,2015)

C. Nasopharyngeal carcinoma
Nasopharyngeal carcinoma is a rare tumor arising from the epithelium of the
nasopharynx. It accounts for approximately 1% of all childhood malignancies.
Whereas almost all adult nasopharyngeal cancers are carcinomas, only 35-50%
of nasopharyngeal malignancies are carcinomas in children. In the pediatric
population, additional nasopharyngeal malignancies include
rhabdomyosarcomas or lymphomas.
The detection of the Epstein-Barr virus (EBV) nuclear antigen and viral DNA
in nasopharyngeal carcinoma has revealed that EBV can infect epithelial cells
and is associated with their malignant transformation. Copies of the EBV
genome have been found in cells of preinvasive lesions, suggesting that it is
directly related to the process of transformation. (Arnold, 2013)
3. Auris
A. Otitis Externa
Otitis externa (OE) is an inflammation or infection of the external auditory
canal (EAC), the auricle, or both. This condition can be found in all age groups.
Classification

OE may be classified as follows:

Acute diffuse OE - Most common form of OE, typically seen in swimmers

Acute localized OE (furunculosis) - Associated with infection of a hair

follicle

Chronic OE - Same as acute diffuse OE but is of longer duration (>6

weeks)

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 Eczematous (eczematoid) OE - Encompasses various dermatologic

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 conditions (eg, atopic dermatitis, psoriasis, systemic lupus erythematosus,
and eczema) that may infect the EAC and cause OE

Necrotizing (malignant) OE - Infection that extends into the deeper tissues

adjacent to the EAC; occurs primarily in immunocompromised adults (eg,
diabetics, patients with AIDS)

Otomycosis - Infection of the ear canal from a fungal species (eg, Candida,

Aspergillus)
Signs and symptoms
The key physical finding of OE is pain upon palpation of the tragus
(anterior to ear canal) or application of traction to the pinna (the hallmark of
OE). Patients may also have the following signs and symptoms:
Otalgia - Ranges from mild to severe, typically progressing over 1-2 days

Hearing loss

Ear fullness or pressure

Erythema, edema, and narrowing of the EAC

Tinnitus

Fever (occasionally)

Itching (especially in fungal OE or chronic OE)

Severe deep pain - Immunocompromised patients may have necrotizing

(malignant) OE

Discharge - Initially, clear; quickly becomes purulent and foul-smelling

Cellulitis of the face or neck or lymphadenopathy of the ipsilateral neck

(occasionally)

Bilateral symptoms (rare)

History of exposure to or activities in water (frequently) (eg, swimming,

surfing, kayaking)

History of preceding ear trauma (usually) (eg, forceful ear cleaning, use of
cotton swabs, or water in the ear canal) (osenfeld RM, 2006)

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B. Otitis Media
Otitis media (OM) is any inflammation of the middle ear, without reference to
etiology or pathogenesis. It is very common in children. Etiology of otitis media is
a multitude of host, infectious, allergic, and environmental factors contribute to the
development of OM.

There are several subtypes of OM, as follows:

Acute OM (AOM)
OM with effusion (OME)
Chronic suppurative OM
Adhesive OM
Signs and symptoms
AOM implies rapid onset of disease associated with one or more of the following
symptoms:
Otalgia
Otorrhea
Headache
Fever
Irritability
Loss of appetite
Vomiting
Diarrhea
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C. Vertigo
Vertigo is a sensation of spinning. If you have these dizzy spells, you might
feel like you are spinning or that the world around you is spinning.
Causes of Vertigo
Vertigo is often caused by an inner ear problem. Some of the most common
causes include:
BPPV. These initials stand for benign paroxysmal positional vertigo. BPPV occurs
when tiny calcium particles (canaliths) clump up in canals of the inner ear. The inner
ear sends signals to the brain about head and body movements relative to gravity. It
helps you keep your balance. BPPV can occur for no known reason and may be
associated with age.
Meniere's disease. This is an inner ear disorder thought to be caused by a buildup of
fluid and changing pressure in the ear. It can cause episodes of vertigo along with
ringing in the ears (tinnitus) and hearing loss.
Vestibular neuritis or labyrinthitis. This is an inner ear problem usually related to
infection (usually viral). The infection causes inflammation in the inner ear around
nerves that are important for helping the body sense balance

D. Congenital Abnormalities
a. Fistula preauricular
Preauricular cysts, pits (as shown below), fissures, and sinuses are benign
congenital malformations of the preauricular soft tissues first described by Van
Heusinger in 1864. Preauricular pits or fissures are located near the front of the
ear and mark the entrance to a sinus tract that may travel under the skin near the
ear cartilage. These tracts are lined with squamous epithelium and may
sequester to produce epithelial-lined subcutaneous cysts or may become
infected, leading to cellulitis or abscess.

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b. Microtia
Microtia is a congenital malformation of variable severity of the external and
middle ear. The microtic auricle consists of a disorganized remnant of cartilage
attached to a variable amount of soft tissue lobule, which often is displaced
from a position symmetrical with the opposite normal ear. The direction of
displacement depends on the degree of associated facial hypoplasia. Depending
on the severity of the anomaly, there may be evidence of external meatus
formation. Microtia commonly involves the external canal and middle ear;
hence, hearing can be affected. Microtia may present within a spectrum of
branchial arch defects (hemifacial microsomia, craniofacial microsomia) or
may manifest as an independent malformation.

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 c. Anotia
Anotia occurs when there is a complete absence of the auricle (external ear,
also called the pinna) and auditory canal. Anotia occur when the tissues that
form the auricle fail to develop during the first few weeks of pregnancy.
Currently, the exact cause of anotia have not been identified. Certain
medications may increase the risk of anotia when taken by the mother during
pregnancy.

E. Mastoiditis
A purist's definition of mastoiditis includes all inflammatory processes of the
mastoid air cells of the temporal bone. As the mastoid is contiguous to and an
extension of the middle ear cleft, virtually every child or adult with acute otitis
media or chronic middle ear inflammatory disease has mastoiditis. In most cases,
the symptomatology of the middle ear predominates (eg, fever, pain, conductive
hearing loss), and the disease within the mastoid is not considered a separate
entity.

F. Labyrinthitis
Labyrinthitis is an inflammatory disorder of the inner ear, or labyrinth.
Clinically, this condition produces disturbances of balance and hearing to varying
degrees and may affect one or both ears. Bacteria or viruses can cause acute
inflammation of the labyrinth in conjunction with either local or systemic
infections. Autoimmune processes may also cause labyrinthitis. Vascular ischemia
may result in acute labyrinthine dysfunction that mimics labyrinthitis. (See
Etiology and Presentation.

G. Cerumen Impaction (Cerumen prop)

Cerumen (i.e., earwax) is composed of secretions and sloughed epithelial cells
and hair from the external auditory canal. It protects the skin in the canal and is
naturally extruded. However, cerumen may accumulate and occlude the canal of
one or both ears, causing discomfort, hearing loss, tinnitus, dizziness, and chronic
cough. It also can contribute to otitis externa. Because the external auditory canal

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is innervated by the auricular branch of the vagus nerve, coughing or even cardiac

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 depression can accompany stimulation of the canal from cerumen impaction or
removal attempts.
Cerumen impaction is diagnosed by direct visualization with an otoscope.
Foreign bodies and a swollen canal from otitis externa can impair tympanic
membrane visualization and should be ruled out before attempting cerumen
removal. Impaction is a common cause of hearing impairment in older patients and
in patients with mental retardation; therefore, it is reasonable to evaluate for
cerumen impaction in patients with hearing problems.
Cerumen removal may be attempted by irrigation of the external auditory
canal, with or without the use of ceruminolytics; by ceruminolytics alone; or by
manual removal using a curette, forceps, or suction.

H. Tympanic Membrane Disorder

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 DAFTAR PUSTAKA

Alcaide AL, Bisno AL. 2006.Pharyngitis and epiglottitis Infect Dis Clin North
Am. 21:449-469.
Arnold C Paulino, MD; Chief Editor: Robert J Arceci, MD, PhD
Bhattacharyya N. 2015.The prevalence of pediatric voice and swallowing
problems in the United States.Laryngoscope. Mar. 125 (3):746-50.

Metin Onerci T, Berrylin J. 2010. Nasal Polyposis (Pathogenesis, medical

and surgical treatment).Springer Science & Business Media

Osenfeld RM, Brown L, Cannon CR, Dolor RJ, Ganiats TG, Hannley M, et al.
2006.Clinical practice guideline: acute otitis externa. Otolaryngol Head
Neck Surg. Apr. 134(4 Suppl):S4-23.

Pete S. Batra. Joseph K Han. 2015. Practical Medical and Surgical Management
of Chronic Rhinosinusitis. Springer

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