Fossil  endocast  of a  Tyrannosaurus  cranial vault, showing extensive olfactory bulb (structure to the left). Tyrannosaur dinosaurs, as well as carnivorous animals in general, have highly developed olfactory bulbs to seek out prey.


Neuroglia of the brain shown by  Golgi's method


Embryonic development in the central nervous system


Plan of olfactory neurons


A schematic drawing of the components of the embryonic olfactory epithelium. ORN =  olfactory receptor neuron , OEC =  olfactory ensheathing cell


Embryonic morphogen signaling on olfactory placode and neural crest cells contributes to formation of neurogenic and non-neurogenic tissue of the olfactory epithelium.


Olfactory sensory neurons (OSNs) express odorant receptors. The axons of OSNs expressing the same odorant receptors converge onto the same glomerulus at the olfactory bulb, allowing for the organization of olfactory information.


Desensitization of olfactory neuron


Structure of Venlafaxine


Piriform cortex from a 14-day-old D2-eGFP (green) mouse stained for  enkephalin  (red) and DAPI (blue) to show nuclei.  Epifluorescence .


Micrograph  highlighting the sustentacular cells in a  paraganglioma .  S100   immunostain


Sample of the UPSIT (German edition).


Placement of Jacobson's organ in a snake


Sagittal section of the vomeronasal organ of garter snake


Stallion  exhibiting the  flehmen response


Chewy candy


Crunchy foods


Location of structures connected to the gustatory nucleus


Basic neuroanatomy of the gustatory system.


Different taste receptors in the tongue and their connections to afferent neurons.


Three of the twelve cranial nerves send input to the Gustatory nucleus: the  facial nerve  (VII), the  glossopharyngeal nerve  (IX), and the  vagus nerve  (X).


Filiform papilla, magnified.


Fungiform papillae, magnified and sectional diagram.


Magnified diagram of a vertical section through some foliate papillae in a rabbit.


Circumvallate papilla in vertical section, showing arrangement of the taste-buds and nerves


Advertisement of  castor oil  as a medicine by Scott & Bowne company, 19th century


Microorganisms reside in saliva


Salivary glands : 1. parotid , 2. submandibular , 3. sublingual .


Pepper stand at  Central Market  in  Houston ,  Texas , showing its peppers ranked on the Scoville scale


The  ghost pepper  of  Northeast India  is considered to be a "very hot" pepper, at about 1 million SHU. [ 1 ]


The  Naga Morich , with around 1 million SHU, [ 2 ]  is primarily grown in India and Bangladesh.


The  Red Savina pepper , a hot chili [ 11 ]


The capsaicin " pharmacophore ", the portion of the molecule that produces biological effects


The underside of a human tongue, showing its rich blood supply.


Foramen cecum and terminal sulcus labelled above


Features of the tongue surface


Lateral view of the tongue, with extrinsic muscles highlighted


Coronal section of tongue, showing intrinsic muscles


Blood supply of the tongue


Section through the human tongue; stained  H&E


Floor of pharynx at about 26 days showing lateral swellings at first pharyngeal arch (mandibular arch).


Giraffe's tongue


Extended proboscis of a long tongued  Macroglossum   moth


Vagus nerve


H&E stained  fibers of the vagus nerve (bottom right) innervate the  sinoatrial node  tissue (middle left)


The middle ear


The outer ear receives sound, transmitted through the  ossicles  of the middle ear to the  inner ear , where it is converted to a nervous signal in the  cochlear  and transmitted along the  vestibulocochlear nerve .


The  otic placode  on a developing embryo (about four weeks old)


The ear develops in the lower neck region and moves upwards as the  mandible  develops (six weeks).


Stretching of the earlobe and various cartilage piercings


Primate  ears Human and  crab-eating macaque ( Darwin's tubercle  highlighted)


Pinnae of  bats


Half-Lop Rabbit Illustration by Charles Darwin, 1868


posterior segment ora serrata ciliary muscle ciliary zonules Schlemm's canal pupil anterior chamber cornea iris lens cortex lens nucleus ciliary process conjunctiva inferior oblique muscle inferior rectus muscle medial rectus muscle retinal arteries and veins optic disc dura mater central retinal artery central retinal vein optic nerve vorticose vein bulbar sheath macula fovea sclera choroid superior rectus muscle retina


Diagram of a human eye; note that not all eyes have the same anatomy as a human eye.


Eyelids and eyelashes are a unique feature of mammalian eyes, and primarily serve to protect the eyes. However, the lids also play a role in nonverbal communication, and the lashes in human culture and sexuality.


Light from a single point of a distant object and light from a single point of a near object being brought to a focus on the retina


A circular tympanum near the eye of a male North  American bullfrog .


Anatomy of the human ear (The length of the auditory canal is exaggerated in this image.).    Brown is  outer ear .      Red is  middle ear .      Purple is  inner ear .


Auditory ossicles from a deep dissection of the tympanic cavity


The  organ of Corti  located at the  scala media


Lateral lemniscus  in red, as it connects the  cochlear nucleus ,  superior olivary nucleus  and the  inferior colliculus , seen from behind


Dual stream connectivity between the auditory cortex and frontal lobe of monkeys and humans.  Top: The auditory cortex of the monkey (left) and human (right) is schematically depicted on the supratemporal plane and observed from above (with the parieto- frontal operculi removed). Bottom: The brain of the monkey (left) and human (right) is schematically depicted and displayed from the side. Orange frames mark the region of the auditory cortex, which is displayed in the top sub-figures. Top and Bottom: Blue colors mark regions affiliated with the ADS, and red colors mark regions affiliated with the AVS (dark red and blue regions mark the primary auditory fields). Abbreviations: AMYG-amygdala, HG-Heschl's gyrus, FEF-frontal eye field, IFG-inferior frontal gyrus, INS-insula, IPS-intra parietal sulcus, MTG-middle temporal gyrus, PC-pitch center, PMd-dorsal premotor cortex, PP-planum polare, PT-planum temporale, TP-temporal pole, Spt-sylvian parietal-temporal, pSTG/mSTG/aSTG-posterior/middle/anterior superior temporal gyrus, CL/ ML/AL/RTL-caudo-/middle-/antero-/rostrotemporal-lateral belt area, CPB/RPB-caudal/rostral parabelt fields. Used with permission from Poliva O. From where to what: a neuroanatomically based evolutionary model of the emergence of speech in humans.   Material was copied from this source, which is available under a  Creative Commons Attribution 4.0 International License .


Examples of the onset and recovery of the acoustic reflex measured with a  laser Doppler velocimetry  system.


Anatomy of the human ear. (The length of the auditory canal is exaggerated in this image.)    Brown is  outer ear .      Red is  middle ear .      Purple is  inner ear .


Audiological exam


Coronal section  of a human brain. BA41(red) and BA42(green) are auditory cortex. BA22(yellow) is  Brodmann area 22 , HF(blue) is  hippocampal formation  and pSTG is posterior part of  superior temporal gyrus .


Lateral view of the human  cerebrum  showing the location of auditosensory cortex.


Section of brain showing the position of the human temporal lobe. The brain functional areas are highlighted above, with the auditory area in green.


Cytoarchitectonics of Brodmann 41 (Auditosensory cortex)


The  fennec fox  uses its distinctive oversized pinnae to radiate excess heat and to amplify the sound of small prey burrowing under the desert sand.


To an impala, the pinna is useful in collecting sound.


Image of a Vintage Acousticon Hearing Aid By Dictograph Products Company, Made in the US, Circa 1934.


A bone conduction  headset  ( GoldenDance  brand)


Calyx of Held microstructure


An astrocytic cell from rat brain grown in tissue culture and stained with antibodies to  GFAP  (red) and  vimentin  (green). Both proteins are present in large amounts in the  intermediate filaments  of this cell, so the cell appears yellow. The blue material shows DNA visualized with  DAPI  stain, and reveals the nuclei of the astrocyte and other cells.


Potassium Channel - 2r9r opm


Noradrenaline


Serotonin


GABA


Glutamic acid


Adenosine


(A)  Presynaptic Neuron.  (B)  Postsynaptic Neuron.  (1)  Mitochondria.   (2)  Synaptic vesicle full of neurotransmitter.  (3)  Autoreceptor.  (4)  Synaptic Cleft.  (5)  Neurotransmitter Receptor.  (6)  Calcium Channel.  (7)  Fused vesicle releasing neurotransmitter.  (8)  Neurotransmitter re-uptake pump


The AMPA receptor bound to a glutamate antagonist showing the amino terminal, ligand binding, and transmembrane domain, PDB 3KG2


3D model of cochlea and semicircular canals


Structural diagram of the cochlea showing how fluid pushed in at the oval window moves, deflects the cochlear partition, and bulges back out at the round window.


1994 body-worn Cochlear Spectra processor. Early cochlear implant users utilized body-worn processors like this one


Cochlear implant recipient utilizing a behind-the-ear processor


Robin Michelson - Early creator of the Cochlear Implant


Internal components of a conventional device (not yet implanted)


Columella (highlighted) in the skull of the extinct therapsid  Dicynodon .


Depiction of the evolution of the ossicles of the ear. Columella (Co) and extra-columella (E) evolve into the stapes and extra-stapes in embryonic mammals (7). [ 4 ]


Mounted skull of a python with disarticulated upper and lower jaw joints. In snakes, the columella would be attached directly to the quadrate bone (c).


In the mammalian cochlea, each outer hair cell stands on the  soma  of a cell of Deiters.  What is not apparent in this diagram is that the phalangeal process is tilted out of the plane of this projection, such that its top is near the top of a different outer hair cell, further along in the directional of cochlear wave propagation.


Cross section of the cochlea


A typical mammalian middle ear: sound makes the tympanum (eardrum) vibrate; 3 small bones, the malleus, incus and stapes, transmit the vibrations to the labyrinth (inner ear), which transforms the vibrations into nerve signals.


Upper and lower portions of a python skull, displaying multiple bony components of the upper and lower jaws. Courtesy of the Peabody Museum of Natural History; Division of Vertebrate Zoology; Yale University.


Mammalian and non-mammalian jaws. In the mammal configuration, the  quadrate  and  articular  bones are much smaller and form part of the middle ear. Note that in mammals the lower jaw consists of only the  dentary  bone. [ 24 ]


Morganucodontidae  and other transitional forms had both types of jaw joint:  dentary - squamosal  (front) and  articular - quadrate  (rear).


The  barn owl ,  Tyto alba , has a prominent heart-shaped facial disc that aids it during hunting.


A gammatone impulse response


Section through the  organ of Corti , showing inner and outer hair cells


Schematic diagram of the human ear [ clarification needed ]


The middle ear uses three tiny bones, the malleus, the incus, and the stapes, to convey vibrations from the eardrum to the inner ear.


The inner ear is a small but very complex organ.


The  lateral lemnisci  (red) connects lower brainstem auditory nuclei to the  inferior colliculus  in the midbrain.


A cat can hear high-frequency sounds up to two octaves higher than a human.


Inner ear


The  cochlea  and  vestibule , viewed from above.


A cross-section of the  cochlea  showing the  organ of Corti .


Cross-section through the spiral organ of Corti at greater magnification.


The middle ear matches mechanical impedance, like a lever.


Retracted eardrum


Graph of a simple  sine wave


Flowchart of sound passage - outer ear


Flowchart of sound passage - middle ear


Flowchart of sound passage - inner ear


Levels of transmission of neural auditory signals


The mammalian olivocochlear bundle, divided into medial (red) and lateral (green) systems. Both contain crossed and uncrossed fibres. The predominant fibres are represented by a thicker line. The insert (far left) shows the position of the cell bodies of the MOCS and LOCS relative to the MSOC and LSOC respectively, as observed in mammals.


The basic MOC acoustic reflex. The auditory nerve responds to sound, sending a signal to the cochlear nucleus. Afferent nerve fibres cross the midline from the cochlear nucleus to the cell bodies of the MOCS (located near the MSOC), whose efferent fibres project back to the cochlea (red). In most mammals, the majority of the reflex is ipsilateral (shown as a thicker line), effectuated by the crossed MOCS.


Attentional filter depths from 12 subjects who underwent a vestibular neurectomy, for the same ear (triangles) or different ears (crosses). Combined mean (----) and 95% confidence intervals are shown. An average ~15% decline in attentional filter depth can be seen following olivocochlear bundle (OCB) lesion. Data taken from Scharf et al. (1997). [ 26 ]


Cross-section through the spiral organ of Corti at greater magnification, showing position of the hair cells on the basement membrane.


Image showing the  outer ear ,  middle ear , and  inner ear , and how sound is conducted through the outer ear, to the  ossicles  of the middle ear, through to the inner ear and the cochlea, where the organ of Corti sits.


Anatomy of the three ossicles


A 40-watt CO 2  laser used in otorhinolaryngology


Royal National Throat, Nose and Ear Hospital  founded in 1874, in  London


Morphology and terminology of  lanternfish  ( Diaphus , left side) and  neoscopelid  otoliths ( Neoscopelus , right side)  [ 9 ]


A pair of sagittae from a  Pacific Cod  ( Gadus macrocephalus )


Removing an otolith from a  red snapper  to determine its age


The size of the  stapes , compared with a 10-cent  euro  coin.


The  stapes , as first described by  Giovanni Filippo Ingrassia   (Labeled M, bottom right) .


Stereocilia of frog inner ear.


Section through the spiral organ of Corti, magnified. The stereocilia are the "hairs" sticking out of the tops of the inner and outer  hair cells .


Volley Theory of Hearing demonstrated by four neurons firing at a phase-locked frequency to the sound stimulus. The total response corresponds with the stimulus.


Harmonic waveform of a fundamental frequency L/2


Anatomy of Human Ear with Cochlear Frequency Mapping


Organ pipes were often used in early hearing experiments.


A hair cell from a frog sacculus.


Illustration of full spectrum and missing fundamental waveforms


Wartenberg wheel  pain stimulation of the areola and nipple


A bottle of  acetaminophen


Diagram of the divisions of the trigeminal nerve, the nerve which supplies sensation to the face.


Dermatomes of the head (paired on either side). Green- ophthalmic division, red- maxillary division, yellow- mandibular division.


The  trigeminal nerve .


Simplified automated pain recognition process.


Lumbar disc herniation


Back pain can be caused by the vertebrae compressing the intervertebral discs.


Diagnostic work-up for acute back pain [ 34 ]


CT scan of the spine, showing calcification of the longitudinal posterior ligament


Schematic presentation of the classification of unilateral and bilateral LSTV according to the proposed Jenkins classification


Chemotherapy drugs


Cross-section of the spinal cord showing the  dorsal column  and the anterolateral  spinothalamic tracts


Cross section of the spinal cord showing the subarachnoid cavity, dura mater and spinal nerve roots including the dorsal root  ganglion


Rattan  cane


A caning sentence being carried out in  Banda Aceh , Indonesia, in 2014


A display of rattan judicial canes from the  Johor Bahru Prison  museum, Malaysia


Caning stand and cane formerly used in Hong Kong prisons under British rule


Visible welts typically sustained from  foot caning


Cartoon of schoolboys receiving the cane from 1888


A picture showing the marks left on a female student's palm after being caned


Fig. 1: A human vertebra showing body and pedicle


Fig. 2: Cross-section of the human head showing the nasopharynx


Fig. 3 The  pancreas : 1. pancreatic head; 4. pancreatic body; 11. pancreatic tail


Fig. 5: Cross section of the spinal cord showing the subarachnoid cavity, dura mater and spinal nerve roots including the dorsal root  ganglion


Fig. 4: Chemotherapy drugs


A woman clutching her chest, a common sign of a  heart attack


A blockage of coronary arteries can lead to a heart attack


Gastroesophageal reflux disease is a common cause of chest pain in adults


Brugada syndrome


Fractured ribs marked


pneumothorax


Percentages of the causes of chest pain in children and adolescents [ 11 ]


Sagittal view of coccyx in standing and sitting position


Coccyx cushion with a cutout


Donut cushion


Severe CRPS of right arm


CRPS visible on hands and wrists


An abscess originating from a tooth which has spread to involve the  buccal space . Above, deformation of the cheek on the second day. Below, deformation on the third day.


Separator found between posterior teeth


Cross section of a tooth. Non-dentin layer is covered by enamel or cementum and gingiva.


An  odontoblast  cell showing odontoblast process (not in proportion – in reality this process is far longer than the body of the cell).


Pain due to a long penis or a small vagina


Chemical Structure of Endorphin


Physical activity and exercise release the most endorphins.


Cocoa powder  helps most among the edible substances to produce endorphins in human body.


World Eskimo Indian Olympics  (2008): A traditional Inuit sport in which the ears are used to pull until one submits.


Prisoners at a whipping post in a  Delaware  prison, circa 1907


Painting of the flagellation of  Jesus  which illustrates the pain the punishment causes.


Punishment with a  knout  (Russia, 18th century)


Public flogging of a slave in  Brazil  – work of German painter  Johann Moritz Rugendas  (1802–1858)


An African-American slave named  Gordon , photo taken at  Baton Rouge, Louisiana , 1863; the scars are clearly visible because of  keloid  formation


1847 disciplinary report re flogging, on the USS  John Adams . The United States Congress banned flogging on all U.S. ships on 28 September 1850


HMS  VICTORY  LOG, OCT 19, 1805,36 lashes each


British sailor, tied to the grating, being flogged with  cat o' nine tails


Fremantle Prison  whipping post


Self-flagellation is ritually performed in the  Philippines  during Holy Week (on  Good Friday , before Easter)


Flagellants , woodcut,  c.  15th century


Flogging demonstration at the 2004  Folsom Street Fair  in San Francisco


In the top panel, the nonnociceptive, large-diameter sensory fiber (orange) is more active than the nociceptive small-diameter fiber (blue), therefore the net input to the inhibitory interneuron (red) is net positive. The inhibitory interneuron provides presynaptic inhibition to both the nociceptive and nonnociceptive neurons, reducing the excitation of the transmission cells. In the bottom panel, an open "gate" (free-flowing information from afferents to the transmission cells) is pictured. This occurs when there is more activity in the nociceptive small-diameter fibers (blue) than the nonnociceptive large-diameter fibers (orange). In this situation, the inhibitory interneuron is silenced, which relieves inhibition of the transmission cells. This "open gate" allows for transmission cells to be excited, and thus pain to be sensed.


The firing of the projection neuron determines pain. The inhibitory interneuron decreases the chances that the projection neuron will fire.  Firing of C fibers inhibits the inhibitory interneuron (indirectly), increasing the chances that the projection neuron will fire. [ 4 ]  Inhibition is represented in blue, and excitation in yellow.  A lightning bolt signifies increased neuron activation, while a crossed-out bolt signifies weakened or reduced activation.


Firing of the  Aβ  fibers activates the inhibitory interneuron, reducing the chances that the projection neuron will fire, even in the presence of a firing nociceptive fiber. [ 4 ]


Patchy depapillation of filiform papillae with prominence of the fungiform papillae.


Median rhomboid glossitis


Geographic tongue (benign migratory glossitis)


Distinct strawberry tongue with "parched" lips as seen in a young child with  Kawasaki disease .


A drawing by  Konrad Lorenz  showing facial expressions of a dog


Closeup of the face of an agouti Russian blue rat


Figure 3B. AP radiograph (e), coronal T1 (f), and PD fat sat (g) weighted images showing loss of fat signal of the epiphysis, edema, and cyst formation in femoral metaphysis in a grade C Perthes disease. [ 1 ]


X-ray of the hips of a 40-year-old female, with dysplasia of her right hip.


The Pillory, from  The Costume of Great Britain  (1805)


Non-trinitarian   Cathars  wearing  loincloths  being burnt at the stake in an  auto-da-fé  ( c.  1495 , with  garrote  and  phallus ), presided over by  Saint Dominic , oil on panel by  Pedro Berruguete .


Paris 1944: Women accused of  collaboration with Nazis  are paraded through the streets barefoot, shaved, and with  swastika  burn marks on their faces.


The Humiliation of  Emperor Valerian  by  Shapur , King of Persia  by  Hans Holbein the Younger


Dental erosion  and loss of  enamel  increase the patency of dentinal tubules


Portrait of Dr. Alfred Gysi taken in 1914, University of Zurich


SEM image of dentine with exposed dentinal tubules (Daood et al. 2018; Electron Microscope Unit, Queen Mary Hospital, The University of Hong Kong)


Consumption of acidic drinks e.g. vinegar, causes dental erosion, thus chemical stimulation


A herniated disc as seen on MRI, one possible cause of low back pain


Harvey Williams Cushing, 1920s


Gate control theory of pain


Microglia (identified by alpha-coronin1a), and neurons in culture. Microglia are proposed to release molecules that alter the excitability of neurons.


The cross-section of the breast. The blockage of milk ducts (Lactiferous ducts), labelled by 6, causes nipple pain. [ 1 ] [ 3 ] [ 4 ]


A symptom of poor positioning is nipple blanching due to reduced blood flow. [ 3 ] [ 4 ]


A child with tongue-tie indicated by an unusually short lingual frenulum which connects the bottom of the tongue to the floor of the mouth.


A photo of lanolin ointment. It is made up of hydrophilic polymers that can increase epithelial regrowth. [ 6 ]


A photo of  Calendula officinalis  (marigold). It consists of saponins, flavonoids and terpenoid which show anti-inflammatory and healing properties to nipple fissure. [ 6 ]


A photo of  Aloe vera . It shows a significant anti-inflammatory effect on nipple fissure. [ 24 ]


A nipple shield placed on the nipple to prevent bacterial invasion. [ 6 ] [ 21 ]


A photo of a silver cap. A silver cap blocks bacterial invasion and prevents nipple pain caused by bacterial infections. [ 25 ]


Defined boundaries of the orofacial pain region


fMRI images of brain regions involved in pain processing. Borsook D, Moulton EA, Schmidt KF, Becerra LR.


Example pain assessment chart based on the  Wong–Baker Faces Pain Rating Scale


A physical therapist uses play as part of a child's treatment plan.


A Chinese pain scale diagram, rating pain on a scale of 1 to 10


Bust of Aristotle


Portrait of René Descartes


Descartes' pain pathway: "Particles of heat" (A) activate a spot of skin (B) attached by a fine thread (cc) to a valve in the brain (de) where this activity opens the valve, allowing the  animal spirits  to flow from a  cavity  (F) into the muscles causing them to flinch from the stimulus, turn the head and eyes toward the affected body part, and move the hand and turn the body protectively. [ 7 ]


Sun Dance of the Shoshone Indians


Visual representation of body parts within the somatosensory cortex


Schematic representation of the ascending pain pathways within the spinal cord


Ramachandran (right) with his original mirror box


Lower limb amputee using mirror box therapy to address phantom pain


Deep brain stimulation for the management of phantom pain


Pregnancy timeline.


A display of hot peppers and the  Scoville scale  at a supermarket in  Houston ,  Texas


A display of spices in  Guadeloupe : some pungent, some not


Progressive neuropathy can lead to irreversible damage, early identification of asymptomatic neuropathy may prevent loss of limb.


The NeuroPace RNS System used in the treatment of  epileptic seizures


A spinal cord stimulator implanted into the  thoracic spine


Return to the Convent , by  Eduardo Zamacois y Zabala , 1868. The painting depicts a group of  monks  laughing while a lone monk struggles with a  donkey .


Sciatica often results in pain radiating down the leg.


Left: Illustration of herniated spinal disc, superior view. Right: MRI showing herniated L5-S1 disc (red arrow tip), sagittal view.


Illustration of fibrovascular bands restricting mobility of the sciatic nerve in multiple directions, like a splattering of glue


Straight leg  test sometimes used to help diagnose a lumbar herniated disc


Location of the sesamoid bones, behind the fetlock.


Tragic mask on the façade of the Royal Dramatic Theatre in Stockholm, Sweden


Landscape with the Fall of Icarus by  Pieter Bruegel the Elder


Neuroimaging sheds light on the seat of suffering


Diagram illustrating tendonitis and tendon rupture


Natural history  of dental caries and resultant toothache and odontogenic infection.


Apical abscess associated with roots of a lower molar.


An  open contact  of approximately 1.5 mm shown between two posterior teeth.  The meat, at right, was recovered from the open contact more than 8 hours after the person had last eaten meat, even though they had brushed the teeth twice since.


Lateral periodontal abscess (blue arrows) due to a fracture (green arrows)


Mild presentation of ANUG on the gums of the lower front teeth


Crown-root fracture with pulp involvement (left). Extracted (right).


Discomfort caused by coronary artery disease can radiate to the neck, lower jaw and teeth


Root canal treatment (blue arrows) carried out on the lower right first molar with temporary restoration in place


Incision of an abscess above a front tooth and insertion of a  surgical drain


Odontogenic infection involving the  buccal space . Above, deformation of the cheek on the second day. Below, deformation on the third day.


Saint Apollonia , patron saint for toothaches, holds one of her own extracted teeth in a pair of forceps ( Nuremberg Chronicle ,  Hartmann Schedel , 1493)


American advertisement from 1885 offering "instantaneous cure" for toothache with "Cocaine toothache drops". [ 53 ]   Cocaine  was the first  local anesthetic , but its addictive and other dangerous side effects eventually led to its use being virtually abandoned by modern health care.


A monk with a toothache examines himself in a mirror, painting by  Carl Bloch  from 1875. [ 54 ]


"toothache tree", Vaishya Dev shrine,  Kathmandu ,  Nepal .


Trigeminal neuralgia


Edvard Munch 's  The Scream  has been used as a symbol of facial pain generally, [ 48 ]  and also specifically of trigeminal neuralgia. [ 49 ]


An illustration of wrist pain


Venn Diagram for Drug Intolerance


Central line with latex cap


Women are far more likely to have MCS. [ 4 ]


The wind farm in Lomont is at the limit of high Doubs specifically on the chain of Lomont through the Franche-Comte region from East to West


1994 body-worn Cochlear Spectra processor. Early cochlear implant users utilized body-worn processors like this one


Cochlear implant recipient utilizing a behind-the-ear processor


Robin Michelson - Early creator of the Cochlear Implant


Internal components of a conventional device (not yet implanted)


IWGEES Founding Board members paying tribute to Dr Tarabichi. [ 1 ]  Left to right: Stephane Ayache, Dave Potheir, Seiji Kakehata, Daniele Marchioni, Joao Noqueira (top right), and Livio Presutti.


Number of publications categorized by the pattern of utilization of the endoscope in ear surgery per the last four decades


Comparison between the field of view in endoscopic versus microscopic ear surgery


Sinus tympani: An area of the tympanic cavity that is hidden from microscope


Using 30 degrees endoscope to look into the bony Eustachian tube on a right ear. * indicates opening of the cartilaginous tube. ca: carotid artery. ttm: Tensor Tympani Muscle. prs: Protympanic spine. sbtr: Subtubal Recess.


"De Sanitate tuenda", Galen, 1517 Wellcome L0003071


The Surgeon , engraving by Lucas van Leyden, 1524, depicting a barber surgeon making an incision


Hermann Schwartze


Retracted eardrum


The German polymath Johann Friedrich Dieffenbach was a pioneer in the fields of plastic surgery. ( c.  1840 )


The auricle is an anatomic structure composed of a cartilage support framework covered with thin, hairless skin.


Prominent ears: the bat-wing type, which extend outwards and to the front, can be corrected with an otopexy procedure.


The angles of the ear  determine the surgical anatomy of the auricle, as considered for otoplasty correction.


Auricular prominence: in the occipital area, behind the auricle, a protruding mastoid process is a proximate cause of bat ears.


The soft tissues of the ear: the anatomic location of the posterior muscle of the ear (auricularis posterior) in relation to the auricle.


Otoplasty: The cranial surface cartilage of the right ear; the ponticulus (center right) and the cauda helicis (right) also can be proximate causes of prominent ears.


The soft tissues of the right ear: the three muscles that serve the auricle (external ear) the auricularis posterior (left), the auricularis superior (above), and the auricularis anterior (right) as considered for otoplasty correction.


Ear showing Darwin's tubercle, an evolutionary human-ear vestige in a woman, and the like morphologic feature in a macaque monkey.


Grade III microtia affecting the left ear of a boy.


Non-surgical otoplasty: the therapeutic aspects, before (left), during (center), and after (right), of a tissue-molding procedure performed with an EarWell device.


Method of obtaining Schuller's view


Endoscopic view of the stapedotomy in the footplate of the stapes bone


Endoscopic view of the piston inserted into the stapedotomy and on to the long processof the incus


Tympanostomy tubes of varying size and shape. Examples of short-term use grommet (left) and long-term use T-shape (right).


Tympanostomy tube in the eardrum, draining fluid from the middle ear during an ear infection.


Alekna (standing second from right) at the Lithuanian conference in Stockholm


Flag of East Timor


The 1944 aerial photo of Treblinka II after 'closing'. The photograph is overlaid with already dismantled structures including German 'armoury' in the lower-left from the unloading platform (centre, marked with an arrow)


Jorge Drexler performing with Tiê at the 2011  Rock in Rio  Festival in  Rio de Janeiro , Brazil.


Antoni Jurasz (1847–1923)


Member of the House of Representatives Roelof Kruisinga and Parliamentary leader  Dries van Agt  during a meeting in  The Hague  on 7 October 1977.


Prof. Kubo (front row, 7th from the left) and his department in 1920


Kubo Museum


Kubo Museum: doorplate in German


Mary D. Lekas was a surgeon aboard the  S. S. Hope  for ten months in 1968, while it was stationed in Ceylon.


Jordan


Wilhelm Meyer


Tomb of Wilhelm Meyer at  San Michele Cemetery, Venice


Desiderio Passali


Ádám Politzer


Politzer balloon with olive [ 1 ]


Prof Jacob Sadé


Schnitzler's birthplace Praterstrasse 16


Schnitzler in 1878


Schnitzler in 1906


Schnitzler in 1926


Memorial in Vienna


Johann Schnitzler,  c.  1875


Polonia Restituta Commander Cross


Polonia Restituta Knight Cross


Karl Stoerk.


Prof. dr. Paul Van Cauwenberghe


Robert Woods in 1921


Tahar Ben Ammar 'o office: Tahar Zaouche is the third from the right


Ear inspection


A 40-watt CO 2  laser used in otorhinolaryngology


Royal National Throat, Nose and Ear Hospital  founded in 1874, in  London


Axial section of the Brainstem (Pons) at the level of the Facial Colliculus


The Clivus


Limitation of  abduction  of the right eye. This individual tries to look to his right, but the right eye fails to turn to the side.


The accessory nerve supplies the  sternocleidomastoid  and  trapezius muscles


3D still showing adenoid hypertrophy.


Removed adenoid


Tip of a dilatation catheter with deflated balloon.


Base of the skull. Inferior surface,  attachment of muscles  marked in red.


Exobasis


Endobasis-resistances beams


Endobasis-resistances nodes


The foramina in the base of the skull are exit and entry points for veins, arteries and  cranial nerves .


The cranial nerves as they exit through various foramina.


Facial nerve : the facial nerve's nuclei are in the  brainstem  (represented in the diagram by "θ"). Orange: nerves coming from the left hemisphere of the brain, yellow: nerves coming from the right hemisphere. Note that the forehead muscles receive innervation from both hemispheres (yellow and orange)


Scottish neurophysiologist Sir Charles Bell was the first author to describe the anatomical basis for facial paralysis, and has since served as the eponym for Bell's palsy.


A sound processor behind the ear


An implant shown in actual size in adult hand


Diagram showing the origin of the upper part of the buccinator muscle to the maxilla (the middle part originates from the  pterygomandibular raphe , where buccinator joins the  superior constrictor muscle )


Diagram showing the origin of the lower part of the buccinator muscle on the lateral surface of the mandible


An abscess originating from a tooth which has spread to involve the buccal space. Above, deformation of the cheek on the second day. Below, deformation on the third day.


Diagram showing muscles of infra-orbital region. The levator labii superioris muscle is colored red.


Diagram showing muscles of the infra-orbital region. Levator anguli oris is colored red. The canine space is situated between the levator anguli oris muscle and the levator labii superioris muscle.


An 1896 ad for Elys Cream Balm, a catarrh remedy


The choanae (internal nostrils) of a cat, indicated by the dashed lines and bounded by the  vomer  (blue gray) and the  palatine bone  (orange)


The wide field view of the endoscope allows "looking around the corner" while utilizing the natural ear canal access to cholesteatoma.


Right chorda tympani nerve, viewed from lateral side


A baby being fed using a customized bottle. The upright sitting position allows  gravity  to help the baby swallow the milk more easily.


A repaired cleft palate on a 64-year-old female


Moche pottery


3D model of cochlea and semicircular canals


Structural diagram of the cochlea showing how fluid pushed in at the oval window moves, deflects the cochlear partition, and bulges back out at the round window.


Fig. 1 Cranial sutures viewed from top of head


Fig. 2 Skull deformities associated with single suture synostosis


Fig. 3 Locations of the incisions used in fronto-supraorbital advancement.


Fig. 4 Bone segments that are removed in fronto-supraorbital advancement


From left to right, Keros type I, II, and III.


Cystic hygromas are classically found in the  posterior triangle  of the neck.


Newborn infant with a cystic hygroma visible on right side of the neck


The four compartents of the right masticator space.  A  Temporalis muscle,  B  Masseter muscle,  C  Lateral pterygoid muscle,  D  Medial ptaerygoid muscle,  E  Superficial temporal space,  F  Deep temporal space,  G  Submasseteric space,  H  Pterygomandibular space,  I  Approximate location of infratemporal space.


An  audiologist  conducting an  audiometric   hearing test  in a  sound-proof  testing booth


Anterior view of digastric muscle


Zinc Gluconate.


Eprosartan .


Diver clearing ears


Section of the human ear, the Eustachian tube is shown in colour


Ear hair protruding from the  external auditory meatus  in a middle-aged male. Note the fine  vellus hair  growth on the  antitragus  and  helix .


Ear hair protruding from the  external auditory meatus  in a middle-aged male.


Strand of human hair at 200× magnification


Royal Navy   admiral  Michael Denny  with ear hair


Otitis media


Referred otalgia from neck and head sources [ 31 ]


Acute ear pain decision tree [ 4 ] [ 8 ] [ 9 ]


Chronic ear pain decision tree [ 4 ] [ 8 ] [ 9 ]


Professor Anton Friedrich von Tröltsch 1869 O. Roth, Inventor of the otoscope


Drawing (left image) and CT scan (right image) of the normal pharynx as a cross-section viewed from the side (sagittal view), including the normal epiglottis (orange arrow), opening to the esophagus (yellow arrow), and opening to the trachea (blue arrow). An infected epiglottis becomes swollen and causes issues with swallowing, speaking, and breathing due to its proximity to the esophagus and trachea. Other labeled structures include the tongue (pink arrow) and vertebral bodies of the cervical spine (grey arrow)


Upper respiratory system, showing  entrance to auditory tube  near middle


The Eustachian tube has recently been redefined as the  fibrocartilaginous structure connecting the air cell system of the temporal bone to the nose. What was thought of as the bony tube is really part of the air cell system of the temporal bone. [ 4 ]


3D reconstruction of the right Eustachian tube from Valsalva CT. Note the sac like shape of the structure.


3D reconstruction of the air cell system of the temporal bone including the Eustachian tube and its narrowest area in close proximity to the ear, the isthmus


Branches of external carotid artery.


Left external carotid artery with normal spectral doppler ultrasound


Superficial dissection of the right side of the neck, showing the carotid and subclavian artery. Branch of facial artery labeled


The  facial nerve


Basic human airway anatomy. Objects can enter the trachea and lungs via the mouth or nose.


Section of larynx showing aspirated fragment of meat (top center).


Chest x-ray of an adult with obstructive pneumonia in the right lung (left side of the image) evidenced by hypodense (less dark) area. This is from a blockage in the respiratory tract leading to an infection distal to the obstruction.


X-ray of focal pneumonia in lower right lung lobe (bottom left of chest in image) due to aspiration and airway obstruction.


Foreign body aspiration of a coin in the esophagus.


Frontal sinus.


Heinz Stammberger at the end of course at Tarabichi Stammberger Ear and Sinus Institute two months before he died.


Professor Stammberger teaching at the Tarabichi Stammberger Ear and Sinus Institute


Squamous cell carcinoma of the mouth


Radiation mask used in the treatment of throat cancer


Age-standardized  death from oro-pharyngeal cancer per 100,000 inhabitants in 2004 [ 122 ]      no data      less than 2      2-4      4-6      6-8      8-10      10-12      12-14      14-16      16-18      18-20      20-25      more than 25


Head mirror


A doctor using a head mirror to illuminate his patient's nasal passages.


A deaf person using a camera-equipped smartphone to communicate in sign language


An  audiologist  conducting an  audiometric   hearing test  in a  sound-proof  testing booth


An in-the-canal hearing aid


Disability-adjusted life year  for hearing loss (adult onset) per 100,000 inhabitants in 2004:             no data      <250      250–295      295–340      340–385      385–430      430–475          475–520      520–565      565–610      610–655      655–700      >700


The sign for "friend" in  American Sign Language


This portrait, though undated, supports the view that tracheotomy was practiced in  ancient history


Hieronymus Fabricius ,  Operationes chirurgicae , 1685


William Beaumont  (1785–1853), American  physiologist


The laryngoscopy. From  García , 1884


Engraving  of French  pediatrician   Eugène Bouchut , by Henri Brauer. From  Angelo Mariani  and Joseph Uzanne (1894).  Figures contemporaines tirées de l'Album Mariani , Volume I. Paris:Ernest Flammarion.


Glidescope video laryngoscope, incorporating a  CMOS   active pixel sensor  (CMOS APS)  video camera  and a  high resolution   LCD monitor


Electron micrograph  of Human Papilloma Viruses


Basaloid pattern of  squamous cell cancer


Genomic structure of HPV


Rhinoscope used in diagnosis and surveillance


CT scan  in  transverse plane , viewed from below, showing a contrast enhancing right  tonsil  mass due to HPV+OPC


Vial of  HPV vaccine


Transverse radiation contours used in treating cancer seen on above CT scan and in machine set up below


Types of oropharyngeal cancer and associated survival rates


The lesser and greater horns of the hyoid


The hyoid bone sits above the  thyroid cartilage .


Schematic image of the hypoglossal nerve and innervation targets.


An injured hypoglossal nerve will cause the tongue to  waste away  and the tongue will not be able to stick out straight. The injury here occurred because of  branchial cyst  surgery.  [ 18 ]


Inferior nasal concha - animation 02


Right and left inferior nasal conchae


The four compartents of the right masticator space.  A  Temporalis muscle,  B  Masseter muscle,  C  Lateral pterygoid muscle,  D  Medial ptaerygoid muscle,  E  Superficial temporal space,  F  Deep temporal space,  G  Submasseteric space,  H  Pterygomandibular space,  I  Approximate location of infratemporal space.


Inner ear


The  cochlea  and  vestibule , viewed from above.


A cross-section of the  cochlea  showing the  organ of Corti .


Cross-section through the spiral organ of Corti at greater magnification.


Internal carotid artery


Segments of the internal carotid artery, delineated on an  MRA  of the head.


Level of 6th cervical vertebrae - still at level of common carotid but relationships are similar to those of cervical segment of internal carotid


Internal carotid artery - dissection


Oblique section through the cavernous sinus.


The ophthalmic artery and its branches


Depicts nerve branches that are involved in the autonomic innervation of the lacrimal gland. The terminal parts of the pathway are variable between individuals and differ for the other glands of the deep face.


Laryngitis


A laryngology exam and procedure room.


Mandibular prognathism


Anatomical landmarks of the mandible from a right lateral view


External oblique line of the mandible (shown in red)


Mandibular first molar teeth (shown in red)


Inter-maxillary fixation of the mandible


Mastoid cells


Mastoid process shown in red


Mastoiditis with subperiostal abscess


Mastoid cells  of Lenoir


CT scan :  Otitis media  (simple arrow) and mastoiditis (double arrow) of the right side (left side in image). The  external auditory canal  is partially occupied by suppuration (triple arrow). 44-year-old woman.


Attack triangle in mastoidectomies


Inferior surface of maxilla


Anterior surface of maxilla at birth


Inferior surface of maxilla at birth


Fracture of the left lacrimal / maxillary bone


The maxillary sinus can normally be seen above the level of the premolar and molar teeth in the  upper jaw .  This  dental x-ray film  shows how, in the absence of the second premolar and first molar, the sinus became  pneumatized  and expanded towards the crest of the alveolar process (location at which the bone meets the gum tissue).


CT Brain showing air-fluid level in bilateral maxillary air sinuses post brain trauma. Maxillary sinusitis will also shows similar air-fluid collection and should be rule out from history taking.


Inner ear


Audiograms  illustrating normal hearing (left) and unilateral low-pitch hearing loss associated with Ménière's disease (right)


Loudness discomfort levels (LDLs) – data of people with hyperacusis without hearing loss. Upper line: average hearing thresholds. Lower long line: LDLs of this group. Lower short line: LDLs of a reference group with normal hearing. [ 15 ]


A podiatrist prepares for microsurgery.


The middle ear matches mechanical impedance, like a lever.


Side view of the cartilages in the nose.


Right side view of the septal nasal cartilage.


Major alar and minor alar cartilages, seen from below.


External incision used during a rhinoplasty.


U.S. Air Force Maj. Brent Feldt, performing a septoplasty.


Patient with metal split after a rhinoplastic procedure.


Nasal cavity anatomy


CT scan  in the  coronal plane , showing the ostiomeatal complex (green area)


Coronal section of nasal cavity


Paranasal sinuses : 1. frontal sinuses, 2. ethmoid sinuses (ethmoidal air cells), 3. sphenoid sinuses, 4. maxillary sinuses


Nasal polyp appearing in the middle meatus.


Histology of nasal polyp, magnification 25x ( H&E stain )


Professor Heinz Stammberger, known as the father of endoscopic sinus surgery, teaching the technique at Tarabichi Stammberger Ear and Sinus Institute.


CT scan images after application of radioactive laced nasal steroids using long nozzle. Note the reach of the medication into the area where nasal polyps originate


Vomer  of infant


Modified radical neck dissection


Two children  boxing , the one on the right having a nosebleed due to a punch to the face, in  Vecsés ,  Hungary  in November 2006


The arteries that supply Kiesselbach's plexus (responsible for anterior nosebleeds)


Coronal image of  mouse  main olfactory bulb cell nuclei. Blue  – Glomerular layer;  Red  – External Plexiform and  Mitral cell  layer; Green  – Internal Plexiform and  Granule cell  layer. Top of image is  dorsal  aspect, right of image is  lateral  aspect.  Scale, ventral to dorsal, is approximately 2mm.


Flow of olfactory information from receptors to glomeruli layer


Fossil  endocast  of a  Tyrannosaurus  cranial vault, showing extensive olfactory bulb (structure to the left). Tyrannosaur dinosaurs, as well as carnivorous animals in general, have highly developed olfactory bulbs to seek out prey.


A schematic drawing of the components of the embryonic olfactory epithelium. ORN =  olfactory receptor neuron , OEC =  olfactory ensheathing cell


Embryonic morphogen signaling on olfactory placode and neural crest cells contributes to formation of neurogenic and non-neurogenic tissue of the olfactory epithelium.


Olfactory sensory neurons (OSNs) express odorant receptors. The axons of OSNs expressing the same odorant receptors converge onto the same glomerulus at the olfactory bulb, allowing for the organization of olfactory information.


A  fundus photograph  showing the back of the retina. The white circle is the beginning of the optic nerve.


Oropharyngeal cancer (from right tonsil, HPV-negative), T4a N2c, 48-year-old man.


Types of oropharyngeal cancer and associated survival rates


Swelling of the right neck from the spread of oral cancer.


Ulceration on the left lower lip caused by cancer


Stall selling betel quid


Oral  leukoplakia  (white patch) on the left tongue. Proven to be severe dysplasia on biopsy


A large squamous cell carcinoma of the tongue as seen on CT imaging


Histopathologic appearance of a poorly differentiated squamous cell carcinoma specimen. Hematoxylin-eosin stain. p16 positive, EBV negative


Spread of cancer beyond the capsule of a lymph node (ENE+).


Post-operative image after removal of oral cancer with part of the  mandible  ( feeding tube  in nose)


Common scar line after cervical lymph node dissection


Radiation treatment


Deaths from mouth and oropharynx cancers per million people in 2012     0–8    9–11    12–15    16–18    19–24    25–31    32–40    41–55    56–75    76–156


A beagle with oral cancer.


3D model of orbit with surrounding bones


The seven bones that form the orbit: yellow =  Frontal bone green =  Lacrimal bone brown =  Ethmoid bone blue =  Zygomatic bone purple =  Maxillary bone aqua =  Palatine bone red =  Sphenoid bone teal =  Nasal bone  (illustrated but not part of the orbit)


Tear system : a. tear gland / lacrimal gland, b. superior lacrimal punctum, c. superior lacrimal canal, d. tear sac / lacrimal sac, e. inferior lacrimal punctum, f. inferior lacrimal canal, g. nasolacrimal canal


Anatomy of the three ossicles


Otitis media


Perforation of the right tympanic membrane resulting from previous severe acute otitis media


Disability-adjusted life year  for otitis media per 100,000 inhabitants in 2004.             no data      < 10      10–14      14–18      18–22      22–26      26–30          30–34      34–38      38–42      42–46      46–50      > 50


Deaths from otitis media per million persons in 2012     0    1    2–4


Thieme  Synthesis: [ 5 ]  Patent: [ 6 ]  Sino: [ 7 ]  Precursor patent: [ 8 ]


Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top). Stratified  epithelium  (e) covers the throat's surface and continues as a lining of the crypt. Beneath the surface are numerous nodules (f) of  lymphoid  tissue. Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the  saliva  as salivary corpuscles (s).


A medical animation still that shows tonsillitis


Paranasal sinuses


Smoking is strongly related to paranasal sinus and nasal cavity cancer


The parotid gland


Relative incidence of parotid tumors. [ 16 ]


Surgical planning using  bone segment navigation  for the  osteotomy  of the jaw bones, based on models fixed into an  articulator  (registration based on infrared devices)


Schematic representation of the SSN system


Actual usage of the SSN system in the operating room


Normal ear drum


Peritonsillar abscess on the person's right as seen on CT imaging


Posterior borders of the petrous part of the temporal bone in the  posterior cranial fossa  shown at (2) in blue


A normal throat


Exudative  pharyngitis in a person with  infectious mononucleosis


A case of strep throat


Throat swab


Upper respiratory system, with the nasopharynx, oropharynx and laryngopharynx labeled at left


Details of  torus tubarius


Pharyngitis is the painful swelling of the throat. The oropharynx shown here is very inflamed and red.


An illustration of the pharyngeal jaws of a moray eel


US Navy 090704-A-0566T-023 Operation Smile staff member Dr. Hal Rosenfeild begins reconstructive surgery for a cleft lip on a three-month-old infant aboard the Military Sealift Command hospital ship USNS Comfort (T-AH 20)


Pathological changes in non-allergic rhinitis [ 26 ]


Mechanism of non-allergic rhinitis: Imbalance between sympathetic and parasympathetic components in the nasal mucous membrane [ 26 ]


Sublabial incision through which  periosteum  of  maxilla  is elevated in an endoscopic midface lift (rhytidectomy).


The difference between an aged eye and a youthful eye, looking at the distance from the cilliary margin to the inferior-most point of the orbicularis oculi muscle.


A. Increased redundancy of the nasolabial fold (caused by a descent of cheek fat)  B. Increased distance from the ciliary margin to the inferior-most point of the orbicularis oculi muscle (caused by decreasing tone of the orbicularis oculi muscle)  C. Jowl (a broken jaw line by ptosis of the platysma muscle)  D. The intended effect of a facelift


The technique of a SMAS facelift, consisting of mobilisation, repositioning and fixating.


Blue represents the incisions in the Skin only facelift. Green represents the S-lift. Red is the extensive undermining done in several facelift techniques.


Cochlea and vestibular system


The Lady and the Unicorn , a Flemish tapestry depicting the sense of smell, 1484–1500.  Musée national du Moyen Âge , Paris.


Schematic of the early olfactory system including the olfactory epithelium and bulb. Each ORN expresses one OR that responds to different odorants. Odorant molecules bind to ORs on cilia. ORs activate ORNs that transduce the input signal into action potentials. In general, glomeruli receive input from ORs of one specific type and connect to the principal neurons of the OB, mitral and tufted cells (MT cells).


Pieces removed from nasal cavities during septoplasty


Screenshot of a PSG system showing an obstructive apnea


No airway obstruction during sleep


Airway obstruction during sleep


Screenshot of a PSG system showing a central apnea


Person using a CPAP mask, covering only the nose


CPAP device on a nightstand


Illustration of surgery on the mouth and throat


Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.


Seven bones articulate to form the  orbit . The sphenoid bone is in red (directly in the middle of the  orbital cavity )


Wedge-shaped sphenoid bone seen laterally


Figure 4 :  Sphenoid bone at birth, posterior aspect.


Paranasal sinuses


The size of the  stapes , compared with a 10-cent  euro  coin.


The  stapes , as first described by  Giovanni Filippo Ingrassia   (Labeled M, bottom right) .


Sternocleidomastoid labelled


The sternocleidomastoid muscle with nearby structures labeled, such as the  triangles of the neck .


Drawing of an open mouth showing the frenulum linguae and surrounding structures


Diagram of medial surface of the mandible, showing the slanting attachment of mylohyoid (the mylohyoid line). This arrangement means that the apices of posterior teeth are more likely to be below the level of mylohyoid, so a  periapical abscess  associated with posterior teeth is more likely to spread into the  submandibular space .


Diagram showing sublingual gland in sublingual space


Sublingual caruncles highlighted on either side of the  lingual frenulum


Human submandibular gland. At the right is a group of mucous  acini , at the left a group of serous acini.


Parasympathetic and Sympathetic connections of the submaxillary and superior cervical ganglia.


Relative incidence of submandibular tumors. [ 15 ]


Diagram of medial surface of the mandible, showing the slanting attachment of mylohyoid (the mylohyoid line). This arrangement means that the apices of posterior teeth are more likely to be below the level of mylohyoid.


Left submandibular space (right side shown with digastric muscle removed).


Cricothyrotomy kit


The diagram (a), (b), (c) show different positions of vocal cords in different conditions.


A piece of thyroid cartilage is cut and pushed towards the medial side by placing an implant.


In this type of implant system, the thyroid cartilage is pushed towards the medial side using the silastic implant.


Low-power microscope magnification of a cross-section through one of the tonsillar crypts (running diagonally) as it opens onto the surface of the throat (at the top). Stratified  epithelium  (e) covers the throat's surface and continues as a lining of the crypt. Beneath the surface are numerous nodules (f) of  lymphoid  tissue. Many lymph cells (dark-colored region) pass from the nodules toward the surface and will eventually mix with the  saliva  as salivary corpuscles (s).


CT scan  of tonsilloliths


General size of a tonsilolith compared to a finger


Cryptic tonsils immediately following surgical removal (bilateral tonsillectomy).


Throat 1 day after a tonsillectomy.


Throat some days after a tonsillectomy.


Tonsil guillotine.


Illustration comparing normal tonsil anatomy and tonsillitis


Bacteria or viruses can cause tonsillitis.


Throat swab


Laryngoscope handles with an assortment of Miller blades (large adult, small adult, child, infant and newborn)


Laryngoscope handle with an assortment of  Macintosh  blades (large adult, small adult, child, infant and newborn)


Laryngoscopy


An endotracheal tube stylet, useful in facilitating orotracheal intubation


A cuffed endotracheal tube, constructed of  polyvinyl chloride


A Carlens double-lumen endotracheal tube, used for  thoracic surgical  operations such as  VATS lobectomy


An endotracheal tube in good position on CXR. Arrow marks the tip.


An endotracheal tube not deep enough. Arrow marks the tip.


Laryngoscopes prepared for emergency anaesthesia


In cricothyrotomy, the incision or puncture is made through the  cricothyroid membrane  in between the  thyroid cartilage  and the  cricoid cartilage


Cricothyrotomy  kit


Diagram of a  tracheostomy tube  in the trachea:  1 -  Vocal folds  2 -  Thyroid cartilage  3 -  Cricoid cartilage  4 -  Tracheal rings  5 - Balloon cuff


A  premature infant  weighing 990 grams (35 ounces), intubated and requiring  mechanical ventilation  in the  neonatal intensive-care unit


Tracheal intubation is anticipated to be difficult in this child with a massive  ameloblastoma


The laryngoscopy. From  García , 1884


Figure A shows a side view of the neck and the correct placement of a tracheostomy tube in the trachea, or windpipe. Figure B shows an external view of a patient who has a tracheostomy.


Tracheotomy tubes and  endotracheal tubes  are often attached to  ventilators  to assist in breathing.


An outer cannula (top item) with inflatable cuff (top right), an inner cannula (center item) and an obturator (bottom item)


A tracheostomy from prior to the 20th century


Hieronymus Fabricius  (1533–1619) was the first to introduce the idea of a tracheostomy tube


Laryngeal structures, trachea (1–4) and invasive procedures (A–B) (1) Thyroid cartilage (2) Cricothyroid ligament (3) Cricoid cartilage (4) Trachea (A) Cricothyrotomy (B) Tracheotomy


Dermatome  distribution of the trigeminal nerve


Dermatome distribution of the trigeminal nerve


C = Cervical segment, S = Sacral segment, VPL =  Ventral posterolateral nucleus , SI =  Primary somatosensory cortex , VM =  Ventromedial prefrontal cortex , MD =  Medial dorsal thalamic nucleus , IL =  Intralaminar nucleus , VPM =  Ventral posteromedial nucleus , Main V =  Main trigeminal nucleus , Spinal V =  Spinal trigeminal nucleus


Brainstem nuclei: Red = Motor; Blue = Sensory; Dark blue = Trigeminal nucleus


Onion-skin distribution of the trigeminal nerve


Cortical homunculus


Uvulopalatopharyngoplasty. A) pre-operative, B) original UPPP, C) modified UPPP, and D) minimal UPPP.


Open vocal cords as seen during normal inhalation


Closed vocal cords as seen during a VCD episode (or when speaking)


Vocal folds (open)


Vocal folds (speaking)


The vocal folds in motion


Diagram depicting mouth acidity changes after consuming food high in  carbohydrates . Within 5 minutes the acidity in the mouth increases as the pH drops. In persons with normal salivary flow rate, acid will be neutralized in about 20 minutes. People with dry mouth often will take twice as long to neutralize mouth acid, leaving them at higher risk of tooth decay and acid erosion


Person demonstrating the allergic salute.


Bones of the nose and septal cartilage


Roof of the mouth showing position of palatine bones making up the floor of the nose, and forming the  posterior nasal spine  for the attachment of the  musculus uvulae .


Nasal cartilages


Anatomy of the nasal cavity.  Nasal-associated lymphoid tissue  labelled NALT


Paranasal sinuses


Nose shapes used in  Topinard's  nasal index.


Carotid arteries


Multiple arteries supply blood to the nose; the nasal septum, shown here is supplied by the anterior and posterior ethmoidal arteries at top; the sphenopalantine artery at the back, and the anterior ethoidal artery and the superior labial artery over the cartilage. These arteries join at  Kiesselbach's plexus .


The  developing head  at about four weeks. The olfactory pit can be seen at the top.


Air enters the upper respiratory tract through the nose. The nasal conchae can be seen in this image.


The cells lining the nose involved in smell ( olfaction ) are shown here


Saddle nose  ( congenital syphilis )


Prosthetic nose  from 17th century Europe.


To prepare an isotonic saline solution for nasal rinsing, approx. 0.25 liter lukewarm, sterilized drinking water and 2.5 ml of table salt (about half a level  teaspoon ) is required.


Nasal irrigation device commonly available at pharmacies


Ceramic neti pot


A woman blowing her nose (expelling  mucus ) into a  handkerchief


Endoscopic rhinoscope


Illustration depicting sinusitis, note the fluid in the sini


The  spectrogram  of the human voice reveals its rich  harmonic  content.


A labeled anatomical diagram of the  vocal folds  or cords.


Armed Forces Radio Services broadcaster Jack Brown interviews Humphrey Bogart and Lauren Bacall for broadcast to troops overseas during World War II.


Electroglottograph, Glottal Enterprises model EG2-PCX shown here.


Photograph of an EGG signal from a Glottal Enterprises EG2-PC (top) and a Laryngograph/Kay electroglottograph (bottom).


Showing the contacts on the electrodes from a Glottal Enterprises EG2-PCX.  Electrodes for other electroglottographs are typically very similar in size and shape.  This set of electrodes is from a Glottal Enterprises EG2-PCX, which is a dual-channel EGG, so it has 2 sets of contacts.  Electrode jelly is used to help conduct the signal from the contacts to the neck.


Figure 7 of: Martin Rothenberg and James J. Mashie,  Monitoring Vocal Fold Abduction Through Vocal Fold Contact Area  Journal of Speech and Hearing Research, Volume 31, 338-351, September 1988


How to construct a wavegram


Fig.1 Example of Electropalate


Fig.2 Electropalatography printout


Vocal fold, scheme


Glottal cycle, falsetto


The horizontal cross section of thyroid cartilage before and after feminization laryngoplasty. The thyroid cartilage is cut along the red line (left), with the part in between the lines removed and the remaining parts sutured together (right).


Granuloma of the vocal cord


Athlete  infibulating  himself ( psykter  by the  Syriskos Painter , c. 480 BC)


Mural from Cave 198,  Kizil Caves , 6th century CE


Spectrogram  of American English vowels  [i,   u,   ɑ]  showing the formants  F 1  and  F 2


A plot of the average formants listed in the above chart


Larynx showing vocal ligaments


Incomplete cleft palate


The basic parts of the human larynx.


Vocal cords abducted and adducted


Extrinsic laryngeal muscles


Image of endoscopy


Cut through the larynx of a horse  (frontal section, posterior view) 1  hyoid bone ; 2  epiglottis ; 3  vestibular fold ; 4  vocal fold ; 5  ventricularis muscle ; 6  ventricle of larynx ; 7  vocalis muscle ; 8  thyroid cartilage ; 9 cricoid cartilage; 10  infraglottic cavity ; 11 first  tracheal  cartilage; 12  trachea


Great tits  sing at a higher frequency in  noise polluted  urban surroundings than quieter ones to help overcome the  auditory masking  that would otherwise impair other birds hearing their  song . [ 1 ]  Although great tits achieve a change in song frequency by switching song types, [ 2 ]  in other urban birds the change in frequency might be related to the Lombard effect. [ 3 ] [ 4 ]  For instance, in humans, the Lombard effect results in speakers adjusting frequency


The  laryngeal prominence , commonly known as the Adam's apple.


For right handed people, the majority of speech production activity occurs in the left cerebral hemisphere.


Examples of speech errors. The target is what the speaker intended to say. The error is what the speaker actually said. These mistakes have been studied to learn about the structure of speech production.


This is an interpretation of the Dell's model. The  words at the top represent the semantic category. The second level represents the words that denote the semantic category. The third level represents the phonemes (syllabic information including onset, vowels, and codas).


Human vocal apparatus used to produce speech


Speech Intelligibility may be expressed by a single number value. Two scales are most commonly used: STI and CIS


Nominal qualification bands for STI


Examples of STI qualification bands and typical applications


Greek orator  Demosthenes  practicing oratory at the beach with pebbles in his mouth


Pythagoras , the man in the center with the book, teaching music, in  The School of Athens  by  Raphael


Examining the vocal mechanism with a  laryngoscope , late 19th century


Mathilde Marchesi  was both an important singer and teacher of singing at the turn of the 20th century.


A labeled anatomical diagram of the  vocal folds  or cords


Places of articulation (passive & active): 1. Exo-labial, 2. Endo-labial, 3. Dental, 4. Alveolar, 5. Post-alveolar, 6. Pre-palatal, 7. Palatal, 8. Velar, 9. Uvular, 10. Pharyngeal, 11. Glottal, 12. Epiglottal, 13. Radical, 14. Postero-dorsal, 15. Antero-dorsal, 16. Laminal, 17. Apical, 18. Sub-apical


A graphical representation of the VOT of voiced, tenuis, and aspirated stops


Voice Onset Timing  spectrograms  for English "die" and "tie".  The voiceless gap between release and voicing is highlighted in red.  Here the phoneme  /t/  has a VOT of 95 ms, and  /d/  has one of 25 ms.


Voice prosthesis


Image of a vocal fold polyp as seen through endoscopic examination.


Flexible endoscope used for physical examination of the vocal structures.


Age-standardised   disability-adjusted life year  (DALY) rates from respiratory diseases by country (per 100,000 inhabitants).


Classic steeple sign indicating croup


Pulmonary interstitial emphysema


Deaths from respiratory diseases per million persons in 2012     19–125    126–169    170–196    197–225    226-–75    276–308    309–365    366–440    441–593    594–1,227


Ragweed is a plant and some are allergic to its pollen.


Skin Prick Test


Some older children can be taught to use their prescribed Metered-Dose Inhaler.


Metered-Dose Inhaler Mask (Child)


A summary diagram that explains how allergy develops


Tissues affected in  allergic inflammation


Degranulation process in allergy. Second exposure to allergen.  1  – antigen;  2  – IgE antibody;  3  – FcεRI receptor;  4  – preformed mediators (histamine, proteases, chemokines, heparin);  5  –  granules ;  6  –  mast cell ;  7  – newly formed mediators (prostaglandins, leukotrienes, thromboxanes,  PAF ).


An allergy testing machine being operated in a diagnostic immunology lab


Skin testing on arm


Skin testing on back


Patch test


Anti-allergy immunotherapy


Signs and symptoms of anaphylaxis


Urticaria  and flushing on the chest of a person with anaphylaxis


Skin allergy testing  being carried out on the right arm


An old version of an EpiPen brand auto-injector


Skin lesion from anthrax


Anthrax skin lesion on the neck


Anthrax skin lesion on the face


Photomicrograph  of a  Gram stain  of the bacterium  Bacillus anthracis , the cause of the anthrax disease


Inhalational anthrax,  mediastinal  widening


Possible edema and necrosis in a case of injection anthrax.


B. anthracis  Capsule Depolymerase (CapD) degrades the unusual PDGA capsule on the outer surface of the bacterium. The pegylated enzyme has been used in mice to protect against 5 LD50 challenges of lethal Ames spores. [ 67 ]  The human enzyme (white surface) has been overlaid onto the bacterial CapD structure (PDB 3G9K [ 68 ] , blue ribbon). In red is the substrate binding loop of HuGGT which CapD lacks. CapD binds polymers of D-glutamate. Original figure from Hu, Legler, et al. [ 67 ]


Louis Pasteur inoculating sheep against anthrax


Colin Powell  giving a  presentation to the United Nations Security Council , holding a model vial of supposed weaponized anthrax


Salbutamol  metered dose inhaler commonly used to treat asthma attacks


Fluticasone propionate  metered dose inhaler commonly used for long-term control


Rates of asthma in 2017 [ 283 ]


The Gold-dust Book of Cold Damage dated '1st year of the Zhengyuan reign period of the Yuan dynasty' (1341) Wellcome.


Atelectasis.


Atelectasis of the right lower lobe seen on chest X-ray.


Atelectasis of the middle lobe on a sagittal CT reconstruction.


Guinea-Bissau's frontline healthcare workers


Health problems associated with cystic fibrosis


Respiratory infections in CF vary according to age. Green =  Pseudomonas aeruginosa Brown =  Staphylococcus aureus Blue =  Haemophilus influenzae Red =  Burkholderia cepacia  complex


Cystic fibrosis has an autosomal recessive pattern of inheritance.


The CFTR protein is a channel protein that controls the flow of H 2 O and Cl −  ions in and out of cells inside the lungs. When the CFTR protein is working correctly, ions freely flow in and out of the cells. However, when the CFTR protein is malfunctioning, these ions cannot flow out of the cell due to a blocked channel. This causes cystic fibrosis, characterized by the buildup of thick mucus in the lungs.


The location of the  CFTR  gene on chromosome 7


Intracytoplasmic sperm injection can be used to provide fertility for men with cystic fibrosis.


Dorothy Hansine Andersen  first described cystic fibrosis in 1938.


The genes for human HLA are located on chromosome 6.


High resolution computed tomography (HRCT) images of the lower chest in a 16-year-old boy initially diagnosed with DPB ( left ), and 8 weeks later ( right ) after a 6-week course of treatment with erythromycin. The bilateral bronchiectasis and prominent centri-lobular nodules with a "tree-in-bud" pattern shows noticeable improvement.


Molecular structure of Erythromycin A, an antibiotic used to treat DPB


Human embryo—length, 2 mm. Dorsal view, with the amnion laid open. X 30.


Key inducers of the epithelial to mesenchymal transition process.


Epithelial to mesenchymal cell transition – loss of cell adhesion leads to constriction and extrusion of newly mesenchymal cell.


Cancer cells enter the bloodstream after undergoing EMT induced by TGF-β released from platelets. Once in the bloodstream, metastatic cancer cells recruit platelets for use as a physical barrier that helps protect these cells from elimination by immune cells. The metastatic cancer cell can use the attached platelets to adhere to P-selectin expressed by activated endothelial cells lining the blood vessel walls. Following adhesion to the endothelium, the metastatic cancer cell exits the bloodstream at the secondary site to begin formation of a new tumor.


Diagnostic approach to solving the puzzle of hemoptysis.


Hemoptysis


Lesions lips, patient with hemorrhagic hereditary telangiectasia.


Tongue telangiectases as seen in a person with hereditary hemorrhagic telangiectasia


A very large arteriovenous malformation in the left hemisphere (on the right in this image) of the brain.


Hereditary hemorrhagic telangiectasia has an autosomal dominant pattern of inheritance.


A schematic representation of the TGF-β signaling pathway. Endoglin (yellow) is needed for signalling. The ligand (blue) binds to the receptor complex; red indicates a type II receptor protein, which activates a type I receptor protein (turquoise) such as alk-1, which in turn phosphorylates a SMAD-based nuclear transcription factor (green and purple).


A vascular lesion in the digestive tract, being treated with argon plasma coagulation.


CT-scan of vascular malformations in the liver in a patient with hereditary hemorrhagic telangiectasia causing an inhomogeneous perfusion pattern.


The  Netherlands Antilles , where HHT is more common than anywhere in the world, located off the coast of Venezuela.


Fusion glycoprotein trimer, Human parainfluenza virus 3 (HPIV3).


A scanning electron micrograph (SEM) depicting a number of Gram-negative  Bordetella bronchiseptica  bacteria.


Transmission electron micrograph of parainfluenza virus. Two intact particles and free filamentous nucleocapsid.


Lipid-laden alveolar macrophages in a case of  vaping-associated pulmonary injury . Left:  Papanicolaou stain ; right:  Oil Red O  stain. [ 1 ]


Placement of an endotracheal tube to aid breathing


Mediastinum Anatomy


CT scan of a patient with Descending Necrotizing Mediastinitis.


Apgar score for newborn infants


Wheat harvested has dust blown in the air.


Breathing air with high oxygen pressure can lead to several adverse effects.


The curves show typical decrement in lung vital capacity when breathing oxygen. Lambertsen concluded in 1987 that 0.5 bar (50 kPa) could be tolerated indefinitely.


The lipid peroxidation mechanism shows a single radical initiating a chain reaction which converts unsaturated lipids to lipid peroxides.


The label on the diving cylinder shows that it contains oxygen-rich gas (36%) and is boldly marked with a maximum operating depth of 28 metres (92 ft)


The retina (red) is detached at the top of the eye.


The silicone band ( scleral buckle , blue) is placed around the eye. This brings the wall of the eye into contact with the detached retina, allowing the retina to re-attach.


Retinopathy of prematurity (ROP) in 1997 was more common in middle income countries where neonatal intensive care services were increasing; but greater awareness of the problem, leading to preventive measures, had not yet occurred. [ 37 ]


Paul Bert, a French physiologist, first described oxygen toxicity in 1878.


Robert W. Hamilton Jr , lead researcher on tolerable repetitive exposure limits at NOAA.


Stress Index of an ARDS patient with different values of PEEP


Piccadilly Circus  during the  Great Smog of London , 1952


Table and title page of John Graunt's (1620–1674)  Natural and political observations ... upon ... mortality  (1662) which notes mortality attributed to air pollution in London [ 16 ]


Disability-adjusted life year  for birth asphyxia and birth trauma per 100,000 inhabitants in 2002


Sagittal CT image showing "tree in bud" appearance of mucous impaction in distal small airways related to primary ciliary dyskinesia


CT image showing dilated and thickened medium-sized airways (bronchiectasis) in a patient with Kartagener syndrome


Oblique sagittal CT image showing lower lobe cylindrical bronchiectasis in the same patient


CT image showing  situs inversus . The liver is normally on the right side of the body and the spleen on the left, they are switched in this patient with situs inversus.


Axial CT image showing dextrocardia with the IVC and morphologic right ventricle on the left and the left ventricle on the right


Axial CT image showing chronic sinusitis in an individual with Kartagener syndrome


An immature  little blue heron  with psittacosis


It is common to see RAD incorrectly used as a synonym for asthma.


First page of the 2010 ICD


Pulse oximetry is a simple, quick, painless test.


Causes of respiratory failure


Clubbing


Arterial blood gas analyzer


Mechanical ventilator


Indoor Swimming Pool


Respiratory system  anatomy


Deaths from respiratory infections per million persons in 2012     24-120    121-151    152-200    201-244    245-346    347-445    446-675    676-866    867-1,209    1,210-2,090


CT scan of a saber-sheath trachea in a patient with COPD


Certified respirators, without exhalation valves, are the recommended form of source control.


In hospitals, proper source control protocols are essential.


Droplet spread without source control: up to ~8 meters (26 ft) for sneezes and coughs, up to ~2 meters (6.6 ft) for talking. Aerosol spread is much further than this. [ 2 ]


Masks with exhalation valves are not very effective for source control. However, some respirators  with  exhalation valves performed as well as a surgical mask in source control. Respirators  without  exhalation valves should be preferred. [ 10 ]


1997 proposed  OSHA   administrative  rule:  No Admittance Without Wearing a Type N95 or More Protective Respirator [ 29 ]


Similar to  NIOSH 's  Hierarchy of Hazard Controls , multiple controls are used for source control of  TB [ 30 ]


NIOSH guidelines for TB, with focus on  respirators  under the old  30 CFR 11 , replaced in  1995  (On  Wikisource )


HICPAC  2007 Guideline for Isolation Precautions . A more general guideline for hospital  PPE  procedures. (PDF, 225 pages)


A chest x-ray showing pulmonary edema with bilateral pleural effusions.


An illustration of an individual receiving intravenous blood transfusion.


A person receiving supplemental oxygen via nasal cannula.


A  schematic of a typical e-cigarette with a cartridge containing nicotine dissolved in propylene glycol


Bronchoalveolar lavage sample from a patient with acute lung injury associated with vaping, showing alveolar macrophages laden with vacuoles (A) and extensive lipid deposits (B) [ 59 ]


The lower lip is retracted, revealing aphthous ulcers on the  labial mucosa  (note  erythematous  "halo" surrounding ulcers)


Ulcers can take many shapes and sizes. This one is long and narrow


Photographic comparison of: [ 19 ]   Canker sore (inside the mouth) Herpes simplex Angular cheilitis Chapped lips


Blood is often taken to assess the  hemoglobin , iron,  folate  and  vitamin B12  levels


A  patch test  is sometimes carried out. Areas of the skin on the back are stimulated with various common  allergens . The ones which cause an inflammatory reaction may also be involved in recurrent oral ulceration


Manuel Belgrano , Castelli's cousin, worked with him at the consulate and in local newspapers


An edition of the  Telégrafo Mercantil , where a sonnet in honor of the recently appointed viceroy Joaquín del Pino is observed


Charlotte of Spain  sought to rule the Río de la Plata as regent.


This bas-relief by  Gustavo Everlein  depicts Castelli demanding that the viceroy  Baltasar Hidalgo de Cisneros  allow an  open cabildo .


The open cabildo of 22 May 1810


Mariano Moreno  shared Castelli's political views.


Santiago de Liniers, shot after organizing a  counterrevolution  against the Primera Junta


The execution of  Santiago de Liniers


The command of the royalist viceroy, calling for a denial of recognition of the  Primera Junta


José Manuel de Goyeneche , victor of the  Battle of Huaqui


Monument to Juan José Castelli in Plaza Constitución, city of Buenos Aires.


The Defence of Rorke's Drift  (1880) by  Elizabeth Thompson . Chard is shown in the centre directing the defence with  Bromhead


The defence of Rorke's Drift  (1879) by  Alphonse-Marie-Adolphe de Neuville . Chard is shown on the right of the painting in pale trousers.


Wolseley presenting the Victoria Cross to Chard at Inkwenke Camp


Chard's  Webley Revolver  on display at the  Royal Engineers Museum


Portray of Huysmans by Louis Félix Beschere (1886)


Huysmans's grave


A portrait of Huysmans, by  Jean-Louis Forain ,  c.  1878  ( Musée d'Orsay )


A caricature showing Huysmans as a somewhat eccentric sort of literary  dandy , by  Coll-Toc , 1885


Commemorative plaque in 31 rue Saint-Placide,  Paris, 6e


A caricature of Huysmans, by  Félix Vallotton ,  c.  1898


Cover of  Trois Primitifs  (1905)


The obelisk raised over Kingsley's grave,  Holy Trinity Church ,  Cuckfield .


Divisions of West Bengal


Ernesto Rayper. Portrait by Francesco Gandolfi (1824-1873)


Rural Landscape


The  Water Gnome  (1886)


Annis Boudinot Stockton


Takanohana's grave in  Suginami, Tokyo .


Jack Wild (right) with  Oliver!  co-star  Mark Lester  at the  41st Academy Awards , 14 April 1969


Wild with the title character in the  NBC  children's series  H.R. Pufnstuf , 1969


The Jack Wild Album


Kerrison punch 02


Figure 1. Example of a paramedian forehead flap design


Figure 2. The nasal defect after adjustment to the aesthetical subunits


Figure 3. The full-thickness forehead flap is sutured into the recipient site during stage one


Figure 4. The result after stage 1, without initial thinning of the flap


Figure 5. Situation before the second stage of reconstruction


Figure 6. Elevation and thinning of the flap during stage 2


Figure 7. The healed excess soft tissue and cartilage have been sculpted to improve contour


Figure 8. The thinned forehead skin is returned to the contoured recipient


Figure 9. The result after a three-stage forehead flap


The modification of the lower nasal cartilage of the left nostril during a surgical rhinoplasty procedure.


A  congenitally  deviated nasal septum shown on  Magnetic Resonance Imaging  (MRI), which can be corrected by septoplasty.


The  coronal  section of nasal cavities showing the ethmoid sinus, which is a hollow space near the nose and the eyes that allows drainage of other sinuses.


The working principle of balloon sinuplasty. A balloon catheter is inserted into the swelling sinus and inflated, which enables reopening of the sinus passage.


The lateral section of the nasal cavity showing the superior, middle, and inferior nasal conchae (turbinates).


BEFORE AND AFTER: Low bridge and under-projected nasal tip (left photo) corrected with Radiesse injection into the tip and dorsum.


Plates vi & vii of the  Edwin Smith Papyrus  at the  Rare Book Room ,  New York Academy of Medicine [ 3 ]


Artificial nose, made of plated metal, 17th–18th century Europe. This would have been worn as an alternative to rhinoplasty.


Nasal anatomy: Squamous epithelium is one of several types of epithelia.


Nasal anatomy: The procerus muscle (musculus procerus, pyramidalis nasi, depressor glabellae).


Rhinoplasty: the surgical nose as aesthetic nasal segments.


Rhinoplasty: The common carotid artery.


Nasal innervation: Cranial nerve V, the trigeminal nerve (nervus trigeminis) gives sensation to the nose, the face, and the upper jaw (maxilla).


Nasal innervation: Cranial nerve VII (nervus facialis) is the facial nerve that gives sensation to the nose and the upper jaw (maxilla).


Nasal anatomy: The shell-form turbinates (conchae nasales).


Nasal anatomy: The  septum nasi  bones and cartilages.


Rhinoplasty. Nasal anatomy: The philtrum.


Rhinoplastic correction: A child affected by a cleft lip and a cleft palate.


Rhinoplasty: In relation to the  nasal bone  (teal green), seven bones compose the orbit: (1) the  frontal bone  (yellow)  (2) the  lacrimal bone  (green)   (3) the  ethmoid bone  (brown)   (4) the  zygomatic bone  (blue)   (5) the upper jaw  maxillary bone  (purple)   (6) the  palatine bone  (aqua)   (7) the  sphenoid bone  (red)


Photograph 2. Open rhinoplasty: The right lower lateral cartilage (blue) is exposed for correction.


Photograph 1. Open rhinoplasty: The columellar incision delineated as a red-dot guideline, will assist the surgeon in the precise suturing of the nose.


Photograph 4. Rhinoplastic correction: A nasal-hump excision plan; the black line delineates the dorsal plane of the new nose.


Photograph 3. Open rhinoplasty: the nasal tip is sutured to narrow the nose.


Rhinoplasty: Right lateral view of the  nasal cartilages  and the nasal bone.


Rhinoplasty: Lateral wall of the nasal cavity.


Rhinoplasty: A  melanoma  lesion, a type of  skin cancer  that occurs to the nasal skin.


Rhinoplasty: The nasal muscle compresses the nasal bridge, depresses the tip of the nose, and flares (elevates) the corners of the nostrils.


Rhinoplasty: A paramedian forehead flap design


Rhinoplasty: A basal-cell carcinoma lesion on the juncture of the left alar base subunit and the left dorsal sidewall subunit, i.e. on the left nostril.


Rhinoplasty: A divided section design used in Mohs surgery for excising cancerous lesions before nasal reconstruction.


Revision rhinoplasty: The American actor W.C. Fields was affected by rhinophyma.


Illustration 2: Nose-narrowing rhinoplasty; two chisel cuts (green and black arrows) meet at the red zig-zag line to release the bone for corrective re-alignment.


Illustration 1: The nasal bones (violet) of the dorsum identified, for effecting a nose-narrowing rhinoplasty.


Rhinoplasty: At 3-days post-operative, the patient wearing their nasal  splint  after a dorsal bone reduction, re-setting, and nasal-tip refinement. The  panda eyes  (orbital discoloration) is consequent to trauma and ocular blood vessel disruption.


Man without nose and hands,  c.  1910


Print of Hindu scene:  Shurpanakha  (blue woman in foreground) has had her nose cut off by  Lakshmana  (with sword).


Audiological exam


Graph showing a typical Auditory Brainstem Response


Human ear anatomy.    Brown is  outer ear .      Red is  middle ear .      Purple is  inner ear .


Anatomy of the human ear (The length of the auditory canal is exaggerated in this image.).    Brown is  outer ear .      Red is  middle ear .      Purple is  inner ear .


Auditory ossicles from a deep dissection of the tympanic cavity


The  organ of Corti  located at the  scala media


Lateral lemniscus  in red, as it connects the  cochlear nucleus ,  superior olivary nucleus  and the  inferior colliculus , seen from behind


Dual stream connectivity between the auditory cortex and frontal lobe of monkeys and humans.  Top: The auditory cortex of the monkey (left) and human (right) is schematically depicted on the supratemporal plane and observed from above (with the parieto- frontal operculi removed). Bottom: The brain of the monkey (left) and human (right) is schematically depicted and displayed from the side. Orange frames mark the region of the auditory cortex, which is displayed in the top sub-figures. Top and Bottom: Blue colors mark regions affiliated with the ADS, and red colors mark regions affiliated with the AVS (dark red and blue regions mark the primary auditory fields). Abbreviations: AMYG-amygdala, HG-Heschl's gyrus, FEF-frontal eye field, IFG-inferior frontal gyrus, INS-insula, IPS-intra parietal sulcus, MTG-middle temporal gyrus, PC-pitch center, PMd-dorsal premotor cortex, PP-planum polare, PT-planum temporale, TP-temporal pole, Spt-sylvian parietal-temporal, pSTG/mSTG/aSTG-posterior/middle/anterior superior temporal gyrus, CL/ ML/AL/RTL-caudo-/middle-/antero-/rostrotemporal-lateral belt area, CPB/RPB-caudal/rostral parabelt fields. Used with permission from Poliva O. From where to what: a neuroanatomically based evolutionary model of the emergence of speech in humans.   Material was copied from this source, which is available under a  Creative Commons Attribution 4.0 International License .


Image of a Vintage Acousticon Hearing Aid By Dictograph Products Company, Made in the US, Circa 1934.


A bone conduction  headset  ( GoldenDance  brand)


The DizzyFIX device


Nystagmus.


Comparison of a black standard processor for CI and a gray version for electric acoustic stimulation.


Human ear anatomy, with the cochlea "uncoiled" showing frequency mapping to different regions of the basilar membrane.


Cross-sectional view of the organ of Corti within the cochlea. The basilar membrane is labeled "basilar fiber."


A typical mammalian middle ear: sound makes the tympanum (eardrum) vibrate; 3 small bones, the malleus, incus and stapes, transmit the vibrations to the labyrinth (inner ear), which transforms the vibrations into nerve signals.


Upper and lower portions of a python skull, displaying multiple bony components of the upper and lower jaws. Courtesy of the Peabody Museum of Natural History; Division of Vertebrate Zoology; Yale University.


Mammalian and non-mammalian jaws. In the mammal configuration, the  quadrate  and  articular  bones are much smaller and form part of the middle ear. Note that in mammals the lower jaw consists of only the  dentary  bone. [ 24 ]


Morganucodontidae  and other transitional forms had both types of jaw joint:  dentary - squamosal  (front) and  articular - quadrate  (rear).


Goldschmidt tone wheel used at the Tuckerton, New Jersey transatlantic receiving station. [ 6 ]


A modern behind the ear hearing aid. The audio tube to the speaker is barely visible.


A modern behind the ear hearing aid with a minicell battery


1940s adult and child combined hearing aid glasses, on display at  Thackray Museum of Medicine . [ 26 ]


A sign in a train station explains that the public announcement system uses a "Hearing Induction Loop" ( audio induction loop ). Hearing aid users can use a telecoil (T) switch to hear announcements directly through their hearing aid receiver.


A hearing aid with an audio boot


A DAI plug on the end of a cable


Block diagram of digital hearing aid


Madame de Meuron  with ear trumpet


Hearing aid shop,  Dublin , Ireland


Logarithmic chart of the hearing ranges of some animals [ 1 ] [ 2 ]


Human hearing area in frequency and intensity. Dashed line describes possible changes due to excessive hearing strain (e.g. loud music).


An audiogram showing typical hearing variation from a standardized norm.


Outer ear ( pinnae ) of a cat


Dolphins


Howard P. House, founder


William F. House


Loudness discomfort levels (LDLs) : group data of hyperacusis patients without hearing loss. Upper line: average hearing thresholds. Lower long line: LDLs of this group. Lower short line: LDLs of a reference group with normal hearing. [ 40 ]


Hyperacusis patient wearing ear protection


Graph of a simple  sine wave


Flowchart of sound passage - outer ear


Flowchart of sound passage - middle ear


Flowchart of sound passage - inner ear


Levels of transmission of neural auditory signals


The mammalian olivocochlear bundle, divided into medial (red) and lateral (green) systems. Both contain crossed and uncrossed fibres. The predominant fibres are represented by a thicker line. The insert (far left) shows the position of the cell bodies of the MOCS and LOCS relative to the MSOC and LSOC respectively, as observed in mammals.


The basic MOC acoustic reflex. The auditory nerve responds to sound, sending a signal to the cochlear nucleus. Afferent nerve fibres cross the midline from the cochlear nucleus to the cell bodies of the MOCS (located near the MSOC), whose efferent fibres project back to the cochlea (red). In most mammals, the majority of the reflex is ipsilateral (shown as a thicker line), effectuated by the crossed MOCS.


Attentional filter depths from 12 subjects who underwent a vestibular neurectomy, for the same ear (triangles) or different ears (crosses). Combined mean (----) and 95% confidence intervals are shown. An average ~15% decline in attentional filter depth can be seen following olivocochlear bundle (OCB) lesion. Data taken from Scharf et al. (1997). [ 26 ]


Cross-section through the spiral organ of Corti at greater magnification, showing position of the hair cells on the basement membrane.


Image showing the  outer ear ,  middle ear , and  inner ear , and how sound is conducted through the outer ear, to the  ossicles  of the middle ear, through to the inner ear and the cochlea, where the organ of Corti sits.


CT scan of otosclerotic focus in the anterior footplate


Endoscopic Stapedotomy


Endocopic view of the ear with the piston inserted into the stapedotomy


Figure 3: Cross-section of the cochlea.


Figure 4: Neural tuning curve for normal hearing.


Figure 5: Neural tuning curve for OHC loss. Adapted from. [ 14 ]


Figure 6: Neural tuning curve for OHC front row loss and IHC loss. Adapted from. [ 14 ]


Figure 7: Response of the basilar membrane to a pure tone.


Figure 8: Response of the basilar membrane to a pure tone, when there is a dead region.


Figure 9: Psychoacoustical tuning curve.


Noise Exposure Limits


Tympanometry in a boy in  Cameroon .


Unterberger test: Video documentation with image overlay


A  blue plaque  at Melton Mowbray Grammar School (now  King Edward VII School ), which Chapman attended


Chapman ended several  Monty Python's Flying Circus  sketches mid-flow dressed as  The Colonel , complaining they were "too silly". [ 32 ]


Chapman lived in this house in  Highgate  with his partner David Sherlock during the 1970s.


Turner at the age of five in Wallace, Idaho [ 5 ]


Edward Norris  and Turner in  They Won't Forget  (1937), her feature film debut


Turner with  Lew Ayres  in  These Glamour Girls  (1939)


Judy Garland , Turner, and  James Stewart  on the set of  Ziegfeld Girl  (1941), which precipitated her rise at MGM


Turner in 1943


Turner performing on  Suspense  radio show, 1945


Turner as Cora Smith in  The Postman Always Rings Twice  (1946), considered by many critics to be her career-defining performance


Turner in a 1940s publicity portrait


Turner with  George Cukor  on the set of  A Life of Her Own  (1950)


Turner in  The Prodigal  (1955)


Turner and  Betty Field  in  Peyton Place  (1957), which earned Turner an  Academy Award  nomination


Turner and Stompanato in  Acapulco  on April 1, 1958, four days before he was stabbed to death by Turner's daughter


Turner (center) with ex-husband Steve Crane and mother Mildred at Cheryl's juvenile court hearing, April 24, 1958


Turner in  Imitation of Life  (1959)


Turner's role in  Madame X  (1966), earned her a  David di Donatello  Golden Plaque


Turner in  The Big Cube  (1969)


Turner in 1944


Lana Turner in a publicity still,  Metro-Goldwyn-Mayer , 1940s


Copies of the poem "Lana Turner has Collapsed" (1964) by  Frank O'Hara  at the  Museum of the City of New York


The American Academy of Otolaryngology–Head and Neck Surgery is headquartered in Old Town Alexandria, Virginia.


The American Academy of Otolaryngology–Head and Neck Surgery unveiled a new logo June 2018.


The American Board of Otolaryngology logo


Building at West Adams and South Peoria Streets in 1922


Different sections of semicircular canals.  utricle  and  saccule  are indicated by circles.


Cauliflower ear in an MMA fighter


A  rugby union  player wearing a tiger-print  scrum cap , a form of headgear used for shock absorption and protection to the head.


A mild auricular hematoma after drainage


Depiction of cauliflower ear in the  Boxer of Quirinal , circa 100–50 BC


The cochlea and vestibule, viewed from above. ( Vestibular aqueduct  labeled at bottom right.)


Tympanic cavity


Bilateral grade III microtia in a 9-year-old boy


Microtia in a 10-year-old girl with Goldenhar syndrome


Microtia in a 50-year-old woman with Saethre-Chotzen syndrome


The SRT process is associated with this logo, registered in 2019


Safety sign from the UK Government Regulations requiring ear protection


Ear pain


Inner Ear Anatomy