Sunteți pe pagina 1din 115

Anatomy of Head

1
• the superior part of the body that is attached to
the trunk by the neck.

• consists of the brain, its protective coverings,


and the ears and face.

2
The Skull

3
Cont…
• Is the collective name for the bones of the head
• Composed of separate bones united by
sutures; mandible is the only mobile bone

4
Terminology pertaining to the skull

• Cranium=skull-mandible
• Calvaria: skull cap (roof)
• Cranial base: inferior aspect of cranium
• Vertex: highest point of the skull

5
Functions
• The bones of the skull provide
• a case to house the brain, the cranium
• a framework for the face
• cavities to house the organs of sight, taste,
hearing and smell
• passages for air and food
• attachment sites for the teeth
• attachment sites for muscles of the back and
shoulder
6
• Formed by two sets of bones
• 8 cranial bones – enclose brain
• 14 facial bones – forms face
• These 22 bones combine to form the cranial cavity and
the facial features
• Two types of skull bones – based on their dev’t
• Neurocranium
• Viscerocranium
• Most bones of the skull are flat bones
• Except for the mandible, all bones are firmly united by
interlocking sutures

7
Neuro cranium
• Is the brain box (cranial vault)
• Houses the brain, cranial meninges, parts of
cranial nerves and blood vessels
• Bones grouped into:
– Flat bones:
• Single: Frontal, Occipital
• Paired: Parietal, Temporal
– Irregular bones
• Sphenoid, Ethmoid

8
• Has a dome-like roof: the
calvaria (skull cap) and a
cranial base
• The cranial vault or calvaria
forms the superior, lateral,
and posterior aspects of
skull

9
Viscero cranium

 Consists of bones of the


face (facial skeleton)
 are irregular in shape
Paired: Lacrimal, Nasal,
Maxilla, Palatine, Zygomatic,
inferior nasal conchae
Single: Mandible, Vomer

10
• Position of the skull in erect posture:
– the lower margin of the orbit and the upper
margin of the external acoustic meatus must be
on the same horizontal plane (eye-ear plane)
• This standard craniometric reference is the
orbitomeatal plane (Frankfort horizontal
plane).

11
General structure

• Facial bones form the anterior aspect


• The cranial bones enclose the brain 12
Cavities of the Skull

• In addition to the large cranial cavity there


are many smaller cavities
– Middle and inner ear cavities
– Nasal cavity
– Orbits for the eyes
– Several bones contain air filled sinuses
• Sinuses surround the nasal cavity thus
referred to as the paranasal sinuses

13
Anterior aspect of skull
• Features
– Frontal & zygomatic bones
– Orbits
– Nasal region
– Maxillae
– mandible

14
Anterior aspect of skull
Frontal bone

• Forms the anterior


portion of the cranium;
the forehead, roofs of the
orbits, and most of the
anterior cranial fossa
• Parts
– Zygomatic process
– orbital plate: forms
anterior cranial fossa

15
Frontal bone: bone markings
• Supraciliary arches - above the medial part of the orbit
• Supraorbital notch (foramen) - transmit supraorbital
nerve and vessels
• Supraorbital margin - thickening above orbits; from this
margin, frontal bone extends posteriorly to form roof of
orbit
• Frontal eminence
• Glabella
• Nasion
• Frontal sinuses
• Sutures - coronal, frontonasal, frontomaxillary,
zygomaticofrontal 16
Mandible
• Forms the lower jaw
• Largest, strongest bone of the face
• the only movable bone of the skull
• Houses lower dentition
• Two parts - the body and the two rami

17
18
19
• Internal surface
– Mylohyoid line - from inferior margin of
body to behind the last molar teeth; directs
up and backward
– Submandibular fossa - below the mylohyoid
line
– Sublingual fossa- above mylohyoid line
– Upper (alveolar) boarder - contains 16 and
10 sockets in adults and children
respectively
– Lower boarder- forms the base of the
mandible

20
21
Posterior aspect of skull
Occipital bone
• Forms most of the posterior wall and base of skull
• Articulates with parietal, temporal and the first cervical
vertebrae
• Bound foramen magnum
• Parts
– Squamous
– basilar
• Sutures:- lambdoid, occipitomastoid, sagittal
• The center of external occipital protuberance and its
most prominenet projection is called the Inion. 22
Occipital bone: landmarks
• Foramen magnum
• Occipital condyles
• External occipital protuberance
• External occipital crest
• Nuchal lines
• Superior nuchal
• Inferior nuchal line

23
24
25
Lateral aspect of skull
Parietal bones
• Forms most of the superior & lateral aspects of
the skull
• Articulates with other cranial bones to form three
major sutures
– Coronal
– Lambdoid
– Parietotemporal
• Articulates with each other at Sagittal suture
26
27
• General features
– Two curved lines on lateral surface
• Superior and inferior temporal lines -
gives attachment of epicranial
aponeurosis, temporal fascia and
temporalis muscle
• Landmarks
– Emissary foramen; located at the posterior
end of the sagittal suture (2-4 cm anterior to
the lambdoid suture )
• It connects the veins of the scalp with
superior sagittal sinus 28
Temporal Bone
• Forms
– Inferolateral aspects
of the skull
– Parts of the cranial
floor
• Divided into four
regions
– Squamous
– Tympanic
– Mastoid
– Petrous
29
Temporal Bone: Squamous part
• Anterior and superior part
• Zygomatic process: projection from
inferior part; meets the zygomatic
bone to form zygomatic arch

• Zygomatic arch - formed by the union


of processes of the temporal and
zygomatic bone; attachment for
masseter, temporal fascia and lateral
ligament of temporomandibular joint

• Mandibular fossa – inferiorly, receives


condyle of mandible to form
temporomandibular joint 30
Parietal bone

31
Temporal Bone: Mastoid part
• Posterior and inferior to ear canal
• Contains mastoid air cells
• Mastoid process - point of attachment for muscles of
neck
• Mastoid foramen – transmit emissary vein, connects the
sigmoid sinus with occipital and posterior auricular
veins.
• It transmits also meningeal occipital artery.
• Styloid process - attachment for stylopharyngeus,
stylohyoid and styloglossus muscles and ligaments -
stylohyoid and stylomandibular
32
Temporal Bone: Tympanic part
• Contains external acoustic meatus

33
Temporal Bone: Petrous part
• Contributes to the cranial floor; with sphenoid bone form
the middle cranial fossa
• Houses internal and middle ear
• Contains carotid foramen

34
35
Superior aspect of skull
Features
• Parietal eminence
• Vertex
• Parietal foramen
• Sutures
– Coronal
– Sagittal
– Lambdoid
• Meeting points of sutures
– Bregma
– Lambda

36
Sphenoid bone

• Bone spanning the width of middle cranial fossa


• Resembles bat with stretched wings
• Articulates as central wedge with all cranial bones
• Parts
– Consists of central body and two processes; greater
and lesser wings and pterygoid process

37
38
• Body
– cube shaped medial portion
– superior surface is termed as Sella turcica
• tuberculum sellae – anterior horn
• hypophyseal fossa - for pituitary gland
• dorsum sellae – posterior horn
– contain sphenoidal sinuses
• Greater wings
– forms anterolateral floor and lateral wall of middle
cranial cavity

39
• Lesser wings
– forms part of posterior floor of anterior cranial
cavity and part of orbit
• Pterygoid Processes - medial and lateral pterygoid
plates which extends inferiorly from the junction of
body and greater wings
– Pterygoid fossa - V shaped space b/n the two
pterygoid plates
• Foramina
– Optic foramina – between body and lesser wing
– Superior orbital fissure – between greater and
lesser wings
– Foramen rotundum, ovale and spinosum on
40
greater wing
41
Ethmoid bone
• Forms anterior part of cranial
floor, medial wall of orbit,
superior portion of nasal septum
and superior side wall of nasal
cavity

• Lies between nasal bones &


sphenoid

• Forms most of the area between


the nasal cavity & orbits of eyes

• Complex shape gives rise to


nasal septum, sinuses and
cribiform plate
42
Ethmoid bone: parts
• Lateral mass
– contain ethmoidal sinuses
– forms superior and middle nasal conchae
• Project into nasal cavity
• Middle part
– Perpendicular plate
• Forms superior part of nasal septum
– Cribiform plates
• Forms roof of nasal cavity
• Contains olfactory foramina for olfactory nerves
– Crista galli
• Project up ward from cribriform plate
• Attachment of the dura mater
– Orbital plates
43
• Forms medial walls of orbits
Facial bones
• Consists of 14 bones
Paired
– maxilla
– zygomatic
– palatine
– nasal
– lacrimal
– inferior nasal conchae
Unpaired - mandible and vomer
44
45
Nasal bones
• Forms bridge of the nose
• Thin, rectangular shape
• Fused medially
• Articulate with the frontal bone and maxillary
bones laterally and with nasal cartilages

46
Maxillary bone
• Forms upper jaw and central portion of facial skeleton
• Surround anterior nasal aperture and unite in medial
plane
• Articulates with all facial bones except mandible
• Forms upper dentition
• Surfaces - nasal, orbital, infratemporal, and anterior
• Parts – Body and Four processes - frontal, alveolar,
zygomatic and palatine
• Body – houses maxillary sinus

47
48
• Frontal process
– Forms lateral aspects of nose
– articulate with the frontal bone and form the medial wall of the
infraorbital border
• Alveolar process - forms socket for maxillary teeth
• Zygomatic process - articulates with zygomatic bone and
completes the infraorbital rim
• Palatine process
– Forms anterior 2/3 of hard palate
– presents median palatine suture (between the two palatine
processes of the maxilla) and incisive foramen posterior to the
maxillary central teeth (transmits nasopalatine nerve and
vessels)
• Foramina
• Infraorbital foramen – transmit Infraorbital nerve and blood
vessels to face
• Inferior orbital fissure – between greater wing and maxilla
49
Palatine Process

50
Zygomatic bones
• Commonly called the cheekbones
• Form prominences of cheeks and inferolateral
margins of orbits
• Articulate with the frontal, temporal,
sphenoidal and maxillary bones
• Three processes - frontal, temporal and
maxillary
• Two surfaces - lateral and temporal
• Foramen - Zygomaticotemporal and
Zygomaticofacial
51
52
Lacrimal Bones
• Forms part of the medial
border of each orbit
• Articulates with frontal,
ethmoid & maxillae
• Forms part of Lacrimal
fossa

53
Palatine bones
• L- shaped
• Parts
• Horizontal plate
– Forms posterior portion of
hard palate
• Vertical plate
– Forms part of the
posteriolateral walls of
nasal cavity
• Orbital surface
– Forms part of inferior
medial aspect of orbit
54
55
Vomer
• Single,
triangular bone
• Forms part of
the nasal
septum

56
57
Inferior Nasal Conchae
• Form part of lateral
walls of nasal cavity
• Project medially from
the lateral walls of
nasal cavity
• Largest of nasal
conchae
• NB: superior and
middle concha are on
the ethmoid bone

58
59
Skull joints
• Sutures
– Immovable joint between skull bones
– 4 prominent
• Coronal suture - between frontal and the two
parietal bones
• Sagittal suture - between the two parietal
bones
• Lambdoid suture - between the two parietals
and occipital bone
• Squamous suture - between parietal and
temporal bones
60
61
62
• Pterion
– Area at which bones forming the floor of the
temporal fossa articulate (frontal, parietal,
temporal and sphenoid)
– H shaped suture
– Clinically important landmark because anterior
branch of middle meningeal artery lies in a groove
on internal aspect of this area.
– Thus, it is vulnerable to tearing if there is fracture
and results in extradural hematomas which can
exert pressure on cerebral cortex

63
64
Temporomandibular joint (TMJ)
• Articulating surfaces
– Head of mandible
– Mandibular fossa and articular tubercle of the temporal
bone
• Type of joint
– Modified hinge synovial joint
• Major supportive elements of the TMJ
• muscles of mastication
• Nerve supply – Auriclotemporal and nerve to masseter
• Arterial supply – from superficial temporal
• Relations of TMJ
• Posteriorly – external acoustic meatus
• Laterally – parotid gland 65
• Medially – maxillary vessels and auriclotemporal nerve
66
Internal surface of the base of the skull (Norma
basalis interna)

1. Internal surface of the skull cap (calvaria)


Bones- frontal anteriorly,
-two parietal bones laterally and
- occipital bone posteriorly

67
Internal feature of the calvaria

68
Internal feature of the parietal bone

69
2. Internal surface of the base of the skull
Cranial fossae
• Internal aspect of cranial base
• Supports the brain
• Three cranial fossae: anterior, middle and
posterior
– Has 3 levels, each is slightly inferior to the one
anterior to it

70
Cranial Base
• Cranial base or
(basicranium) forms the
skull’s inferior aspect
• Three prominent ridges
divide the base into fossae
• The brain rests on these
cranial fossae completely
enclosed by the cranial
vault
• The brain occupies the
cranial cavity
71
72
Anterior cranial fossa
• Bones forming are
– Median part- anteriorly ethmoid bone (cribriform plate and
crista galli ) and posteriorly anterior part of body of sphenoid
– Lateral part- anteriorly orbital plate of frontal and posteriorly
lesser wing of sphenoid
General and particular features
Median part presents
• frontal crest
• crista galli
• foramen caecum - between frontal crest and crista galli
transmitting emissary veins connecting sagittal sinus with veins
of the nose and frontal sinus

73
• Cribriform plate of ethmoid- at the sides of the crista
galli, communicate cranial fossa and nasal cavity
• Anterior and posterior ethmoidal canals- communicate
orbit with cranial cavity
• Slit at the side of the crista galli- transmits anterior
ethmoidal nerves and vessels from cranial cavity to
the nasal cavity
Lateral part presents
• Anteriorly - orbital plate of frontal bone
• Posteriorly- lesser wing of the sphenoid, lateral end is
pterion and medial end is anterior clenoid process

74
75
Middle cranial fossa
Deeper than anterior cranial fossa
Bones forming are
body of sphenoid medially
laterally greater wing of sphenoid, petrous and
squamous part of temporal bone

76
Foramina

• Optic canal
• Superior orbital fissure
• Foramen rotundum
• Foramen ovale
• Foramen spinosum
• Foramen lacerum
• Carotid canal

77
78
Posterior cranial fossa
• The largest and the deepest fossa containing pons
and medulla oblongata anteriorly and cerebellum
posteriorly
Formed by
-sphenoid bone
-temporal bone
-occipital bone

79
General and particular features
• Foramen magnum
• Jugular foramen
• Hypoglossal canal
• Internal acoustic meatus
• Cerebellar fossa

80
81
Age difference in the skull bone
Skull at birth
• The cranium is large
• The bone of the face are small; it is 1/8 of the size of
the skull at birth but is 1/2 of the size of the skull in
adults
• Paranasal sinuses are absent
• The maxillae are short
• The teeth are absent
• Frontal (Metopic) suture between the two frontal bones
• Bones are connected by membranous sutures and
fontanels
82
83
Fontanels
• Membranous part of sutures
• Provide flexibility to skull
• 6 prominent
– Anterior fontanel
• Diamond shape
• At the meeting of coronal and sagittal suture
• Closes by 18 months to 2 years and is then known as the
bregma
– Posterior fontanel
• Triangular in shape, at the junction of sagittal and
lambdoid sutures
• Ossify at the 3rd month of postnatal life
84
– Anteriolateral fontanels
• Present at the meeting of parietal, frontal, greater
wing of sphenoid and squamous part of temporal
bone
• Ossify at the 3rd month of postnatal life
– Posterolateral fontanels
• Present at the meeting of parietal, mastoid part of
temporal and occipital bone
• Ossify at the 3rd month of postnatal life

85
86
The Scalp

87
Scalp
• Soft tissue covering the cranial vault
• It is hair bearing area of the skull
• Extend from supra orbital margin anteriorly to
external occipital protuberance & superior
nuchal line posteriorly
• On each side to superior temporal line
SCALP
• S-Skin
• C-connective tissue (superficial fascia)
• A-aponeurosis (galea aponeurotica)
• L-loose areolar tissue
• P-pericranium
SCALP
Skin
• Thick and hairy
• Firmly attached to the epicranial aponeurosis
through dense fascia
• Abundant sebaceous glands
• Sebaceous cyst are common
Connective tissue
• Fibrous and dense containing blood vessels and
nerves
• Binds skin to subjacent aponeurosis
• Wounds bleed profusely as blood vessels are
prevented from retraction by fibrous tissue. Bleeding
is stopped by applying pressure against the bone
• Subcutaneous hemorrhage are not extensive since
fascia is dense
• Inflammation cause little swelling but are much
painful
Aponeurosis

• Anteriorly frontal belly and posteriorly


occipital belly of occipitofrontalis muscle
• Frontal belly originate from skin of forehead
and mingled with orbicularis oculi muscle
• Occipital belly originate from lateral 2/3 of
superior nuchal line
• It gaps if cut transversely and should be
stitched
Loose areolar tissue
• Extends anteriorly into the eyelids because frontalis
has no bony attachment
• Posteriorly to superior nuchal line
• On each side to superior temporal line
• Bleeding cause generalized swelling of scalp
• Called dangerous layer of scalp-emissary veins open
here and carry any infections inside the brain (venous
sinus)
• injury to the scalp and/or the forehead Bleeding
lead to black eye in adult and Caput succedaneum
in new born.
Pericranium
• Is the periosteum of skull
• Loosely attached to surface of bone but is
firmly adherent to the sutures
• Injury deep to it take the shape of bone
(cephalhaematoma)
• Scalping injury- should be replaced and
stitched because healing is better
Nerves of the scalp
• 10 nerves on each side, 5 in front of the auricle
and 5 behind the auricle
• In front of the auricle
– Motor - temporal branch of facial nerve
– Sensory -branches of all the 3 divisions of
trigeminal
• Supraorbital nerve - branch of ophthalmic nerve
• Supratrochlear nerve - branch of ophthalmic nerve
• Zygomaticotemporal nerve - from maxillary nerve
• Auriculotemporal nerve - from mandibular nerve

96
• Behind the auricle
– Motor - posterior auricular branch of facial nerve
– Sensory - branches from C2, C3
• Great auricular nerve
• Greater occipital n. (dorsal ramus C2)
• Lesser occipital n. (ventral ramus C2 and C3)
• Third occipital n. (dorsal ramus C3)

97
98
99
100
Blood supply
• Arteries of the scalp
– numerous anastomoses between external and
internal carotid arteries
– Branches of the external carotid
• Superficial temporal
• Occipital
• Posterior auricular
– Branches of the internal carotid, via the ophthalmic
artery
• Supraorbital
• Supratrochlear
101
102
Veins of the scalp
• Veins draining into the anterior facial vein
– Supraorbital
– Supratrochlear
• Veins draining into maxillary /external jugular veins
– Superficial temporal
– Occipital
– Posterior auricular
• Emissary veins connect extra cranial veins with
venous sinuses. Infection may spread through them
into intracranial sinuses

103
Lymphatic drainage of the scalp
• Submandibular lymph nodes – forehead
• Parotid lymph nodes - from the area of the temple and
the scalp anterior the auricle
• Mastoid (retro auricular) and occipital lymph nodes -
from the scalp behind the auricle
– Mastoid lymph nodes - the upper end of the
sternocleidomastoid muscle
– Occipital lymph nodes - upper end of the trapezius
muscle

104
105
Clinical correlations
Few of the branches of arteries of the scalp cross down
to supply calvaria which is supplied by middle
meningeal artery. Thus, scalping does not produce
necrosis of cranial bone

Superficial infections of the scalp tend to remain


superficial because of the dense aponeurotic layer

Due to the denseness of this layer of the scalp, blood


vessels in this area are unable to retract or contract
when lacerated and because scalp has rich blood supply,
scalp wounds tend to bleed profusely
106
Infections in the loose subaponeurotic layer, however,
can be transmitted through bony channels by emissary
and diploic veins to the cranial cavity. Thus, this layer is
considered as dangerous area of scalp

Fluid accumulating in subaponeurtic layer cannot pass


posteriorly or laterally because of the bony attachments
of the occipitalis and galea aponeurotica to the occipital
bone and zygomatic arches.

 However, since the frontalis muscle is inserted into the


skin and not into bone, fluids can enter the eyelids and
the nasion region of the nose.

107
108
Injury to the scalp and/or the forehead
Bleeding lead to black eye in adult and Caput
succedaneum in new born.
• Caput succedaneum
Cephalhematoma

• Sometimes after a difficult birth,


bleeding occurs between the baby's
pericranium and calvaria, usually over
one parietal bone.

•Blood becomes trapped in this area,


causing a cephalhematoma. • cephalhaematoma

•This condition frequently results from


birth trauma that ruptures multiple,
minute periosteal arteries that nourish
the bones of the calvaria.
Cranial anomalies
Acrania
• In this condition the calvaria is absent and extensive
defects of the vertebral column are often present

Microcephaly
• Infants with this condition are born with normal sized
or slightly small calvaria
• Is the result of abnormal development of the CNS in
which the brain and the cranium fails to grow
• Microcephalics are severely mentally retarded
Craniosynostosis
• Premature closure of the sagittal suture, in
which the anterior fontanelle is small or
absent, results in a long, narrow, wedge-shaped
cranium, a condition called scaphocephaly
• When premature closure of the coronal or the
lambdoid suture occurs on one side only, the
cranium is twisted and asymmetrical, a
condition known as plagiocephaly
• Premature closure of the coronal suture results
in a high, tower-like cranium, called
oxycephaly .
Molding
• The softness of the
cranial bones in
infants and their
loose connections at
the sutures and
fontanelles enable
the shape of the
calvaria to change
(mold) during birth

S-ar putea să vă placă și