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• the superior part of the body that is attached to
the trunk by the neck.
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The Skull
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Cont…
• Is the collective name for the bones of the head
• Composed of separate bones united by
sutures; mandible is the only mobile bone
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Terminology pertaining to the skull
• Cranium=skull-mandible
• Calvaria: skull cap (roof)
• Cranial base: inferior aspect of cranium
• Vertex: highest point of the skull
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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
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• 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
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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
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• 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
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Viscero cranium
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• 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).
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General structure
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Anterior aspect of skull
• Features
– Frontal & zygomatic bones
– Orbits
– Nasal region
– Maxillae
– mandible
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Anterior aspect of skull
Frontal bone
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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
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• 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
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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
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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
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• 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
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Temporal Bone: Squamous part
• Anterior and superior part
• Zygomatic process: projection from
inferior part; meets the zygomatic
bone to form zygomatic arch
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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
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Temporal Bone: Tympanic part
• Contains external acoustic meatus
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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
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Superior aspect of skull
Features
• Parietal eminence
• Vertex
• Parietal foramen
• Sutures
– Coronal
– Sagittal
– Lambdoid
• Meeting points of sutures
– Bregma
– Lambda
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Sphenoid bone
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• 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
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• 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
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greater wing
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Ethmoid bone
• Forms anterior part of cranial
floor, medial wall of orbit,
superior portion of nasal septum
and superior side wall of nasal
cavity
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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
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• 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
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Palatine Process
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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
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Lacrimal Bones
• Forms part of the medial
border of each orbit
• Articulates with frontal,
ethmoid & maxillae
• Forms part of Lacrimal
fossa
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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
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Vomer
• Single,
triangular bone
• Forms part of
the nasal
septum
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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
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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
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• 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
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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
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Internal surface of the base of the skull (Norma
basalis interna)
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Internal feature of the calvaria
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Internal feature of the parietal bone
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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
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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
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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
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• 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
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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
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Foramina
• Optic canal
• Superior orbital fissure
• Foramen rotundum
• Foramen ovale
• Foramen spinosum
• Foramen lacerum
• Carotid canal
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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
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General and particular features
• Foramen magnum
• Jugular foramen
• Hypoglossal canal
• Internal acoustic meatus
• Cerebellar fossa
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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
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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
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– 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
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The Scalp
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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
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• 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)
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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
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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
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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
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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
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Injury to the scalp and/or the forehead
Bleeding lead to black eye in adult and Caput
succedaneum in new born.
• Caput succedaneum
Cephalhematoma
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