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I. CALVARIUM = SKULL CAP-
Consists of bones linkedby sutures
SKULL SESSION- bones rigidly connected by sutures to protect brain; attach, move eyes
FRONTAL (1)
BONES OF CALVARIUM
PARIETAL (2)
FRONTAL (1)
OCCIPITAL (1)
SPHENOID (1)
TEMPORAL (2)
NOSE
C. LANDMARKS
1. BREGMA - MID POINT OF CORONAL SUTURE
2. LAMBDA - MID POINT OF LAMBDOIDAL SUTURE
3. LAMBDOIDAL SUTURE
2. SAGITTAL SUTURE
1. CORONAL SUTURE
B. SUTURESNOSE
1. ANTERIOR FONTANELLE AT BREGMA
3. LATERAL FONTANELLE AT PTERION
2. POSTERIOR FONTANELLE - AT LAMBDA
- FONTANELLES PERMIT CRANIAL COMPRESSION AT BIRTH - CRANIAL GROWTH
D. FONTANELLES – MEMBRANES LINK BONES AT BIRTH
CORONAL SUTURELANDMARKS
3. PTERION
- JUNCTION OF TEMPORAL SPHENOID PARIETAL & FRONTAL BONES
NOSE
INTRACRANIAL HEMATOMAS
1) EPIDURAL HEMATOMA – meningeal artery, rapid
other:
2) SUBDURAL HEMATOMA – venous (bridging vein, sinus), slow
3) SUBARACHNOID HEMATOMA – cerebral artery (or vein) – aneurysm or tear, rapid if arterial
E. INTERNAL STRUCTURE OF CALVARIUM
1. INNER & OUTER TABLES - HARD CORTICAL BONE
MIDDLE LAYER - SOFT SPONGY BONE CALLED DIPLOE (DOUBLE IN GREEK)
OUTER
MIDDLEINNER
COURSE IN DIPLOE -CONNECT BOTH TO CRANIAL CAVITY & SURFACE OF SKULL
- CAN TRANSMIT INFECTION FROM SCALP TO BRAIN VIA EMISSARY VEINS
2. DIPLOIC VEINS
PARIETALEMISSARYFORAMINA
MASTOIDEMISSARYFORAMINA
1. FRONT OF SKULL
FRONTAL BONE (1)
NASAL BONES (2)
ZYGOMATIC BONE (2)-FORMS CHEEK
MAXILLARY BONE (2)-ALVEOLAR PROCESS FOR UPPER TEETH
MANDIBLE(1)-ALVEOLAR PROCESS FOR LOWER TEETH
ORBIT
EYE SOCKET
NASAL APERTURE
II. LANDMARKS AND BONES
ZYGOMATICO-FACIAL FORAMEN – IN ZYGOMATIC BONE
INFRAORBITAL FORAMEN - IN MAXILLARY BONE
MENTAL FORAMEN- IN MANDIBLE BELOW SECOND PREMOLAR TOOTH
1. FRONT OF SKULL
SUPRAORBITAL FORAMEN – INMAXILLARY BONE
ZYGOMATIC ARCH-
1)ZYGOMATIC BONE
2)MAXILLARY BONE- ZYGOMATIC PROCESS
3)TEMPORAL BONE- ZYGOMATIC PROCESS
TEMPORAL BONE - PARTS
1)MASTOID PROCESS - hard2)SQUAMOUS PART- flat 3)TYMPANIC PART - ANT. TO EXTERNAL AUDITORY MEATUS
TEMPORO-MANDIBULAR JOINT- FROM RAMUS OF MANDIBLE
2. LATERAL VIEW OF SKULL
4)PETROUS PART – inside skull
C)HARD PALATE-PALATINE BONES & PALATINE PROCESS OF MAXILLARY BONES
B)OCCIPITAL BONE- HAS FORAMEN MAGNUM- SPINAL CORD; OCCIPITALCONDYLES- FOR C1-ATLAS
OCCIPITAL CONDYLE
FORAMEN MAGNUM
4. BASE OF SKULL - COMPLEX
HARDPALATE
ANTERIOR CRANIAL FOSSA (ROOF OF NASAL CAVITY, ORBIT)
MIDDLE CRANIAL FOSSA (ORBIT, NASAL CAVITY, FACE)
POSTERIOR CRANIAL FOSSA (FACE, ORAL CAVITY, NECK)
V. CRANIAL CAVITY- DIVIDED INTO DEPRESSIONS (FOSSAE)
ANTERIOR CRAN. FOSSA -FORMED: FRONTAL, ETHMOID, SPHENOID;
CONTAINS: CNI (CRIBRIFORM PLATE), FRONTAL LOBES, OLFACTORY BULB
MIDDLE CRAN. FOSSA -FORMED: SPHENOID, TEMPORAL, PARIETAL ;
CONTAINS: CNII-VI -TEMPORAL LOBES -PITUITARY & BRAIN STEM
POSTERIOR CRAN FOSSA -FORMED: SPHENOID, TEMPORAL, OCCIPITAL, PARIETAL;
CONTAINS - CNVII-XII -CEREBELLUM, BRAINSTEM -FORAMEN MAGNUM TRANSMITS SPINAL CORD, VERTEBRAL ARTERIES
SKULL SESSION 1: FORAMINA OF INTERIOR OF SKULL AND CRANIAL NERVES
Basic facts:
1) Cranial nerves are numbered 1-12
2) Learn foramina of interior of skull in anterior-posterior sequence; this reflects numbering of cranial nerves
ANTERIOR
POSTERIOR
CRANIAL NERVES
I
II
III, IV, V1, VIV2V3Middle Meningeal A.VII, VIIIIX, X, XIXII
NOSE
I. Olfactory II. OpticIII. OculomotorIV. TrochlearV. TrigeminalVI. AbducensVII. FacialVIII. Vestibulo‑cochlear IX. GlossopharyngealX. VagusXI. Accessory XII. Hypoglossal
CRANIAL NERVES
OLFACTORYFORAMEN –CN IOLFACTORYNERVE
CRISTAGALLIOFETHMOID
OPTICFORAMEN CN IIOPTICNERVE
SUPERIORORBITALFISSURE –CN III, IVV1, VIOPHTHALMICVEINS
CAVERNOUSSINUS
SELLA TURCICA
VENOUS SINUSES
7. Cavernous sinuses - in middle cranial fossa; on side of the body of the sphenoid bone; connected by Intercavernous sinus; receive blood from Sup. and Inf. Ophthalmic veins, Cerebral veins; drain to Sup. and Inf. Petrosal sinuses
8. Sup. and Inf. Petrosal sinuses - on petrous part of temporal boneSup. drains to TransverseInf. Drains to Internal Jugular
FORAMENROTUNDUM –CN V2
FORAMENOVALE –CN V3
FORAMENSPINOSUM
F. BLOOD SUPPLY TO CALVARIUM
1) OUTER SURFACE – ARTERIES TO SCALP
2) INNER SURFACE- MENINGEAL ARTERIES
COURSE NEXT TO BONE; MISNAMED - SOUND LIKE SUPPLY MENINGES- MOST BLOOD TO BONES
OPENINGOFCAROTIDCANAL(FORAMENLACERUM)
C)HARD PALATE-PALATINE BONES & PALATINE PROCESS OF MAXILLARY BONES
B)OCCIPITAL BONE- HAS FORAMEN MAGNUM- SPINAL CORD; OCCIPITALCONDYLES- FOR C1-ATLAS
OCCIPITAL CONDYLE
FORAMEN MAGNUM
BASE OF CRANIUM FROM EXTERNAL SIDE
HARDPALATE
MEDIAL ANDLATERALPTERYGOIDPLATES
EXTERNALAUDITORYMEATUS
FORAMENOVALE
FORAMENSPINOSUM
CAROTIDCANAL –OPENS TOFORAMENLACERUMINSIDEMIDDLECRANIALFOSSA
OPENINGOFCAROTIDCANAL(FORAMENLACERUM)
INTERNAL CAROTID ARTERY: ENTERS SKULL
PASSESTHROUGHCAVERNOUSSINUS
INTERNALCAROTIDARTERY
VENOUS SINUSES
7. Cavernous sinuses - in middle cranial fossa; on side of the body of the sphenoid bone; connected by Intercavernous sinus; receive blood from Sup. and Inf. Ophthalmic veins, Cerebral veins; drain to Sup. and Inf. Petrosal sinuses
8. Sup. and Inf. Petrosal sinuses - on petrous part of temporal boneSup. drains to TransverseInf. Drains to Internal Jugular
DIAGRAM OF CAVERNOUS SINUS
SYMPATHETICS TO HEAD
- First neuronOut T1, T2
Ascends Chain
SYMPATHETICS TO HEAD
Second neuron In SuperiorCervical Ganglia
Joins Plexus onInternal and ExternalCarotid Arteries1) Unnamed branches2) Few named branchesEx. Deep Petrosal N.
PATHWAY:
- Preganglionic: OUT T1, T2
- Ascend Sympathetic Chain
- synapse in Superior Cervical Ganglion
- Postganglionic: Distributed with Arteries
Forms Plexus on Internal and ExternalCarotid Arteries
OUT SPINALCORDT1,T2
SYMPATHETICCHAIN
SUP.CERVICALGANGLION
PLEXUSON INT.CAROTID
SYMPATHETIC PLEXUS ONINTERNAL CAROTID ARTERY
CAVERNOUS SINUS SYNDROME
CAUSES
1) an aneurysm of the internal carotid artery in the cavernous sinus, 2) infection or venous thrombus (blood clot) in cavernous sinus, or by 3) pituitary tumor encroaching into sinus.
NERVES EFFECTED III, IV, V1, V2, and VI and Sympathetic fibers to orbit (travel on Internal Carotid) SPREAD OF INFECTION TO
CAVERNOUS SINUS
CAVERNOUS SINUS SYNDROME SYMPTOMS1) III- Ocular palsy (impaired eye movement)- Damage III - Dilated pupil (paralyze constrictor)- No pupillary light reflex (paralyze constrictor)- No accommodation (paralyze ciliary muscle)- Ptosis (drooping eyelid, paralyze levator palpebrae superioris)
2) V1, V2Facial pain (pressure on nerves)
3) Sympathetics on Internal Carotid
Ptosis (drooping eyelid)Miosis (constricted pupil)
SPREAD OF INFECTION TOCAVERNOUS SINUS
INTERNALAUDITORYMEATUS –VII, VIII
JUGULARFORAMEN –CN IX, X, XI
HYPOGLOSSALCANAL –CN XII
FORAMENMAGNUM
I. Olfactory II. OpticIII. OculomotorIV. TrochlearV. TrigeminalVI. AbducensVII. FacialVIII. Vestibulo‑cochlear IX. GlossopharyngealX. VagusXI. Accessory XII. Hypoglossal
CRANIAL NERVES
OPTICFORAMEN CN IIOPTICNERVE
FORAMINA OF ORBIT: OPTIC FORAMEN
OPTICFORAMENAND CANAL
SUPERIORORBITALFISSURE –CN III, IVV1, VI,OPHTHALMICVEINS
SUPERIORORBITALFISSURE
INFERIORORBITALFISSURE
SUPERIOR ORBITAL FISSURE
1) OPTIC CANAL- IN BASE OF LESSER WING OF SPHENOID BONE, CONTAINS OPTIC NERVE & OPHTHALMIC ARTERY
2) SUPERIOR ORBITAL FISSURE BETWEEN GREATER AND LESSER WINGS OF SPHENOID, CONTAINS III, IV, V1, VI, OPTHALMIC VEINS
NOSE
INFERIOR ORBITAL FISSURE
1) INFERIOR ORBITAL FISSURE- SLIT BELOW SUP. ORBITAL FISSURE: BETWEEN SPHENOID & MAXILLARY - CONNECT PTERYGOPALATINE FOSSA AND INFRATEMPORAL FOSSA WITH ORBIT - CONTAINS INFRAORBITAL AND ZYGOMATIC N., A. AND V. (V2, MAXILLARY A.)
3. MEDIAL WALL- INCLUDES MAXILLARY, LACRIMAL, ETHMOID, FRONTAL & SPHENOID (NASAL CAVITY IS MEDIAL TO MEDIAL WALL OF ORBIT)
MAXILLARY
LACRIMAL
ETHMOIDSPHENOID
BONES OF ORBIT
FRONTAL
NOSE
2) ANT. & POST. ETHMOIDAL FORAMINA- BETWEEN ETHMOID & FRONTAL BONES -CONNECT ORBIT & NASAL CAVITIES -CONTAIN ANT & POST ETHMOIDAL N., A. & V. (V1 & OPHTHALIC A.)
ANTERIOR AND POSTERIOR ETHMOIDAL FORAMINA
OPENING OF 3) NASOLACRIMAL DUCT- IN MAXILLARY, LACRIMAL BONES & INF. NASAL CONCHA -CONTAINS MEMBRANEOUS NASOLACRIMAL DUCT & TEARS
NASOLACRIMAL DUCT
NASOLACRIMAL DUCT
ORBIT- SERVES AS PASSAGEWAY FOR NERVES, VESSELS TO FACE, SCALP & NASAL CAVITY
1) SUPRAORBITAL NOTCH OR FORAMEN-IN FRONTAL BONE CONTAINS SUPRAORBITAL N., A. and V. FROM V1, OPTHALMIC A. and V.
2) INFRAORBITAL FORAMEN- IN MAXILLARY BONE CONTAINS INFRAORBITAL N., A. and V. FROM V2 & MAXILLARY
OTHER FORAMINA OF ORBIT