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SKULL SESSION- bones rigidly connected by
sutures to protect brain; attach, move eyes
I. CALVARIUM
= SKULL CAPConsists of
bones linked
by sutures
FRONTAL (1)
BONES OF CALVARIUM
PARIETAL (2)
FRONTAL
(1)
SPHENOID (1)
OCCIPITAL (1)
TEMPORAL (2)
NOSE
NOSE
B. SUTURES
1. CORONAL
SUTURE
2. SAGITTAL
SUTURE
3. LAMBDOIDAL
SUTURE
C. LANDMARKS
1. BREGMA - MID
POINT OF CORONAL
SUTURE
2. LAMBDA - MID
POINT OF
LAMBDOIDAL
SUTURE
D. FONTANELLES – MEMBRANES LINK
BONES AT BIRTH
1. ANTERIOR
FONTANELLE
AT BREGMA
- FONTANELLES PERMIT
CRANIAL
COMPRESSION AT
BIRTH - CRANIAL
GROWTH
2. POSTERIOR
FONTANELLE AT LAMBDA
3. LATERAL
FONTANELLE
AT PTERION
CORONAL SUTURE
LANDMARKS
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
OUTER
INNER
MIDDLE
1. INNER & OUTER TABLES - HARD
CORTICAL BONE
MIDDLE LAYER - SOFT SPONGY BONE
CALLED DIPLOE (DOUBLE IN GREEK)
2. DIPLOIC VEINS
COURSE IN
DIPLOE CONNECT BOTH
TO CRANIAL
CAVITY &
SURFACE OF
SKULL
- CAN TRANSMIT INFECTION FROM SCALP TO
BRAIN VIA EMISSARY VEINS
PARIETAL
EMISSARY
FORAMINA
MASTOID
EMISSARY
FORAMINA
II. LANDMARKS AND BONES
1. FRONT OF SKULL
FRONTAL BONE (1)
NASAL BONES (2)
ORBIT
EYE
SOCKET
NASAL
APERTURE
ZYGOMATIC BONE (2)FORMS CHEEK
MAXILLARY BONE (2)ALVEOLAR PROCESS
FOR UPPER TEETH
MANDIBLE(1)-ALVEOLAR
PROCESS FOR LOWER
TEETH
1. FRONT OF SKULL
SUPRAORBITAL FORAMEN – IN
MAXILLARY BONE
ZYGOMATICO-FACIAL FORAMEN
– IN ZYGOMATIC BONE
INFRAORBITAL FORAMEN - IN
MAXILLARY BONE
MENTAL FORAMEN- IN MANDIBLE
BELOW SECOND PREMOLAR
TOOTH
2. LATERAL VIEW OF SKULL
ZYGOMATIC ARCH1)ZYGOMATIC BONE
2)MAXILLARY BONEZYGOMATIC PROCESS
3)TEMPORAL BONEZYGOMATIC PROCESS
TEMPORAL BONE - PARTS
1)MASTOID PROCESS - hard
2)SQUAMOUS PART- flat
3)TYMPANIC PART - ANT. TO
EXTERNAL AUDITORY
MEATUS
4)PETROUS PART – inside skull
TEMPORO-MANDIBULAR JOINTFROM RAMUS OF MANDIBLE
4. BASE OF SKULL - COMPLEX
HARD
PALATE
OCCIPITAL CONDYLE
FORAMEN
MAGNUM
C)HARD PALATEPALATINE BONES &
PALATINE PROCESS OF
MAXILLARY BONES
B)OCCIPITAL BONEHAS FORAMEN
MAGNUM- SPINAL
CORD;
OCCIPITALCONDYLESFOR C1-ATLAS
V. CRANIAL CAVITY- DIVIDED INTO
DEPRESSIONS (FOSSAE)
ANTERIOR CRANIAL
FOSSA (ROOF OF
NASAL CAVITY, ORBIT)
MIDDLE CRANIAL
FOSSA (ORBIT, NASAL
CAVITY, FACE)
POSTERIOR CRANIAL
FOSSA (FACE, ORAL
CAVITY, NECK)
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 anteriorposterior sequence; this reflects numbering of
cranial nerves
ANTERIOR
NOSE
CRANIAL NERVES
I
II
III, IV, V1, VI
V2
V3
Middle Meningeal A.
VII, VIII
IX, X, XI
XII
POSTERIOR
CRANIAL NERVES
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulo-cochlear
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal
CRISTA
GALLI
OF
ETHMOID
OLFACTORY
FORAMEN –
CN I
OLFACTORY
NERVE
OPTIC
FORAMEN
CN II
OPTIC
NERVE
SUPERIOR
ORBITAL
FISSURE –
CN III, IV
V1, VI
OPHTHALMIC
VEINS
CAVERNOUS
SINUS
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 bone
Sup. drains to Transverse
Inf. Drains to Internal Jugular
FORAMEN
ROTUNDUM –
CN V2
FORAMEN
OVALE –
CN V3
FORAMEN
SPINOSUM
F. BLOOD SUPPLY TO CALVARIUM
1) OUTER SURFACE –
ARTERIES TO SCALP
2) INNER SURFACEMENINGEAL ARTERIES
COURSE NEXT TO
BONE;
MISNAMED - SOUND
LIKE SUPPLY
MENINGES- MOST
BLOOD TO BONES
OPENING
OF
CAROTID
CANAL
(FORAMEN
LACERUM)
BASE OF CRANIUM FROM EXTERNAL SIDE
HARD
PALATE
OCCIPITAL CONDYLE
FORAMEN
MAGNUM
C)HARD PALATEPALATINE BONES &
PALATINE PROCESS OF
MAXILLARY BONES
B)OCCIPITAL BONEHAS FORAMEN
MAGNUM- SPINAL
CORD;
OCCIPITALCONDYLESFOR C1-ATLAS
MEDIAL AND
LATERAL
PTERYGOID
PLATES
EXTERNAL
AUDITORY
MEATUS
FORAMEN
OVALE
FORAMEN
SPINOSUM
CAROTID
CANAL –
OPENS TO
FORAMEN
LACERUM
INSIDE
MIDDLE
CRANIAL
FOSSA
OPENING
OF
CAROTID
CANAL
(FORAMEN
LACERUM)
INTERNAL CAROTID ARTERY: ENTERS SKULL
PASSES
THROUGH
CAVERNOUS
SINUS
INTERNAL
CAROTID
ARTERY
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 bone
Sup. drains to Transverse
Inf. Drains to Internal Jugular
DIAGRAM OF CAVERNOUS SINUS
SYMPATHETICS TO HEAD
- First neuron
Out T1, T2
Ascends
Chain
SYMPATHETICS TO HEAD
Second neuron In
Superior
Cervical Ganglia
Joins Plexus on
Internal and External
Carotid Arteries
1) Unnamed branches
2) Few named branches
Ex. Deep Petrosal N.
PLEXUS
ON INT.
CAROTID
SUP.
CERVICAL
GANGLION
SYMPATHETIC PLEXUS ON
INTERNAL CAROTID ARTERY
PATHWAY:
- Preganglionic: OUT T1, T2
SYMPATHETIC
CHAIN
- Ascend Sympathetic Chain
- synapse in Superior Cervical Ganglion
OUT
SPINAL
CORD
T1,T2
- Postganglionic: Distributed with
Arteries
Forms Plexus on Internal and External
Carotid Arteries
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
SPREAD OF INFECTION TO
CAVERNOUS SINUS
III, IV, V1, V2, and VI and
Sympathetic fibers to orbit
(travel on Internal Carotid)
CAVERNOUS SINUS SYNDROME SYMPTOMS
1) 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)
SPREAD OF INFECTION TO
CAVERNOUS SINUS
2) V1, V2
Facial pain (pressure on nerves)
3) Sympathetics on Internal Carotid
Ptosis (drooping eyelid)
Miosis (constricted pupil)
INTERNAL
AUDITORY
MEATUS –
VII, VIII
JUGULAR
FORAMEN –
CN IX, X, XI
HYPOGLOSSAL
CANAL –
CN XII
FORAMEN
MAGNUM
CRANIAL NERVES
I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulo-cochlear
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal
OPTIC
FORAMEN
CN II
OPTIC
NERVE
FORAMINA OF ORBIT: OPTIC FORAMEN
OPTIC
FORAMEN
AND CANAL
SUPERIOR
ORBITAL
FISSURE –
CN III, IV
V1, VI,
OPHTHALMIC
VEINS
SUPERIOR ORBITAL FISSURE
SUPERIOR
ORBITAL
FISSURE
INFERIOR
ORBITAL
FISSURE
2) SUPERIOR
ORBITAL
FISSURE
BETWEEN
GREATER AND
LESSER
WINGS OF
SPHENOID,
CONTAINS III,
IV, V1, VI,
OPTHALMIC
VEINS
1) OPTIC
CANAL- IN
BASE OF
LESSER
WING OF
SPHENOID
BONE,
CONTAINS
OPTIC NERVE
&
OPHTHALMIC
ARTERY
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.)
BONES OF ORBIT
3. MEDIAL WALL- INCLUDES MAXILLARY,
LACRIMAL, ETHMOID, FRONTAL & SPHENOID
(NASAL CAVITY IS MEDIAL TO MEDIAL WALL
OF ORBIT)
FRONTAL
SPHENOID
ETHMOID
LACRIMAL
MAXILLARY
NOSE
ANTERIOR AND POSTERIOR
ETHMOIDAL FORAMINA
2) ANT. & POST.
ETHMOIDAL
FORAMINABETWEEN ETHMOID
& FRONTAL BONES CONNECT ORBIT &
NASAL CAVITIES CONTAIN ANT &
POST ETHMOIDAL
N., A. & V. (V1 &
OPHTHALIC A.)
NASOLACRIMAL DUCT
OPENING OF 3)
NASOLACRIMAL
DUCT- IN
MAXILLARY,
LACRIMAL BONES
& INF. NASAL
CONCHA CONTAINS
MEMBRANEOUS
NASOLACRIMAL
DUCT & TEARS
NASOLACRIMAL DUCT
OTHER FORAMINA OF ORBIT
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