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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