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Skull Yu-Qiang Ding, M.D., Ph.D. 丁玉强 [email protected] 1 Head 头 Conceptual view The head is composed of a series of compartments that are formed by bone and soft tissues. 2 The cranial cavity Two ears Two orbits Two nasal cavities An oral cavity The cranial cavity contains the brain 脑 and associated membrane (meninges) Two ears 耳:external ears are visible, but internal ears are embedded in a bone. Two orbits 眶 contain the eyes. The apex of cone-shaped chambers are directed posteriomedially. 3 Two nasal cavities 鼻腔 are the upper part of the respiratory tract. The anterior openings are nares (nostrils), and posterior one is choanae (post. nasal aperture). 4 Two nasal cavities 鼻腔 are the upper part of the respiratory tract. Air-filled extensions are paranasal sinuses. 5 An oral cavity口腔 is separated from the nasal cavity by the palates. Unlike nasal cavity, the openings (oral fissure and oropharyngeal isthmus) can be opened and closed. 6 The face面 and Scalp头皮 Muscles of the facial expression adjust the contours of the face to relay non-verbal signals. 7 Scalp Clinical note: abundant blood supply and serious bleeding. 8 Skull Many bones of the head collectively form the skull. Most of them are interconnected by sutures, which are immovable fibrous joints. 9 Clinical note about the sutures (fontanelle 囟) In the fetus and newborn, large membranous and unossified gaps (fontanelles) between the large flat bones that cover the top of the cranial cavity, allowing its passage through the birth canal and postnatal growth. Bregma and Lambda in adulthood. 10 Twenty two bones, excluding the ossicles of the ear. Except for the mandible, which forms the lower jaw, the bones of the skull attach to each other. 11 An upper domed part: calvaria 颅顶 (corresponds to the scalp) A lower anterior part: facial skeleton (corresponds to the face) 12 13 Anterior view Frontal bone额骨 Ceiling of the orbit Superciliary arch Supra-orbital notch Inferiolaterally, one process connects to zaygomatic bone Inferiomedially, articulates with the nasal bone and the frontal process of the maxilla. 14 Anterior view (I) Zygomatic bone 颧骨 (cheek bone) Lateral and inferior rims of the orbit 15 Anterior view (II) Nasal bone 鼻骨 Medial to the frontal process of the maxilla. Contribute to the piriform aperture, large opening of bony nasal cavity. 16 Anterior view (III) Maxilla上颌骨 Inf. rim of the orbit Lateral wall of the nasal cavity Piriform aperture Bony nasal septum A paired inferior nasal concha. 17 Anterior view (IV) Maxilla上颌骨 Inf. rim of the orbit Lateral wall of the nasal cavity Two processes: Laterally: zygomatic Superiorly: frontal processes. Body: inferior end is the alveolar process containing the teeth. Infra-orbital foramen 18 Anterior view (IV) Mandible下颌 骨 (lower jaw) Body, anteriorly, base + alveolar part. Ramus, posteriorly, Ant. and post. processes. 19 Anterior view (V) Mandible下颌 骨 (lower jaw) Body anteriorly, base + alveolar part. Ramus posteriorly, Ant. and post. processes. Condylar process:joint with temporal bone Coronoid process: muscle attachment 20 21 Lateral view Lat. portion of calvaria Upper part: Frontal, parietal, occipital bones Lower part: great wing of sphenoid bone 蝶骨 squamous part of temporal bone 颞骨. 22 Lateral view (I) Pterion 翼点: Four bones are in close proximity. Bones are thin, and overlay middle meningneal artery in the inner surface. Skull fracture here leads to serious consequences, because this artery may be torn resulting in an extra-dural hematoma. 23 Lateral view (II) The middle mengingeal artery: Arises from external carotid artery, enter the skull through the foramen spinosum, goes vertically in a upward direction, crossing the pterion during its course. Temporal bone颞骨 Squamous part: Lateral wall of cranium. Zygomatic process: project laterally and then anteriorly, form zygomatic arch with temporal process of zygomatic bone. 25 Lateral view (III) Temporal bone 颞骨 Tympanic part鼓部: external acoustic opening leading to external ear canal. Mastoid part乳突部: posteriorly, Petrous part岩部: Body-invisible Inferiorly, a long process called styloid process Mandibular fossa: articulate with condylar process of mandible. 26 Lateral view (IV) clinical note: Big laugh may lead to a big anterior movement of condylar process out of the mandibular fossa. 27 Lateral view (III) Temporal fossa Contains temporalis muscle (coronoid process of mandible) , which raises the mandible and thus close the jaw. Masseter muscle Lateral view (V) 28 Posterior view 29 Occipital bone 枕骨 Like temporal bone, also has a big squamous part. Several bony land markers, e.g. external occipital protuberance. 30 Posterior view (I) Inferior view 31 Ant. Part Alveolar process 牙槽突 Hard palate : two components: (1) palatine process of Maxilla (2) horizontal process of palatine bone Palatine bone: L-shaped Vertical part: lateral wall of bony nasal cavity Horizontal part: hard palate 32 Clinical Note Hard palate 硬腭: two components: (1) palatine process of Maxilla (2) horizontal process of palatine bone Cleft palate Caused by a failure of fusion of two maxilla processes during embryonic development. 33 Inferior view (II) Middle part 1. Vomer 犁骨: in midline, resting on the sphenoid bone, post. part of bony nasal septum. 2. Sphenoid 蝶骨;centrally located, looks like butterfly. body, greater and lesser wings, pterygoid process 34 Sphenoid 蝶骨 Body: centrally placed cube of bone containing two air sinuses separated by a septum. Greater and lesser wings: Sup. view project from the body laterally Pterygoid process 翼突: project downward from the body Post. view Inf. view 35 Post. Part Occipital bone枕 骨 Basilar part: posterior to the body of the sphenoid. More posteriorly, foramen magnum. Laterally is bounded by the temporal bones. Occipital condyle: articulate with the first cervical vertebrate. Hypoglossal canal 36 Inferior view (III) Temporal bone Inferior view (IV) Petrous part: Wedge-shaped, its apex is located between the greater wing and basilar part; forms one of the boundaries of the foraman lacerum, an irregular opening filled with cartilage in life. 37 Temporal bone 颞骨 Tympanic part鼓部: external acoustic opening leading to external ear canal. Mastoid part乳突 部: posteriorly, Petrous part岩部: Body-invisible Inferiorly, a long process called styloid process Mandibular fossa: articulate with condylar process of mandible. 38 Lateral view (IV) Temporal bone Inferior view (IV) Petrous part: Wedge-shaped, its apex is located between the greater wing and basilar part; forms one of the boundaries of the foraman lacerum, an irregular opening filled with cartilage in life. Carotid canal: circular opening for carotid artery entering the skull. Jugular foramen: jugular (vein) and cranial nerves exit the cavity . 39 Cranial cavity Roof: dome-shaped. Consists of the fontal bone anteriorly, paired parietal bone in the middle, and the occipital bone posteriorly. 40 Cranial cavity 颅腔 The floor of the cavity is divided into ant. middle and post. fossae. Anterior cranial fossa: 1. Orbital part of the frontal bone: ceiling of the orbits 2. A small wedge-shaped Ethmoid bone 筛骨: Ceiling of the nasal cavity Crista galli (cockscomb) in the middle (attachment for the falx cerebrum) Cribriform plate, laterally, 41 Anterior cranial fossa (I) Anterior cranial fossa: 3. Lesser wing of sphenoid Ant. clinoid process: widens and curves posteriorly. Optic canal: through which optic N pass as it exit the cavity to enter the orbit. located anterior to the anterior clinoid process. 42 Middle cranial fossa (II) Inner surface of two bones: sphenoid and temporal bones 1. Body of the Sphenoid bone: : Anterior part: elevated, called chiasmatic sulcus The reminder: sella turcica Middle: hypophysial fossa, in which the pituitary gland is located. 43 Middle cranial fossa (III) Fissure and foramina in the greater wing of Sphenoid bone : Superior orbital fissure: between great and lesser wings; a major passageway to orbit; several cranial nerves innervating the eyeballs pass through. foramen rotundum: V2 foramen ovale: V3 foramen spinosum: a artery pass through intracranial opening of carotid canal: dorsal to the foramen lacerum 44 Middle cranial fossa (III) Upper surface of the Temporal bone: Tegmen tympani and Arcuate eminence (middle ear) Trigeminal impression (trigeminal ganglion) 45 Posterior cranial fossa 1. Posterior surface of the petrous part of the temporal bone internal acoustic meatus, jugular foramen (anterior to the occipital bone) 2. Occipital bone: 46 Clivus, groove and crest, hypoglossal canal lateral to the condyle in the inf. Surface. Vertebra and vertebral column Functions Support the body’s weight, transmit forces through the pelvis to the lower limbs, carry and position the head, and brace and help maneuver (move) the upper limbs. 47 Curvatures The two primary curvatures of the vertebral column: 1. Concave anteriorly. 2. Original shape of embryos 3. Retained in the thoracic and pelvic regions in adult. 48 Curvatures The two primary curvatures of the vertebral column: 1. Concave anteriorly. 2. Original shape of embryos 3. Retained in the thoracic and pelvic regions in adult. The two secondary curvatures of the vertebral column: Concave posteriorly; in the cervical and lumbar regions Bring the center of the body into a vertical line, which allows the body’s weight to be balanced 49 Movement Although the amount of movement between any two vertebrae is limited, the effects between vertebrae are additive along the length of the column. 50 More important function: Protection of the spinal cord 51 Bones 7 cervical, 12 thoracic, 5 lumbar, 5 sacral and 3-4 coccygeal vertebrae. Sacral vertebrase fuse into a single bony element, the sacrum. Coccygeal vertebrae are rudimentary (loss of use) in structure, vary in number, and often fuse into a single coccyx. 52 A typical vertebra Consists of a Body and a Vertebral arch. 1. Body: the major weight-bearing component, increase in size from C1 to L5. 2. Arch: anchored to the body by two pedicles, two laminase form the roof of the arch and fused in the middle. 3. Body and Arch form a bony canal, vertebral canal 53 Projections from the Arch 1. Spinous process, posterioly 2. Transverse process, laterally 3. Superior and Inferior articular process, with similar processes on adjacent vertebrae. 54 Intervertebral foramen 1. Allows spinal nerve and blood vessel, to pass in and out of the vertebral canal. 2. Formed by the adjacent sup. notch and inf. notch. 55 A typical vertebra Consists of a Body and a Vertebral arch. 1. Body: the major weight-bearing component, increase in size from C1 to LV. 2. Arch: anchored to the body by two pedicles, two laminase form the roof of the arch and fused in the middle. 3. Body and Arch form a bony canal, vertebral canal 56 57 A typical cervical vertebra 1. Body: short in height and square shaped. 2. Transverse process perforated by a round foramen transversarium (for a artery going into skull) 3. Spinous process: short and bifid 58 C1 (atlas) and C2 (axis) C1: lacks the body, ring- shaped, two large lateral mass (facet for occipital condyle) interconnected by an ant. arch and post. arch. Atlanto-occipital joint: allows the head to node up or down. C2: a Dens from the body, which form atlanto-axial joint with facet for dens in C1, allows the head to rotate. 59 60 Vertebra prominens 61 A typical thoracic vertebra 1. Articulation with ribs: Body: with head of ribs, superior or inferior demifacet Transverse process: facet for articulation with tubercle of rib 62 63 Sacrum 1. Triangular in shape with the apex pointed inferiorly. 2. Two large L-shaped facet on each lateral surface, for articulation with pelvic bone. 3. Ant. and Post. Sacral foramen (foramina). 64 Joints Symphysis (fused) between the bodies: inter-vertebral joint Synovial joints between articular processes. 65 Intervertebral disc: Intervertebral joint Anulus fibrosus: circular fibrocartilage Nucleus pulposus: gelatinous, absorbs compression forces 66 Intervertebral joint Clinical Note: Degenerative changes in the anulus fiberosus can lead to herniation of the nucleus, and posteriolateral herniation can impinge the spinal nerve root leading to back pain. 67 Ligaments Ant. & post. longitudinal ligaments 68 Ligaments Ligament flava (yellowish): on each side, pass between the laminae of adjacent verbebrae. 69 Supraspinous ligament Connect and passes along the tips of the spinous processes Ligamentum nuchae: (nucha --- nape) The most predominant one, a triangular, sheet-like structure in the median sagittal plane 70