Head & Neck Anatomy

The Skull
The Facial Bones The Cranial Vault and The Cranial Base The Cranial Fossae

Done By : Mu'ad Al-Zou'bi

For the facial bones that provide the shape of the face, all of them are paired except the vomer bone and the mandible which are single, the facial bones are fourteen (14) bones divided as the following:

Lacrimal Bone Vomer Bone Maxilla

Nasal Bone Zygomatic Bone Inferior Concha

Mandible

1- The two zygomatic bones (in the area of the zygoma). 2- The two maxillary (single: maxilla, plural: maxillae) bones which fuse together to form the upper jaw. 3- The two nasal bones which are two small plates on the bridge of the nose (i.e the upper part of the nose), those bones are the most common bones to be fractured in the skull because of the prominence of the nose (as when somebody falls down on his face, the first part to be hit is the nose) and because they are small. 4- The two lacrimal bones (they are named like this because the lacrimal sacs lie over them), in the orbital cavity, the eyeball is located (the vision system) also the lacrimal system is there, the lacrimal apparatus is composed of the lacrimal gland which is located in the upper lateral aspect of the orbit and secretes the tears, the tears will drain down from the upper lateral aspect of the orbit crossing the eyeball and rinse the eyeball and gathered in the inferior medial corner or the orbit, here is located the lacrimal sac which collect the tears, once this sac is filled, the tears start to drop down from the eye and that's why the first area where they start to drop is the the medial corner of the orbit because the lacrimal sac is there, in the lacrimal bone there is a depression or fossa containing the lacrimal sac.

5- The vomer bone (vomer is a Latin word that means the plowshare), when you look at this bone in a way or another it looks sharp and triangular in shape resembling the plowshare, it's also referred to as the plowshare bone, it forms the lower part of the nasal septum which separate the nose into right and left cavities (recall that the upper part of the nasal cavity is formed by the perpendicular plate of ethmoid bone).

Vomer Bone

6- The two palatine bones (which contribute to the hard palate) are very small and are located behind the maxillary bones, they are considered as facial bones because they contribute to the hard palate,the palate is divided into two parts, the bony part which is the hard palate forming about 3/4 of the palate and the soft palate behind it which is composed only from muscles (soft tissue) and forming about 1/4 of the palate, the hard palate is composed of the maxillary and the palatine bones

Maxillary Bone Palatine Bone

Palatine Bone

7- The two inferior conchae (singular: concha, concha means scroll or shelf), they are small shelves of bone which go down from the lateral wall of the nasal cavity, the majority of the air sinuses open into the lateral wall of the nose, the conchae protect the openings of the paranasal sinuses, the conchae are of three types (three pairs of conchae), the superior conchae which are not visible upon the anterior view of the skull because it's hidden by the nasal bones, the middle conchae and the inferior conchae, the superior and the middle conchae are parts of the ethmoid bone whereas the inferior conchae are separate bones by themselves, thery're not parts of any other bone (formed separately) and classified as parts of the facial skeleton bones

Middle Concha Inferior Concha

A coronal section through the face

Superior Concha Middle Concha

Inferior Concha

8-The last bone of the facial skeleton is the mandible, the strongest facial bone, yet, it's the second most to be fractured after the nasal bone as noted before because it's the only movable bone of the skull.

The term cranium represents the skull without the mandible, this is for you to know scientifically what's the difference between the word "cranium" and the word "skull", so, the cranium consists of twenty one (21) bones, but now, most clinicians refer to the skull as the cranium or the cranium as the skull (as if there was no difference).

The Cranium The neurocranial bones (which are discussed in the previous lecture) are eight bones which gather to form a box or a case, within this box, the brain is located, and the cavity that forms inside the this case is called the cranial cavity because it's covered by the cranial bones.(remember that a cavity is a completely covered space whereas the fossa is a depression and not completely covered, it has no roof and sometimes it doesn't have lateral walls). In anatomy the neurocranial part of the skull (i.e. the braincase) is divided into the cranial vault or the calvaria (the roof plus the lateral sides of the cranial cavity) and the cranial base (the floor of the cranial cavity).

Cranial Vault

The Cranial Base (Superior view)

The cranial vault is made of the frontal bone1, the parietal bones2, the squamous part of the occipital bone3, the squamous part of the temporal bones4 and the greater wings of sphenoid bone5 (squamous = flat).

Parietal Bone Squamous Temporal Bone Squamous Occipital Bone

Frontal Bone Greater Wing of Sphenoid Bone

The cranial base is made of the orbital part of the frontal bone1 (the roof of the orbit), the cribriform plate of the ethmoid bone in the middle2, parts of the sphenoid bone3 (the greater wings, the lesser wings, the body of the sphenoid bone or the roof of the body which is called the sella turcica, actually, you can see most of the sphenoid bone), the petrous part of the temporal bone4 (petrous means rocky, it's named like this because it goes up like a rocky mountain) inside this part of the temporal bone, the middle and the inner ear are located and because of this a swelling is formed within the temporal bone forming the petrous part, and the basilar part of the occipital bone5.

Orbital Part of Frontal Bone Cribriform plate of Ethmoid Bone Sphenoid Bone Petrous Temporal Bone

Basilar Occipital Bone

On the occipital bone which forms the back of the head, a prominence is present, this is called the external occipital protuberance (or the inion), this represents the demarcating line between the basilar and the squamous parts of the occipital bone.

The EOP The EOP 6

The occipital bone is made of three parts, the squamous1, the basilar2 and the condylar3 parts, the condylar part is composed of two smooth elevations that are called the occipital condyles (in anatomy, condyle means smooth round elevation, but this elevation is not rough as a tubercle), an elevation in bone is caused by an attachment, e.g. a ligament or a tendon pulling and forming this elevation (remember, tubercle: short and narrow elevation, tuberosity: short and wide elevation, for example the muscle attachment is large or more than a muscle attach to the bone, process: long elevtion), the condyle is different from those (i.e. process, tubercle and tuberosity) in that it's specialized, it's smooth and rounded because it participates in a joint formation, it's smooth and rounded to make the movements easy (it has nothing to do with muscle or ligament attachment), an example is the head of the mandible (mandibular condyle), the occipital condyles are very important because they connect the whole skull with the first vertebra in the vertebral column (i.e. the atlas, the first cervical vertebra or the C1).

4 3 2 1

1 = The Squamous Occipital Bone. 2 = The External Occipital Protuberance (EOP). 3 = The Basilar Occipital Bone. 4 = The Occipital Condyle. 5 = The Atlanto-occipital Joint.

1 2 3

1 2 3

When you look at the cranial vault (or the calvaria) from above (a superior view), you will find three important sutures (the sutures are the fibrous joints between the neurocranial bones in the calvaria) and four important intersections (points). The three sutures are: 1- The coronal sutures, lies in the coronal plane from side to side, it joins the frontal bone anteriorly with the two parietal bones behind. 2- The sagittal suture, lies in the sagittal plane from anterior to posterior, it joins the two parietal bones. 3- The lambdoid suture, it resembles the Greek letter lambda () it's like an inverted V, it joins the occipital bone with the two parietal bones. There are other sutures which are named by the contributing bones such as the squamous suture wich joins the squamous part of the temporal bone with the parietal bone, the occipitotemporal suture which joins the temporal bone to the occipital bone, but the main three ones that you should know are those noted above.
The joints are classified into three main types: 1- Fibrous joint : bone-bone with some collagen fibers in between, hence the name fibrous, it permits no movement. (Examples: sutures of the skull and the inferior tibiofibular joint). 2- Cartilaginous joint : bone-cartilage-bone, it's subdivided into primary (no movement) and secondary cartilaginous, which permits a little movement. 3- Synovial joints : bone-space-bone, it permits a free range of movement, the majority of the joints in the human body are of this type.

The four important intersections or points between these sutures, these are depended on by the orthodontists and the maxillofacial specialists, there are certain distances between these point when doing a surgery or an orthodontic procedure, these point are : 1- The bregma (a Latin word that means the forehead), it's located in the forehead and determines the beginning of the forehead, it's the intersection between the sagittal and coronal sutures. 2- The lambda, is the intersection between the sagittal and the lambdoid suture i.e. between the occipital and the parietal bones. 3- The vertex, in the middle of the sagittal suture, it's the superior topmost point of the skull, it's the point where the gauge has to hit to measure your height. 4- The pterion, located at the side of the vault (not the roof),(pterion is a Greek word which means wing), it's named like this because it's located on the lateral side, like a wing, the area of the pterion is demarcated by the Hshaped suture, a suture formed between the temporal and the sphenoid, the sphenoid and the frontal, the frontal and the parietal, the parietal and the temporal, the parietal and thesphenoid (five joints), it's a very weak point (five joints in one area), this is the weakest point in the skull, so if you have a lateral blow or hit on the skull, the most common area to have a fracture is the pterion, the sutures themselves detach, it's located two to three 8

fingers above the middle of the zygomatic arch, the thing which increase the danger is that the largest meningial artery passes over this region, so any fracture or any suture discontinuation in this area might lead to injury to that artery, and leads to hematoma (epidural hemorrhage or epidural hematoma, above the dura mater), the blood will accumulate between the dura mater of the meninges and the skull bones, increasing the pressure over the meninges, the meninges then increases the pressure on the brain which leads to a severe coma because it's an artery (within half an hour, the patient will lose his consciousness, within two hours he will die). About 80% of the epidural hemorrhage is due to fractures of the pterion and injury to the anterior branch of the middle meningeal artery(the meninges are supplied by the meningial arteries, inside the cranial cavity the meninges protect the brain).

The Pterion Bregma

Vertex

Lambda

Inside the skull, there are two types of arteries: 1- The meningial arteries, which supply the bones of the skull and the meninges, the largest meningeal artery is located in the middle cranial fossa and is called the middle meningeal artery, this artery gives an anterior and a posterior branches, the anterior branch lies in the pterion area, any fracture in the pterion indicates an injury to this branch and epidural hematoma. 2- The cerebral arteries, supply the brain itself.

The three layers of meninges are: 1- The dura mater. 2- The arachnoid mater. 3- The pia mater.

So, the pterion is a dangerous area because it's the weakest point in the skull, and the anterior branch of the middle meningial artery passes there.

The cranial base has two surfaces: 1- External surface (from the inferior aspect of the skull) 2- Internal or endocranial surface (from superior view), it's internal because it's inside the skull, within the cranial cavity, this internal surface is made of three depressions or cranial fossae (singular, fossa), namely, the anterior cranial fossa, the middle cranial fossa (like a butterfly in shape) and the posterior cranial fossa, for each fossa you should know what bones contributing to it, and the foramina (singular, foramen) located in it and what pass through these foramina.

The External Surface of The Cranial Base

The Internal Surface of The Cranial Base

The Anterior Cranial Fossa

It's made of the following: 1- The orbital plate of the frontal bone (anteriolaterally). 2- The lesser wing of the sphenoid bone (posteriolaterally, sharp boundary). 3- The cribriform plate of ethmoid bone (central, the roof of the nasal cavity) In the anterior cranial fossa, there are two foramina, the cribriform plate of the ethmoid bone1 (about 20 perforation on each side), the olfactory nerve fibers passe from there, and the second is the formaen cecum2 (cecum = obliterated) it's located anterior to the ethmoid bone, between the frontal and the ethmoid bones in the sagittal plane or the midline, it's a small foramen and it's obliterated, it's usually open during infant life (the first year of life), passing from this foramen some veins communicating with the face, the emissary veins, then the veins disappear and the foramen is closed or obliterated. Another important thing to know which is located in the anterior cranial fossa is an elevation or a median projection called the crista galli (the rooster's comb), it's a part of the perpendicular plate of ethmoid bone located in the cranial cavity, it provide an attachment site for the meninges that cover the brain (or more specific, for the falx cerebri, a dural fold).

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Foramen Cecum Crista Galli Cribriform Plate of Ethmoid Bone

The Frontal Crest Orbital Plate of Frontal Bone

Lesser Wing of Sphenoid Bone

The Anteroir Cranial Fossa

In the previous lecture the sphenoid bone was discussed, an addition is that if you look from above to the sphenoid bone, there is a depression on the body of the sphenoid bone, the roof of the body is made like the horse saddle and it's known as the sella turcica (means the Turkish saddle), this depression provides a place to cover or to protect the pituitary gland (or the hypophysis), this fossa is called the hypophysial fossa (a part of the sella turcica). The parts of the sella turcica are : 1- The tuberculum sellae (anterior elevation, represents the horn of the saddle). 2- The hypophysial fossa (or the pituitary fossa). 3- The dorsum sellae (posterior bony elevation, represents the back of the saddle). The sella turcica is surrounded by clinoid processes (bed post).

Tuberculum Sellae Hyposhysial Fossa

Anterior Clinoid Process Posterior Clinoid Process

Dorsum Sellae

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The Middle Cranial Fossa

In the middle of this fossa, the sella turcica is located, laterally there are two depressions (one on each side), in these depressions there are important openings, the posterior cranial fossa extend from the posterior border of the lesser wing of sphenoid bone to the superior part of petrous temporal bone. The openings in this fossa are: 1- optic canal, it's located in the lesser wing of the sphenoid bone, it allows for the optic nerve to pass from the brain across this canal anteriorly to the orbit where the eyeball is located. 2- The superior orbital fissure, it's located between the lesser and greater wings of the sphenoid bone, it communicates the orbit with the middle cranial fossa, the cranial nerves III,IV,VI and V1 pass from this fissure (the oculomotor, trochlear, abducent nerves and the ophthalmic division of the trigeminal nerve, respectively) , their function is to produce the movement of the eyeball (except the V1 which is sensory), the eyeball has skeletal muscle attachment to move it, these muscles need nerves, the nerves that move these muscles pass through this fissure. 3- Foramen rotundum (rotundum = round), it's located in the greater wing of the sphenoid bone, the maxillary nerve (V2) nerve passes through it to supply the upper teeth, this is the nerve which is anesthetized when a dental procedure is going to be done for the upper teeth. [Note : the trigeminal nerve, which is the 5th cranial nerve and the largest cranial nerve, gives three main divisions which are the ophthalmic nerve (V1) that passes through the superior orbital fissure and supplies the face or the fore head, the maxillary nerve (V2) that passes through the foramen rotundum, enters the maxilla and supplies the upper teeth, and the mandibular nerve (V3) that passes through the foramen ovale, enters the mandible and supplies the lower teeth] 4- Formen ovale, it's located in the greater wing of the sphenoid bone, the mandibular nerve (V3) pass through it then enters the mandible to supply the lower teeth, this is the nerve which is anesthetized when a dental procedure is going to be done for the lower teeth. 5- foramen spinosum, it's located in the greater wing of the sphenoid bone, the middle meningeal artery enters this foramen making a groove in the bone while passing between the skull bones and the meninges and supplying them, it passes over the pterion. 6- foramen lacerum (lacerated, rough, irregular or teared border), it's located medial to the last three foramina, it's located between the temporal, the sphenoid and the occipital bones, it's not a true foramen and located between bones, it's an artifact and is not present in the living human, rather covered by cartilage, after death and decomposition of the soft tissue (the skin and muscles decompose within the first 2-3 days, the cartilage decompose within 15-20 days, the remnants after 1-2 months is the bone), it was thought that it's present in the skull and named foramen lacerum, then it was discovered that it's not a true foramen. This area has cartilage because when the cartilaginous part of the petrous temporal bone, the basilar occipital bone and the sphenoid bone start to calcify, the ossification ends in the region where the sphenoid,the temporal and the occipital bones meet, this region remains as cartilage and there is no bone (endochondral ossification). 12

The Middle Cranial Fossa

Optic Canal Foramen Rotundum

Foramen Ovale Foramen Lacerum Foramen Spinosum

Superior Orbital Fissure

Optic Canal

Inferior Orbital Fissure

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The division of the braincase into cranial vault and cranial base is because the formation of these parts is different, the cranial vault (including the lateral walls and the roof) is formed by a process known as the intramembranous ossification (direct ossification of the mesenchyme which is a primary or embryonic tissue, the calcium enter this mesenchyme forming hydroxyapatite crystals converting it into bone), because of this, no cartilage is present in the cranial vault whereas the bones of the cranial base are formed by endochondral ossification, even within the same bone a part might be formed by inramembranous ossification (e.g. squamous temporal) and another part might be formed by the endochondral ossification (e.g. petrous temporal) in this type i.e. the endochondral ossification, the mesenchyme is converted into cartilage then the cartilage calcifies and is converted into bone. WHY DOES THIS OCCUR ??? . THIS IS A HOMEWORK THE ANSWER IS SOMETHING LIKE THE FOLLOWING AS I THINK . The cranial vault is made of simple shaped bones, they are flat somehow that don't have many details, because of this no need for a cartilaginous form in the beginning, rather the bone directly forms from the mesenchyme WHEREAS The cranial base is made of complicated shaped bones, that have many details (you did notice the sphenoid bone having a body, lesser wings, greater wings, etc. and the petrous temporal bone), because of this a cartilaginous form or model is made in the beginning to guarantee that everything is okay, every detail is there, then it is converted into bone.

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- I apologize for any scientific, grammatical or spelling error if it's present. "Mu'ad Salahuddin Al-Zou'bi"

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