Skull

• Bones of cranium, face, mandible

• Sutures and joints (temporomandibular joint;
atlanto-occipital joint
• Foramina for passage of nerves and blood
vessels
• Bones associated with various cavities:
cranial cavity, orbit, nasal & oral cavity, ear,
infratemporal fossa
 Lateral view of skull showing major bones and sutures

parietal bone C

frontal bone

pterion
L
sphenoid bone
occipital bone

nasal bone
lacrimal bone

zygomatic bone
temporal bone

maxilla

C: coronal suture
L: lambdoid suture mandible Grant’s Atlas of Anatomy
 skull fracture at the pterion could lead to epidural bleeding
Branches of middle
meningeal aa.

Netter's Clinical Anatomy

Thieme Atlas of Anatomy

Grant’s Atlas of Anatomy

Base of skull showing foramina for blood vessels and cranial nerves

Grant’s Atlas of Anatomy

 Cranial fossae and relationships to brain and cranial nerves

CUHK
M A

P A: anterior
M: middle cranial fossa P
CUHK P: posterior
 Petrous temporal bone: tympanic cavity and inner ear

CUHK

Wolf-Heidegger’s Atlas of Human Anatomy

petrous part of temporal bone
 Cranial Cavity
• Calvaria (roof), cranial fossae (floor)
• Houses the brain
• Dura lines the cavity
• Dural specializations: dural folds, dural sinuses
• Internal carotid artery (ICA) and vertebral artery
enter the cavity to supply brain and orbit
• Important relationships between cavernous
sinus, ICA and cranial nerves
 Meninges •Dura - most superficial, tough
•Arachnoid – membranous
•Subarachnoid space – CSF, blood vessels
•Pia - thin, firmly attached to nervous tissue

dural sinus

dura

arachnoid
Outermost layer (dura) intact CUHK

(with CSF)

pia

brain tissue

dural fold
Dura removed to show
underlying (arachnoid) CUHK
 Cranial Dura
•periosteal & meningeal
layers
•dural venous sinuses
(endothelium-lined)
•dural folds: falx cerebri,
tentorium cerebelli, falx
cerebelli

Thieme Atlas of Anatomy

 Bleeding associated with meninges

Epidural- from middle meningeal artery

Subdural: from torn cerebral vein at its junction with

dural sinus

Subarachnoid- from a ruptured aneurysm of

artery in subarachnoid space

Thieme Atlas of Anatomy

 Herniation of brain tissues

Herniation beneath falx cerebri

Nolte; the Human Brain

Tentorial herniation Tonsillar herniation

Dural venous sinuses drain blood into internal jugular vein

Netter's Clinical Anatomy

internal carotid artery enters cranial cavity through temporal bone

Grant’s Atlas of Anatomy

Structures associated with cavernous sinus

Grant’s Atlas of Anatomy

Spread of infection from face to cavernous sinus and cranial cavity

Cavernous
sinus

Facial vein

Hollinshead & Rosse; Textbook of Anatomy

Snell; Clinical Anatomy for Medical Students

Danger triangle of face
Moore; Clinically Oriented Anatomy
 Orbit
• Bony boundaries
• Relations to neighboring regions of skull
• Superficial structures: eyelids, lacrimal
gland and tear drainage system
• Nerve supply: sensory, motor, autonomic
• Blood supply
• Extraocular muscles & eye movements
Bones and related foramina

Netter's Clinical Anatomy

Eyelids and associated structures

Netter's Clinical Anatomy

 Muscles related to eyelids

MacKinnon & Morris; Oxford Textbook of

Functional Anatomy, Vol 3

Netter's Clinical Anatomy

 Superficial and deeper
levels of orbit to show
major nerves
sensory
•CN II (vision)
•CN V1: frontal, lacrimal, nasociliary

parasympathetic to iris & ciliary body

of eye
•CN III - via ciliary ganglion

parasympathetic to lacrimal gland

•CN VII - via pterygopalatine ganglion

motor to extraocular muscles

•CN III, IV, VI (motor)

Netter's Clinical Anatomy

Autonomic innervation of orbital structures
Sympathetic
• from superior cervical ganglion
via internal carotid plexus

Parasympathetic to iris &

ciliary body
• CN III - via ciliary ganglion
• note proximity to nasociliary
nerve (V1)

Parasympathetic to lacrimal
gland
• CN VII - via
pterygopalatine ganglion
• note proximity to maxillary
nerve (V2)

Gray's Atlas of Anatomy

 Horner’s syndrome (interruption of sympathetic pathways
related to superior cervical ganglion)

AccessMedicine: The Big

Picture- Gross Anatomy

Gray’s Anatomy
 Major blood vessels in orbit

Ophthalmic artery branches:

•supply orbit, nasal cavity,
scalp
•anastomose with branches
of ext. carotid arteries

Ophthalmic veins:
•communicate with cavernous
sinus

Netter's Clinical Anatomy

Anastomosis of
branches of internal
and external carotid
aa. at the scalp
Grant’s Atlas of Anatomy AccessMedicine: The Big Picture- Gross Anatomy
 Extracranial-intracranial anastomoses may compensate for brain ischemia

Adams and Victor's Principle of Neurology 10th Ed

Arrangement of the major arteries on the right side carrying blood from the heart to the brain. Also shown are collateral vessels that may modify the effects of
cerebral ischemia. For example, the posterior communicating artery connects the internal carotid and the posterior cerebral arteries and may provide anastomosis
between the carotid and basilar systems. Over the convexity, the subarachnoid interarterial anastomoses linking the middle, anterior, and posterior cerebral
arteries are shown, with inset A illustrating that these anastomoses are a continuous network of tiny arteries forming a border zone between the major cerebral
arteria l territories. Occasionally a persistent trigeminal artery connects the internal carotid and basilar arteries proximal to the circle of Willis, as shown in inset B.
Anastomoses between the internal and external carotid arteries via the orbit are illustrated in inset C. Wholly extracranial anastomoses from muscular branches of
the cervical arteries to vertebral and external carotid arteries are indicated in inset D .
 Eye movement elicited by extraocular muscles Clinical testing of extraocular muscles

AccessMedicine: The Big Picture- Gross Anatomy

Visual
axis

Grant’s Atlas of Anatomy

Netter's Clinical Anatomy