The skull

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1
 Glossary
 Acoustic = Related to hearing.
 Asteriorn = Starry = resembling a star.
 Bregma = Defect; the front of the skull, top of the head, .
 Calvaria = the portion of a skull including the braincase and
excluding the lower jaw.
 Condyle = (Knuckle) is the round prominence at the end of a
bone.
 Coronal = Crown.
 Cranium = Skull without mandible.
 Cribriform = Pierced with small holes / sieve-like.
 Emissary = Providing outlet; to send out; delegate ‫فير‬00‫وث س‬0‫مبع‬
‫؛‬
 Ethmoid bone = sieve
 Fontanelle = Small fountain.
(The emissary veins are valveless veins which normally drain from the dural venous sinuses into veins that
lie outside the skull (external veins). However, because they are valveless, pus can flow into the skull
through them as well, making them a possible route for transmission of extracranial infection to get into the
skull.) 2
 Fovea = Small pit = a small depression.
 Frontal = The fore part.
 Galli = Cock, roaster.
 Jugular = throat.
 Lacerum = Jagged wound; tear; to lacerate.
 Lambdoid = Lambda = A letter in alphabet “λ”.
 Lingula = Tongue-like structure.
 Ovale = Oval in shape.
 Magnum = a big thing, from magnus large.
 Mastoid = Breast like.
 Maxilla = A jaw bone (upper or lower).
 Metopic = The forehead.
 Nuchal = Back of the neck.
 Occipital = Back of the head; ob = back; caput = head.
 Parietal = Wall of a cavity.
 Petrous = Stony; stone; rock.
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 Pterion = A wing.
 Pterygoid = Wing-like.
 Rotundum = Round, circular.
 Sagittal = An arrow.
 Sphenoid = Wedge-like.
 Squamous = A scale.
 Styloid = Pillar-like.
 Suture = A seam (= stitching line).
 Temporal = Time (gray hair starts hear)
 Tympanic = Drum.
 Vault = Ceiling.
 Vomer = Ploughshare = a sharp steel wedge that cuts loose the top
layer of soil.
 Zygomatic = to join or unite / yoke).

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Is formed of 22 bones Bones of the skull
22 bones

Bones of the skull

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 Bones of the skull

Sphenoid bone
Frontal bone

Occipital bone

Parietal bone

12/11/22 Skull
Bones of the skull Back Next 6
 Sphenoidal bone

Occipital bone

Left temporal bone

Bones of the skull Back Next 7

 Temporal bone

Maxilla

Zygomatic bone

Bones of the skull Back Next 8

 Calvaria
Frontal crest

Granular foveolae
= (small pit)

Groove for branches of

middle meningeal
vessels

Groove for sup. sagittal

sinus *

Bones of the skull Back Next 9

External features

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1. Superior view
2. Posterior view
3. Lateral view
4. Anterior view
5. Inferior view
6. Intracranial fossa 11
 Metopic suture 1. Superior view
= the forehead

Bregma Frontal bone Coronal suture

= defect

Sagittal
Parietal suture
foramena

Parietal bones
Parietal
Transmits: eminence *
Emissary vein
‫وث‬0‫مبع‬

Lambda Occipital
=ʎ bone
External features Fig 67 Back Next 12
 Parietal eminence:
widest part of the cranium *

The two parietal eminences mark the widest part of the cranium *

External features Back Next 13

 2. Posterior view
Parietal bones Sagittal
Lambda “λ” suture
Sutural bones
Lambdoid suture (Wormian bones)

Inter-parietal
bone
Highest nuchal Sup. Nuchal line
line (faint- scalp)
Occipital (demarks the
bone boundary bet
o r al scalp and neck)
em p e
T bon

Mastoid Mastoid Ext. occ. protuberance

process emissary (scalp)
External features foramen * Back Next 14
 3. Lateral view
Frontal Parietal bone
bone

Temporal
Nazal bone bone

Greater it al
wing of c i p
sphenoid Oc ne
bo
Maxilla

Mandible * Zygomatic bone

(= to join or unite / yoke)

12/11/22
External features Skull Back Next 15
 Temporal fossa Sup. and inf.
temporal lines
-scalp
The pterion = wing Suprameatal
crest
External
acoustic
meatus
Zygomatic process of Squamous
the frontal bone part of temporal
bone
Fronto-zygomatic
suture (Palpable)

Frontal process of Asterion =

the zygomatic bone resemble a star
Mastoid
Greater wing process
of sphenoid Styloid
process Tympanic part Back
of temporal bone Next
Temporal process
of zygomatic
External bone
features
+ Zygomatic process
of temporal bone = Zygomatic arch * 16
 Greater wing 4. Anterior view Frontal
of sphenoid bone forms
Frontal bone the upper
Parietal 1/3rd of the
bone ant. view

Temporal
bone

Ethmoidal Zygomatic

Max
bone bone
Maxilla &
Middle & illa Nazal bone mandible
inferior nazal form the
chonchae * lower
2/3rd

Vomer
Mandible
12/11/22
External features Skull Back Next 17
 Frontal process Supra-orbital
of maxilla foramen/notch
Nasion
Zygomatic process
of the frontal bone

Orbital margins
Infra-orbital
foramen
Sup. orbital fissure

Inf. orbital fissure

1st & 2nd lower
Ant. nasal aperture premolar teeth

Mental foramen *
Ante. nasal spine

12/11/22 Skull
External features
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5. Inferior view
Maxilla ti c
m a
g o
Palatine Zy

Sph
eno
Vomer

id
Temporal *

Occipital

Fig 74
External features
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Pterygoid
hamulus
Lat. pterygoid plate
Med. pterygoid
plate
Petrous part of
Foramen temporal bone *
lacerum
Occipital condyle
Pterygoid
tubercles
Foramen
Mastoid process magnum
External occipital
Inf. nuchal line crest
External occipital
Occipital bone protuberance
(squamous part)
Sup. nuchal line
External features
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 Basi-occiput Pharyngeal tubercle
Greater wing of
Inf. orbital fissure sphenoid
Foramen ovale
Foramen lacerum
(closed in life) Spine of sphenoid &
Foramen spinosum

Carotid canal Petrous part of

= carotid foramen temporal bone
Styloid process
Jugular
foramen
s * Foramen Stylo-mastoid
ce s magnum foramen
pr o
t o id Mastoid process
as
M
Occipital bone Hypoglossal canal
(sqamous part)
Condylar canal
Occipital condyle
External features
f008-023 Back Next 21
Foramina from the inferior view

22
 Basi-occiput Pharyngeal tubercle
Greater wing of
Inf. orbital fissure sphenoid
Foramen ovale
Foramen lacerum
(closed in life) Foramen spinosum &
Spine of sphenoid

Petrous part of
Carotid canal temporal bone
= carotid foramen
Styloid process
Jugular
foramen
s s Foramen
e
proc magnum
t o id
as Stylo-mastoid
M Occipital bone foramen
(squamous part)
Hypoglossal canal *

External features
Back Next 23
 6. Intracranial fossae Crista galli

Orbital plate of frontal bone

Anterior cranial fossa
Cribriform plate of
ethmoid bone
Lesser wing of sphenoid
Greater wing of sphenoid Middle cranial fossa
Sella turcica
Squamous part
of temporal bone
Petrous part of temporal bone Posterior cranial fossa
Basilar part of occipital bone
Internal occipital crest
Internal occipital
protuberance
Fig 72
*
Intracranial fossa
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Foramina in the intra-cranial fossa
& their related cranial nerves

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X
The pterygo-palatine fossa

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 Bones involved in the pterygo-
palatine fossa

Pterygoid bone
Palatine Maxilla
bone Back Next 28
 The pterygo-palatine fossa
Pterygo-maxillary
fissure (the pterygo-
Infratemporal crest: palatine fossa lies deep
separates temporal to the fissure: ganglion)
and infratemporal
fossae

Pterygo-tympanic
fissure (Glaserian Maxilla Grant’s 832
fissure) passage of
chorda out of
facial canal in
middle ear * Palatine
bone
Pterygoid bone
Back
Tuberosity
External features
Fig 65 of maxilla * Next 29
The
mandible

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 Hea
d
Nec Condylar
k process =
head + neck *
a c e
s ur f
ner
In Ramus

l v e ol a r bo rd er
= a
Sup.r border le
Body Outer surface g
An

d e r = b a se
or
Inferior b
Back Next 31
 Outer surface of the body

Incisive fossa *

Oblique line: ant. border of

Mental foramen ramus to mental tubercle
c le
er
Mental symphysis b Mental protuberance
tu
t al (triangular elevated area)
en
M
Fig 119
Back Next 32
 lar
Inner surface of the mandible

not ndibu
Coronoid process

ch
Ma
Ant. border
Condyloid
process *
Mandibular
Post. border foramen:
(related to parotid gland) inf alveolar n.
Lingula
Sublingual fossa:
(sublingual gland)
Mylohoid groove
Genial tubercle (lodging mylohyoid n.+
(upper + lower) vessels.)
Submandibular fossa:
(submandibular gland)
Mental spine Mylohoid line: from mental spine
to below 3 molar:
rd
(Mylohyoid muscle separates the
mouth from the neck) Plate 10 B Back Next 33
 Ramus of the mandible

Type of joint? *

*
is s
h y . Oblique line:
p b
ym l tu ant. border of ramus
l s ta to mental tubercle
t a e n
e n M
M Back Next 34
 l a r t.
Coronoid process
i bu s se s
n d ma sel
Ma tch:d ves
Anterior border no an
n. Condyloid
process
Sublingual fossa
Mandibular f.:
inf alveolar n.

Post. border
Lingula

Mylohoid groove:
(lodging mylohoid n.+
vessels)
Mental spine Inf. border Submandibular fossa *
Mylohyoid line:
from mental spine to below 3rd molar.
(Mylohyoid muscle separates the Fig 118 Back Next
mouth from the neck) 35
Newborn mandible. Newborn: Angle of the mandible: 140o.
Compare the ramus of the Mental foramen: near lower border
mandible, body of the
mandible, and coronoid
process with the adult and 110o
elderly.
140o
Adult mandible
Elderly mandible. The alveolar Adult: angle of the mandible: 110o.
part is completely atrophied, Mental foramen: midway between
moving the opening of the upper and lower border
mental foramen and the exit of
the mental nerve upward.
:‫بسم هللا الرحمن الرحيم‬
َ ُ‫ق َأفَال يَ ْعقِل‬
* )68 ‫ يس‬:‫ون (سورة‬ ِ ‫َو َم ْن نُ َع ِّمرْ هُ نُنَ ِّك ْسهُ فِي ْال َخ ْل‬

140
o Eldery: angle of the mandible: 140o.
Mental foramen: near upper border
Fig 117, 121, 122 Back Next 36
 Hard palate
Zygomatic process
Pre-maxilla = of maxilla
Incisive bone of maxilla

Maxilla
(palatine process)

Sphenoid bone * Palatine bone

(horizontal palate)

Fig 86 Back Next 37

X
 Nerves related to the mandible
(all are branches of the mandibular nerve)
1. Lingual nerve: (passes below the root of 3rd molar tooth)
2. Inferior alveolar nerve: (enters the mandibular foramen)
3. Mylohoid nerve: (runs in the mylohoid groove)
4. Mental nerve: (escape through the mental foramen)
= continuation of inf. alveolar n.
5. Auriculotemporal nerve: (runs deep to the neck of the mandibe)
6. Masseteric nerve and vessel
(pass lateral through mandibular notch) *6
5

2
1

Fig 118
3 4
Fig 119

Nerves related to mandible Back Next 39

 Foramen ovale
Mandibular nerve
(posterior division)

5. Auriculotemporal n.

1. Lingual nerve

2. Inf. alveolar n.

3. Nerve to mylohyoid
Submandibular gland
Mylohyoid + anterior belly
of digastric muscles 4. Mental n.
Plate 41A Sublingual gland Back Next 40
Nerves related to mandible
 6. Masseteric n.
+ vessels

Parotid gland

Masseter muscle

Inferior alveolar nerve

Fig 141 Nerves related to mandible Back Next 41

Neonate
skull

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 Frontal suture
= metopic suture
Frontal bones
Anterior fontanelle
(closes at 18 months)

Coronal suture
Parietal bones
Sagittal suture

Lambdoid
suture
Posterior fontanelle
(closes at 6 months) * Occipital bone
Back Next 43
Squamous part
of occipital bone

Back Next 44
Back Next 45
Back Next 46
 ‫سبحانك اللهم وبحمدك نشهد أالّأ إله إالّ أنت‬
‫نستغفرك و نتوب إليك‬

‫بِس ِْم هَّللا ِ الرَّحْ َم ِن الر ِ‬

‫َّح ِيم‬

‫ان لَفِي ُخ ْس ٍر ‪ ‬إالَّ الَّ ِذ َ‬

‫ين آ َمنُوا‬ ‫َو ْال َع ْ‬
‫ص ِر ‪ِ ‬إ َّن اِإل ن َس َ‬
‫ص ْب ِر‬
‫ص ْوا بِال َّ‬‫ق َوتَ َوا َ‬‫ص ْوا بِ ْال َح ِّ‬ ‫َو َع ِملُوا الصَّالِ َحا ِ‬
‫ت َوتَ َوا َ‬

‫سبحان ربك رب الع‪0‬زة عما يصفون وسالم على المرسلين والحمد هلل‬
‫رب الع‪0‬المين‬
‫‪47‬‬
 a. 1ry cartilaginous joint
(Syn-chondr-oses) Hyaline cartilage joint

Primary cartilaginous joints also are called

syn-chondr-oses. These joints are temporary
during development of long bones.
It is formed by an epiphyseal cartilaginous
plate known as epiphysis, and the body of
the bone is the diaphysis.
Epiphyseal plate = physis Diaphysis
= growth/to generate: Epiphysis *
segment of bone that is
responsible for lengthening

48
 Clinical correlation: the pterion
The pterion = wing: weakest part of the
skull
(2.5cm behind & 1.3cm above fronto-
zygomatic suture: middle meningeal a.)

Fronto-zygomatic suture:
palpable.

The pterion: H-shaped sutures:

Frontal bone,
parietal,
squamous of temporal bone
and
greater wing of sphenoid.
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 Clinical correlation: the facial artery

The pterion: H-shaped sutures bet. 4 bones:

frontal, Grant’s 641

parietal, greater wing of sphenoid

and squamous part of temporal bone.

Pterion is the weakest bones of the skull: a hard blow to the side of the
head may fracture the thin bones forming the pterion, rupturing
the anterior branch of the middle meningeal artery )crossing the
pterion( extradural (epidural) hematoma pressure on the
underlying cerebral cortex. If untreated death in a few hours. 50
Clinical correlation: trigeminal nerve

Supra-orbital
foramen/notch

Infra-orbital
foramen

Mental f. *

A vertical line between: 1st & 2nd lower premolar teeth passes through
branches from each of the trigeminal ns.:
a. From ophthalmic: supra-orbital n.
b. From maxillary: infra-orbital n.
c. From mandibular: mental n. (off inf. alveolar) * 51
52
Subdural Hematoma Sub-dural hematoma
Tearing of bridging veins during rapid or (venous blood)
sudden changes in velocity thereby causing
an accumulation of venous blood below the
dura but above the arachnoid membrane (i.e.,
the "subural space").
Bleeding cross suture lines since bleeding is
below the dura, which is tightly attached to
the calvarium, thus giving the "crescent
shape" appearance on head CT.
Can result in mass effect leading to uncal
and/or tonsillar herniation if left untreated.
Occur more frequently in elderly patients due
to reduced brain volume and "stretched"
bridging veins.
Treatment includes craniotomy and clot
evacuation.
53
 Epidural Hematoma = extra-dural hge
Epidural hematomas occur when an artery is
injured and arterial blood accumulates
between the dura and the calvarium.
Bleeding do not cross suture lines because
Epi-dural hematoma of the tight adherence of the dura to the
(arterial blood)
calvarium and thus have a biconvex or
elliptical appearance.
The middle meningeal artery is classically
involved, especially with a skull fracture.
Associated with a "lucid interval", which
means that a patient can be conscious
and appear "normal" right after an injury,
but as the blood accumulates the
headache will worsen and mental status
will decline as the intracranial pressure
Middle rises.
meningeal a.
Treatment: decompression of the hge54by
Bridging veins, which drain the
underlying neural tissue and
puncture the dura mater, empty into
these dural sinuses. A rupture of a
bridging vein causes a subdural
hematoma.
Sub-dural hematoma
Epi-dural hematoma (venous blood)
(arterial blood)

Middle
meningeal a.
Dura

56
Subdural haematoma (SDH)
SDH, as illustrated in the diagram above, is a collection of blood
(clotting blood) that forms in the subdural space. Usually resulting from
tears in bridging veins which cross the subdural space, subdural
hemorrhages may cause an increase in intracranial pressure (ICP), which
can cause compression of and damage to delicate brain tissue. A severe
SDH may lead to loss of consciousness (but very rare), and lucidness of
a few hours. Treatment includes craniotomy and clot evacuation.

Epidural haematoma (EDH)

This is also called extradural haematoma, and it is the accumulation of
blood in the epidural space due to injury, for example from a road traffic
accident or sports injury, involving the middle meningeal artery.
Treatment may require decompression of the haematoma, usually to
ease-out the pressure cause by the clothed blood on the brain.

57
 Epidural Hematoma
Artery is injured
Occurs between the dura and the
calvarium
Do not cross suture lines
Biconvex or elliptical appearance in CT
Middle meningeal artery
Associated with a "lucid interval",
Any age
Subdural Hematoma
Tearing of bridging veins
Occurs bet. dura and arachnoid
subdural space
Cross suture lines
Crescent shape" appearance on
head CT
Bridging veins
Can result in mass effect leading
to uncal and/or tonsillar
herniation if left untreated
More frequently in elderly due
to reduced brain volume and
"stretched" bridging veins
58