I. CALVARIUM = SKULL CAP-

Consists of bones linkedby sutures

SKULL SESSION- bones rigidly connected by sutures to protect brain; attach, move eyes

FRONTAL (1)

BONES OF CALVARIUM

PARIETAL (2)

FRONTAL (1)

OCCIPITAL (1)

SPHENOID (1)

TEMPORAL (2)

NOSE

C. LANDMARKS

1. BREGMA - MID POINT OF CORONAL SUTURE

2. LAMBDA - MID POINT OF LAMBDOIDAL SUTURE

3. LAMBDOIDAL SUTURE

2. SAGITTAL SUTURE

1. CORONAL SUTURE

B. SUTURESNOSE

1. ANTERIOR FONTANELLE AT BREGMA

3. LATERAL FONTANELLE AT PTERION

2. POSTERIOR FONTANELLE - AT LAMBDA

- FONTANELLES PERMIT CRANIAL COMPRESSION AT BIRTH - CRANIAL GROWTH

D. FONTANELLES – MEMBRANES LINK BONES AT BIRTH

CORONAL SUTURELANDMARKS

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

1. INNER & OUTER TABLES - HARD CORTICAL BONE

MIDDLE LAYER - SOFT SPONGY BONE CALLED DIPLOE (DOUBLE IN GREEK)

OUTER

MIDDLEINNER

COURSE IN DIPLOE -CONNECT BOTH TO CRANIAL CAVITY & SURFACE OF SKULL

- CAN TRANSMIT INFECTION FROM SCALP TO BRAIN VIA EMISSARY VEINS

2. DIPLOIC VEINS

PARIETALEMISSARYFORAMINA

MASTOIDEMISSARYFORAMINA

1. FRONT OF SKULL

FRONTAL BONE (1)

NASAL BONES (2)

ZYGOMATIC BONE (2)-FORMS CHEEK

MAXILLARY BONE (2)-ALVEOLAR PROCESS FOR UPPER TEETH

MANDIBLE(1)-ALVEOLAR PROCESS FOR LOWER TEETH

ORBIT

EYE SOCKET

NASAL APERTURE

II. LANDMARKS AND BONES

ZYGOMATICO-FACIAL FORAMEN – IN ZYGOMATIC BONE

INFRAORBITAL FORAMEN - IN MAXILLARY BONE

MENTAL FORAMEN- IN MANDIBLE BELOW SECOND PREMOLAR TOOTH

1. FRONT OF SKULL

SUPRAORBITAL FORAMEN – INMAXILLARY BONE

ZYGOMATIC ARCH-

1)ZYGOMATIC BONE

2)MAXILLARY BONE- ZYGOMATIC PROCESS

3)TEMPORAL BONE- ZYGOMATIC PROCESS

TEMPORAL BONE - PARTS

1)MASTOID PROCESS - hard2)SQUAMOUS PART- flat 3)TYMPANIC PART - ANT. TO EXTERNAL AUDITORY MEATUS

TEMPORO-MANDIBULAR JOINT- FROM RAMUS OF MANDIBLE

2. LATERAL VIEW OF SKULL

4)PETROUS PART – inside skull

C)HARD PALATE-PALATINE BONES & PALATINE PROCESS OF MAXILLARY BONES

B)OCCIPITAL BONE- HAS FORAMEN MAGNUM- SPINAL CORD; OCCIPITALCONDYLES- FOR C1-ATLAS

OCCIPITAL CONDYLE

FORAMEN MAGNUM

4. BASE OF SKULL - COMPLEX

HARDPALATE

ANTERIOR CRANIAL FOSSA (ROOF OF NASAL CAVITY, ORBIT)

MIDDLE CRANIAL FOSSA (ORBIT, NASAL CAVITY, FACE)

POSTERIOR CRANIAL FOSSA (FACE, ORAL CAVITY, NECK)

V. CRANIAL CAVITY- DIVIDED INTO DEPRESSIONS (FOSSAE)

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 anterior-posterior sequence; this reflects numbering of cranial nerves

ANTERIOR

POSTERIOR

CRANIAL NERVES

I

II

III, IV, V1, VIV2V3Middle Meningeal A.VII, VIIIIX, X, XIXII

NOSE

 I. Olfactory II. OpticIII. OculomotorIV. TrochlearV. TrigeminalVI. AbducensVII. FacialVIII. Vestibulo‑cochlear IX. GlossopharyngealX. VagusXI. Accessory XII. Hypoglossal

CRANIAL NERVES

OLFACTORYFORAMEN –CN IOLFACTORYNERVE

CRISTAGALLIOFETHMOID

OPTICFORAMEN CN IIOPTICNERVE

SUPERIORORBITALFISSURE –CN III, IVV1, VIOPHTHALMICVEINS

CAVERNOUSSINUS

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 boneSup. drains to TransverseInf. Drains to Internal Jugular

FORAMENROTUNDUM –CN V2

FORAMENOVALE –CN V3

FORAMENSPINOSUM

F. BLOOD SUPPLY TO CALVARIUM

1) OUTER SURFACE – ARTERIES TO SCALP

2) INNER SURFACE- MENINGEAL ARTERIES

COURSE NEXT TO BONE; MISNAMED - SOUND LIKE SUPPLY MENINGES- MOST BLOOD TO BONES

OPENINGOFCAROTIDCANAL(FORAMENLACERUM)

C)HARD PALATE-PALATINE BONES & PALATINE PROCESS OF MAXILLARY BONES

B)OCCIPITAL BONE- HAS FORAMEN MAGNUM- SPINAL CORD; OCCIPITALCONDYLES- FOR C1-ATLAS

OCCIPITAL CONDYLE

FORAMEN MAGNUM

BASE OF CRANIUM FROM EXTERNAL SIDE

HARDPALATE

MEDIAL ANDLATERALPTERYGOIDPLATES

EXTERNALAUDITORYMEATUS

FORAMENOVALE

FORAMENSPINOSUM

CAROTIDCANAL –OPENS TOFORAMENLACERUMINSIDEMIDDLECRANIALFOSSA

OPENINGOFCAROTIDCANAL(FORAMENLACERUM)

INTERNAL CAROTID ARTERY: ENTERS SKULL

PASSESTHROUGHCAVERNOUSSINUS

INTERNALCAROTIDARTERY

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 boneSup. drains to TransverseInf. Drains to Internal Jugular

DIAGRAM OF CAVERNOUS SINUS

SYMPATHETICS TO HEAD

- First neuronOut T1, T2

Ascends Chain

SYMPATHETICS TO HEAD

Second neuron In SuperiorCervical Ganglia

Joins Plexus onInternal and ExternalCarotid Arteries1) Unnamed branches2) Few named branchesEx. Deep Petrosal N.

PATHWAY:

- Preganglionic: OUT T1, T2

- Ascend Sympathetic Chain

- synapse in Superior Cervical Ganglion

- Postganglionic: Distributed with Arteries

Forms Plexus on Internal and ExternalCarotid Arteries

OUT SPINALCORDT1,T2

SYMPATHETICCHAIN

SUP.CERVICALGANGLION

PLEXUSON INT.CAROTID

SYMPATHETIC PLEXUS ONINTERNAL CAROTID ARTERY

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 III, IV, V1, V2, and VI and Sympathetic fibers to orbit (travel on Internal Carotid) SPREAD OF INFECTION TO

CAVERNOUS SINUS

CAVERNOUS SINUS SYNDROME SYMPTOMS1) 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)

2) V1, V2Facial pain (pressure on nerves)

3) Sympathetics on Internal Carotid

Ptosis (drooping eyelid)Miosis (constricted pupil)

SPREAD OF INFECTION TOCAVERNOUS SINUS

INTERNALAUDITORYMEATUS –VII, VIII

JUGULARFORAMEN –CN IX, X, XI

HYPOGLOSSALCANAL –CN XII

FORAMENMAGNUM

 I. Olfactory II. OpticIII. OculomotorIV. TrochlearV. TrigeminalVI. AbducensVII. FacialVIII. Vestibulo‑cochlear IX. GlossopharyngealX. VagusXI. Accessory XII. Hypoglossal

CRANIAL NERVES

OPTICFORAMEN CN IIOPTICNERVE

FORAMINA OF ORBIT: OPTIC FORAMEN

OPTICFORAMENAND CANAL

SUPERIORORBITALFISSURE –CN III, IVV1, VI,OPHTHALMICVEINS

SUPERIORORBITALFISSURE

INFERIORORBITALFISSURE

SUPERIOR ORBITAL FISSURE

1) OPTIC CANAL- IN BASE OF LESSER WING OF SPHENOID BONE, CONTAINS OPTIC NERVE & OPHTHALMIC ARTERY

2) SUPERIOR ORBITAL FISSURE BETWEEN GREATER AND LESSER WINGS OF SPHENOID, CONTAINS III, IV, V1, VI, OPTHALMIC VEINS

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.)

3. MEDIAL WALL- INCLUDES MAXILLARY, LACRIMAL, ETHMOID, FRONTAL & SPHENOID (NASAL CAVITY IS MEDIAL TO MEDIAL WALL OF ORBIT)

MAXILLARY

LACRIMAL

ETHMOIDSPHENOID

BONES OF ORBIT

FRONTAL

NOSE

2) ANT. & POST. ETHMOIDAL FORAMINA- BETWEEN ETHMOID & FRONTAL BONES -CONNECT ORBIT & NASAL CAVITIES -CONTAIN ANT & POST ETHMOIDAL N., A. & V. (V1 & OPHTHALIC A.)

ANTERIOR AND POSTERIOR ETHMOIDAL FORAMINA

OPENING OF 3) NASOLACRIMAL DUCT- IN MAXILLARY, LACRIMAL BONES & INF. NASAL CONCHA -CONTAINS MEMBRANEOUS NASOLACRIMAL DUCT & TEARS

NASOLACRIMAL DUCT

NASOLACRIMAL DUCT

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

OTHER FORAMINA OF ORBIT