2009

Anatomy
TheSkull
SveinnRnarSigursson,group5.

svenni76@gmail.com
MedicalUniversityofDebrecen
4/20/2009

Anatomy::Theskull

Contents
Introduction....................................................................................................................................5
Theskull::verybriefoverview........................................................................................................7
1.Thevertebralcolumn(bones,joints,ligaments,curvatures,movements)....................................8
Commonfeaturesofthevertebrae....................................................................................................8
Cervicalvertebrae...............................................................................................................................8
Generalfeaturesofthecervicalvertebrae.....................................................................................9
Typialcervicalvertebrae(otherthanC1,C2,C7)............................................................................9
Atlas(C1).........................................................................................................................................9
Axis(C2)...........................................................................................................................................9
Vertebraeprominens(C7)...............................................................................................................9
Thoracicvertebrae............................................................................................................................10
Lumbarvertebrae..............................................................................................................................10
TheSacrum........................................................................................................................................10
Joints..................................................................................................................................................11
Structureoftheintervertebraedisks............................................................................................11
Synostosis......................................................................................................................................11
Ligaments..........................................................................................................................................11
Otherimportantligaments...........................................................................................................12
Curves................................................................................................................................................12
Movement.........................................................................................................................................12
2.Vertebrae.Craniovertebraljoints..............................................................................................13
3.Musclesandjointsofthethorax................................................................................................14
Musclesofthethorax........................................................................................................................14
Pectoralis.......................................................................................................................................14
major.............................................................................................................................................14
Pectoralis.......................................................................................................................................14
minor.............................................................................................................................................14
Subclavius......................................................................................................................................14
Serratus.........................................................................................................................................14
magnus..........................................................................................................................................14
Externalintercostals(eleveninnumber)......................................................................................14
Internalintercostals(eleveninnumber).......................................................................................14
Triangularis....................................................................................................................................14
sterni..............................................................................................................................................14
Levatorscostarum(twelveinnumber).........................................................................................14
Diaphragm.....................................................................................................................................14
Jointsofthethorax............................................................................................................................15
Costovertebraljoints.....................................................................................................................15
Costochondraljoints......................................................................................................................15

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Interchondrialjoints......................................................................................................................15
Sternocostaljoints.........................................................................................................................15
4.Extrinsicandintrinsicmusclesoftheback(withtheexceptionofthenuchalregion).................16
Theextrinsicmusclesoftheback......................................................................................................16
TheTrapeziusmuscle....................................................................................................................16
TheLatissimusDorsiMuscle.........................................................................................................16
TheLevatorScapulaeMuscle........................................................................................................17
Theintrinsicmusclesoftheback......................................................................................................17
TheSpleniusMuscles(Superficiallayer).......................................................................................17
TheErectorSpinaeMuscle(Intermediatelayer)..........................................................................17
ActionsoftheErectorSpinaeMuscles..........................................................................................18
5.Partsofthecranium;calvaria,fontanelles,parietalbone..........................................................19
Calvaria..............................................................................................................................................19
Fontanelles........................................................................................................................................19
Parietalbone.....................................................................................................................................19
6.Anteriorcranialfossa.Frontalbone...........................................................................................20
Borders..........................................................................................................................................20
Structures......................................................................................................................................20
Openings........................................................................................................................................20
Thefrontalbone................................................................................................................................21
7.Middlecranialfossa.Temporalbone.........................................................................................22
Structuresopenings........................................................................................................................22
Superiororbitalfissure..................................................................................................................22
Opticcanal.....................................................................................................................................22
Foremanrotundum.......................................................................................................................22
Foremanovale...............................................................................................................................22
Foremanspinosum........................................................................................................................23
Foremanlascerum.........................................................................................................................23
Hiatusforlesserpetrosalcanal.....................................................................................................23
Hiatusforthegreaterpetrosalnerve............................................................................................23
Sellaturcica(Eng:TheTurkishsaddle).........................................................................................23
TheTemporalbone...........................................................................................................................23
8.Posteriorcranialfossa.Occipitalbone.......................................................................................24
Theposteriorcranialfossa................................................................................................................24
Occipitalbone....................................................................................................................................24
Squamuspart................................................................................................................................24
9.Externalsurfaceofthecranialbase...........................................................................................26
Externaloccipitalprotuberance....................................................................................................26
Superiornuchalline.......................................................................................................................26
Inferiornuchalline........................................................................................................................26

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Occipitalcrest................................................................................................................................26
Foramanmagnum.........................................................................................................................26
Occipitalcondyles..........................................................................................................................26
Condylarfossa...............................................................................................................................26
Mastoidprocess............................................................................................................................26
Mastoidnotch...............................................................................................................................26
Mastoidforamen...........................................................................................................................26
Styloidprocess...............................................................................................................................26
Styleomastoidforamen.................................................................................................................26
Hypoglossalcanal..........................................................................................................................27
Jugularfossa..................................................................................................................................27
Fossulapetrosa..............................................................................................................................27
Cochlearcanalicule........................................................................................................................27
Carotidcanal..................................................................................................................................27
Foremanlacerum..........................................................................................................................27
Scaphoidfossa...............................................................................................................................27
Groovefortheauditorytube........................................................................................................27
Musculotubariancanal..................................................................................................................27
Pterygoidcanal..............................................................................................................................27
Mandibularfossa...........................................................................................................................28
Inferiororbitalfissure....................................................................................................................28
Zygomaticotemporalforamen......................................................................................................28
Zygomaticofacialforeman.............................................................................................................28
Greaterpalatinecanals.................................................................................................................28
Lesserpalatinecanal.....................................................................................................................28
Incisivecanal.................................................................................................................................28
Zygomaticcanal.............................................................................................................................28
10.Temporal,infratemporalandpterygopalatinefossae..............................................................29
11.Bonesofthefacialskeleton.Maxilla........................................................................................30
TheFrontalbone...........................................................................................................................30
Zygomaticbone.............................................................................................................................30
TheSphenoidbone........................................................................................................................30
TheMaxilla........................................................................................................................................30
12.Bonesofthefacialskeleton.Ethmoidalbone..........................................................................31
The5largestbonesofthefacialskeleton.........................................................................................31
Frontalbone..................................................................................................................................31

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Zygomaticbone.............................................................................................................................31
Maxilla...........................................................................................................................................31
Sphenoidbone..............................................................................................................................31
Thethreesmallerfacialbones..........................................................................................................32
Nasalbone.....................................................................................................................................32
Lacrimalbone................................................................................................................................32
Palatinebone.................................................................................................................................32
Ethmoidalbone.................................................................................................................................32
13.Wallsandopeningsonthewallsoftheorbit...........................................................................33
14.Nasalcavity,paranasalsinuses................................................................................................34
Entrance:Piriformicaperture.......................................................................................................34
Thenasalcavity.............................................................................................................................35
NasalMeati....................................................................................................................................35
Exitofthenasalcavity...................................................................................................................36
Paranasalsinuses...............................................................................................................................37
Sphenoidsinus...............................................................................................................................37
Maxillarysinus...............................................................................................................................37
Frontalsinus..................................................................................................................................37
Ethmoidsinus................................................................................................................................37
15.Mandible.Temporomandibularjoint.......................................................................................38
TheTemporomandibularjoint..........................................................................................................38
Movementsatthejoint.................................................................................................................39
Musclesthatmovethejaw...........................................................................................................39
TheTemporalisMuscle.................................................................................................................40
TheMasseterMuscle....................................................................................................................40
TheLateralPterygoidMuscle........................................................................................................40
TheMedialPterygoidMuscle........................................................................................................40
Additionalinformation..................................................................................................................41
Thecranialnerves.............................................................................................................................41
Notestakendownfromhereandthere...........................................................................................41
CranialForaminaandapertures........................................................................................................42

Introduction
ThisdocumentcontainssuggestedanswerstoThetopicsofthe3rdselfcontroltest,aspreparedby
theAnatomydepartment.
Theskullisthemostcomplexboneinthebody.So,inordertounderstandeachtopicfullyandwith
lessefforts,itiscriticaltostartwithahighleveloverviewoftheskullitself.

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Iusedvarioussourcestocreatethisdocument,rangingfromMoore,Netter,Graysanatomyand
teacherhandouts.IrecommendusingthissummaryasaguidelinealongsideanAnatomyAtlas,such
asNetter.Bones,ligamentsandotherstructuresaredescribedinentiresentences,insteadofsimply
listingthefeaturestobementionedonthetest.IthinkthisisabetterapproachthaninSamannotes
forexample,sinceanatomicallocationofeachanatomicalfeaturemustbedescribedontheexam,
butnotonlyitsname.Nevertheless,Ialsodecidedtoincludealotofanatomicdetailsfoundoneach
boneandincludethemasrawdata.Suchdetailsaredisplayedinlistsandwithasmallerfont.
Finally,therearedefinatellysomeerrorshereandthere,orsomethingsmissing...so,onceagain,use
thesummaryasaguide,alongsideanAtlas,inordertopasstheSCT.
SpecialthanxgotoCsabbaM.&TamasJ.forreviewingmynotes,providingmewithadditional
information,errorcorrectionsetc.
ReferencestoMooresClinicallyOrientedAnatomyweremadeusingthelatest,6th,edition.Same
appliestoNettersAnatomyAtlas.Thereferencesarenotvalidforothereditions.

Svenni

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Theskull::verybriefoverview
Beforedivingintothetopicsthemselves,thefollowingbriefoverviewcanbeappliedasan
introductiontoallthetopics.
Theskullisthemostcomplexboneinourbody.Itismadeofseveralbonesanditisdividedintoa
fewsegments.
Theskullisreferredto,astheCranium,whichmeanstheskull+thelowerjaw.
TheNeurocraniumisthebonycaseforourbrain.Itisformedby8bones.Fourbonesthattouchthe
midline(frontal,ethmoidal,sphenoidalandoccipitalbones)andtwosetsofbonesthatcomeinbi
lateral(thatis,existonoppositelateralsides)temporalandparietalbones.
TheNeurocraniumhasaroof,whichlookslikethedomeofthechurchifyouwill.Itisalsoreferredto
toastheCalvaria(skullcap).Whenremovingthebrain,duringautopsyetc.,thisisthepartthatis
removedfromthehead,inordertoremovethebrain.Mostofthesebonesareunitedbyfibrous
interlockingsutures.
ThefloorofthecalvariaiscalledtheCranialbase.ThebonesthatmakeuptheCranialbaseare
mostlyirregularboneswhilemostofthebonesthatmakeuptheCalvariaaremainlyflatbones.
TheViscerocraniumcosistsof15irregularbonesandthisregionisusuallyreferredtoasthefacial
skeleton.

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Anatomy::Theskull

1.Thevertebralcolumn(bones,joints,ligaments,curvatures,
movements).
PAGESINNETTER::153,154,155,13,17,18,157,185,248
MOORE::19,982984,440448,477480
Structuretheanswerbyfirstnamingthesections,thengooverthe
commonfeaturesofthevertebrae,thenspecialfeaturesofeach
section,thenjoints,ligaments,curvatureandmovementsending
withblueboxes
Thevertebralcolumncanbesplitinto3sections.
Cervicalvertebrae(7bones,Atlas(C1),Axis(C2),
Vertebraeprominens(C7))
Thoracicvertebrae(T1T12)
Lumbarvertebrae(L1L5)
Sacrum(5fusedsacralvertebrae+coccyx)
Theaveragehumanhasbetween3335vertebrae.Thedifferencedependsonwhetherthecoccyx
has4or6vertebrae.

Commonfeaturesofthevertebrae
Thevertebraeofall3sections(cervical,thoracicandlumbar)havesomeelementsincommon.They
allhaveabodyandonthedorsalsidewefindanarch,Pedicles(means:asmallfoot)anda
vertabraeforamenthatformsthevertebraecanal.Insideit,wefindthespinalchord.
Allthevertebraehavedifferentprocesses.Someoftheseprocessesarepaired.Thespinous
(meaning:thorn)process,locateddorsally,isnotapairedprocess.Lateraltoit,wefindaTransverse
processwhichisapairedprocessandanArticularprocesses.Wefindtwoarticularprocessesonthe
superiorsideofthevertebraeandtwoontheinferiorside,sototalof4exists.

Cervicalvertebrae
Thereare7cervicalvertabraeinthehumanbody.The3rd6thvertebraearetypicalwhilethe1st,
2ndand7thareatypical1.Atypicalvertebraconsistsofavetrebralbody,vertebralarchandseven
processes.

Containspecialfeatures.

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Generalfeaturesofthecervicalvertebrae
Thecervicalvertebraehaveaquadrangularshapedbody.Thecervicalvertebraehaveatriangular
foramen.Onthetransverseprocesseswefindatransverseforamina.Insidethetransverseforamina
wefindvertebraearteries.
AtlasandAxisareadaptedtoallowmovementofthe
head2attheAtlantooccipitaljoints(synovialjoint).
Theythereforecontainsomefeatureswhichweneed
tomentionspecifically.Rotationofthehead,takes
placebetweenAtlasandtheAxis,attheAtlanto
axialjoints.
Typialcervicalvertebrae(otherthanC1,C2,C7)
Hasabodyinfront,Neuralarchbehind,togetherclosingtheVertebral
Foramen,Aspinousprocesswith2tubercles,atransverseprocessoneach
site.Thearticularsurfacesoneachsiteformtheintervertebraljoints.The
cervicalvertebraearejoinedbytheintervertebraldisk,infront,andtwo
intervertebraljointsbehind.
Atlas(C1)
Thevertebraewhichconnectstotheskull,theAtlas,hasafew
uniqueelements.
Atlashasnobody.Instead,ithasananteriorandaposteriorarch
whichencloseanunusuallylargeforamen.Itsspinousprocessis
missing.OntheAtlas,wefindthefoveadentis.Articularsurfacesmustbementionedandpointed
out.TheyareshapedlikecupssothattheycanmatchthecondylesoftheOccipitalbone(towhich
theyconnect).
FRACTUREANDDISLOCATIONOFTHEATLAS : V ERTICALFORCES(LIKEHITTINGTHEBOTTOMOFAPOOLWITHYOURHEAD) CANFRACTUREONE
ORBOTHOFTHEANTERIORORPOSTERIORARCHES . / T HETRANSVERSELIGAMENTCANALSORUPTURE .

Axis(C2)
AxisisfoundrightbelowtheAtlas.CanbedistinguishedbytheOdontoid
process3.Inrotation,theAtlasvertebraerotatesaroundthisprocess.
TheAxishasaregularquadrangularshapedbody.Italsohastransverse
processes.Ithasadenseaxis.
FRACTUREANDDISLOCATIONOFTHEATLAS : ONEOFTHEMOSTCOMMONVERTEBRAEINJURIES. U PTO 40%. H YPEREXTENSION, USEDTO
EXECUTECRIMINALSBYHANGING . TH EKNOTISPLACEDUNDERTHECHIN , THEREFORESOMETIMESCALLED H ANGMAN SINJURY .

Vertebraeprominens(C7)
Thevertebraeprominensisthe7thcervicalvertebrae.Whatisimportanttomentionhereisthatits
spinousprocessisnotbifurcated.Anothernicewaytodistinguishthisvertebraistospotthebony
spiculedividingthetransverseforamenintotwoparts.

2
3

Forwardandlateralflexion;extensionofthehead.
InNetter:theOdontoidprocessiscalledthedensofaxis

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DISLOCATIONOFTHECERVICALVERTEBRAE: BECAUSEOFTHELARGECANAL , WECANDISLOCATETHESEVERTEBRAEWITHOUTDAMAGINGTHE

SPINALCHORD . CANSLIPBACKINTOPLACE , RESULTINGONLYINSOFTTISSUEDAMAGE .

Thoracicvertebrae
NETTER:154
Inthehumanbodywefind12thoracicvertebrae.Thebodyofthethoracicvertebraeisarchshaped.
Theformeniscircularinshapeinthisregion.Inthisregionwefindobliquespinousprocesseswhich
overlapeachotherbetweenadjacentvertebrae.Inthethoracicregionwefindalargenotch
betweenthebodyandthespinousprocesses.Thisnotchiscalledtheintervertebraenotch.The
notchparticipatesintheformationoftheintervertebraeforamina,whichisformedbetween2
adjacentnotches.Theintervertebraeforaminacontainnerves(ganglion4/Properganglion).
Inthethoracicregionwefindarticularsurfacesfortheribs(smoothsurfaces).Thissurfaceis
exclusivelyfoundinthethoracicregion.Onthelateralsideofthebodyofthethoracicvertebrae,we
findanotherarticularsurfacefortheheadoftheribs5.

Lumbarvertebrae
Thereare5lumbarvertebraeinthehumanbody.Thelumbarvertebraehavealarge/massive
body.Thevertebraearekidneyshaped.Thevertebraeforaminaistriangularinshape.The
vertebraehaveahugespinousprocess,locatedinasagitalplane.Theprocessisflat.Costal
processes6arefoundonthevertebrae.Thelumbarvertebraehaveverysmalltransverseprocesses7.
Thelumbarvertebraehavepairedarticularsurfaces.
LUMBARSPINALSTENOSIS :DESCRIBESANARROWVERTEBRALFORAMENINONEORMORELUMBARVERTEBRAE.CANCAUSEACOMPRESSION
OFONEORMOREOFTHESPINALNERVEROOTS .

TheSacrum
ThevertebraeoftheSacrumarefusedtogether.Inthiscontextitisimportanttomentionthefusion
line.Thefusionlineisseenontheinternalsurface(whichissmooth).Weneedtobeableto
recognizeearshapedsmoothsurfaceandtheauricularsurface.
DorsalsurfaceoftheSacrum:HerewefindtheSacrumcanal,Sacralhiatus.TheSacrumcanal
containsmerelytherootsofthespinalchord8.OnthedorsalsurfaceweneedtorecognizeMedian
sacral(..)(fusedspinousprocesses).LaterallytoitwefindtheMedialsacralcrestsandfuther
laterallytoitwefindlateralsacralcrests.Wecannoticeossificationbetweenthetransverse
processes.
Therearegroupsofholes,foundanteriourlyandposteriourlyontheSacrum.ThesearetheSacral
foramina.
Betweenthe5thsacralvertebraeandthecoccyxwefindajoint,butinmales,itisfused.

Ganglioncontainsmanyaxisofnervecells.
NospecificnamefoundinNetter/Moore.
6
Costalprocessesareremnantsoftheribs(notsure,needtocheckagain).
7
AlsoreferredtoasAccessoryprocessinthisregion
8
Thespinalchordsendsbelowthe2ndlumbarvertebrae.
5

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Joints
Theintervertebralarticulations,speciallythecraniovertebraljointsatitssuperiorendprovidethe
flexibilitynecessarytoallowpositioningofthehead.
Theintervertebraljointsaresynovialjoints.Therefore(asinallsynovialjoints)eacharticularsurface
iscoveredwithsmootharticularcartilage.Andthespacebetweenthecartilageisfilledwithsynovial
fluid.Thefluidiscontainedwithinafibreousjointcapsule.
Theintervertebraldisksaremadeoffibrocartilage.Theyallowminimummovementandare
thereforenotfoundbetweentheAtlasandtheAxis,instead,onlysynovialjoints.
Syndesmosis(notcategorizedasaarealjoint)isfoundbetweenbonesinthevertebralcolumn.
Syncondrosisisaconnectionbetweenbonesbycartilage.
Structureoftheintervertebraedisks.
Anulusfibrosus(meaning:ring)consistsoffibrouscartilage.Inthemiddleoftheeachdiskisa
structure,thenucleuspulposus.
THEINTERVERTEBRALDISKCANSOMETIMESPROTRUDEINTOTHEVERTEBRAECANALANDPUSHTHESPINALCHORD .

Synostosis
Ossificationorabonyconnection.Includessynovialjoints.Inthevertebreacolumnwefindplane
synovialjoints.Zygophysialjoints9arefoundaswell.

Ligaments
Wefind3ligamentsthatrunverticallythroughoutthevertebrae
column.TheNuchalLigament(Latin:LigamentumNuchae).Itlimits
theforwardflexionofthehead.
Fromtheanterioraspectweseetheanteriorlongitudinalligament.It
lookslikeabroadbandandconnectstothevertebraebodies
throughoutthewholevertebraecolumn10.Originatefromtheforaminmagnum.Itliesonthe
anteriorsurfaceofeachvertebrae.Continuestotheperiosteum.
Thethirdligament,theposteriorlongitudinalligamentrunsinsidethe
vertebraecanalitself.ItoriginatesfromtheTectorialmembraneand
connectstothebackofthebodiesthroughouttheentirevertebrae
column.
Supraspinousligaments,arefoundontheedgesontheneckandasadirectcontinuationofthe
nuchal.
Ligamentumflavum(meaning:yellowligament)Locatedbetweentheneighboringarches.Onthe
surfaceoftheseligamentsisahole(theintervertebraeforamen)

Betweenneighboringvertebrae
Endsonatubercle,foundontheAtlas

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Otherimportantligaments
ThetransverseligamentoftheAtlas.Itisattachedontwooppositetuberclesandenclosesthe
OdontoidprocessoftheAtlas.Italsocontainsasuperiorandaninferiorband(thebandsare
refferedtoasthecruciformligaments11.Alarligamentsarefoundbehindthetransverseligament
(limitmovementofhead,speciallylateralflexion).
Theligamentsthatconnectthearchesofthevertebraearecalledligamentumflavum12.
ArchesofatlasandAxisandedgesofForamenMagnumareheldtogetherbyAtlantooccipitaland
Atlantoaxialligaments.

Curves
Thevertebraecolumnisroughlysshaped.Inthecolumnwemustdifferentiatebetweenseveral
curvations.Thesecurvaturesarecategorizedintotwogroups,namelylordosisandkyphosisandthey
correspondtoanteriorandposteriorcurvature,respectively
Fromtoptobottomthecurvatureofthevertebraecolumncanbedescribedassuch:

Cervicallordosis
Thoracickyphosis
Lumbarlordosis
Sacralkyphosis

Thecurvesarefurthermorecategorizedintoprimaryorsecondarycurves.Primarycurvesare
developedduringembryoniclifetimeandsecondarycurvesaredevelopedafterbirth.
SCOLIOSIS :THE V ERTEBRAECOLUMNISLOCATEDMORETOTHERIGHT , THEAORTAPRESSESTHECOLUMN. P EOPLEWITHSCOLIOSISHAVEA
SMALLCURVATUREOFTHECOLUMN . FU RTHERMORE , PEOPLEWHOSUFFERFROMSCOLIOSISHAVEAHIGHERTENDENCYTOBELEFTHANDED .

Movement
Wedifferentiatebetweenventralanddorsalflexions.Ventralflexionisgeneratedinthecervicaland
lumbarpartofthecolumn.
Torsion/rotation
Finallyyouhavetobeabletoexplaintheyesandbendingmovementsofthehead,wherethis
movementoriginatesetc.

11

Behindthesuperiorcruciformband,wefindasmallligamentthatliesdeepest,theApicalligamentofdens
Yellowfribrouscartilage

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2.Vertebrae.Craniovertebraljoints
NETTER::
MOORE:982984,19,440444
Thistopicoverlapswiththe1sttopicofthissummary.So,inregardsofthevertebrae(bonesonthe
vertebralcolumn)andthecraniovertebraljointsIrefertothetextintopic1Thevertebralcolumn
(bones,joints,ligaments,curvatures,movements).,andthesectionAdditionalinformationatthe
veryendofthissummary.
Aproperpresentationofthisstructureistostartbymentioningthenumberof
vertebraefoundinthevertebralcolumn,thenthenumberofdifferent
segments,thenanatomicalfeaturesofeachsegments(startingwiththe
SacrumandendingwithAtlas(C1),thengointothecraniovertebraljoints,the
ligamentsofthesejoints,movements/rotationsandfinallyclinical
correlations.
Lumbosacralangleoccursatthejunctionofthelongaxesofthelumbarregionandthesacrum.The
vertebraebecomelargerastheydescendtowardsthesacrum.

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3.Musclesandjointsofthethorax
MOORE::7981,8283,8691
Eventhoughtheskeleton(ofthethoracicwall)isnotapatofthetopic.Itsusefultostartby
mentioningit,andthereforeenvelopingtheareaunderdiscussion.
Thethoracicskeletonformstheosteocartilaginousthoraciccage,whichprotectsthethoracic
viscera.Thethoracicskeletonincludes12pairsofribsandcostalcartilages,12thoracicvertebrae
andintervertibrealdisksandfinally,thesternum.
Theribsandthecostalcartilageformthelargestpartofthethoraciccage.Theribsarecurved,flat
bonesthatformthelargestpartofthethoraciccage.Theyarelightinweightyetresilient.Eachrib
hasaspongyinteriorcontainingbonemarrow.Thereare3typesofribs:true,falseandfloating
ribs.

Trueribs:Thesearethe7firstribs.Theyarecalledsobecausetheyattachdirectlytothesternumthroughtheirowncostal
cartilage.
Falseribs:Theseareribs810.Theircartilagesarejoinedtotheribabovethemsotheyindirectlyconnecttothesternum.
Floatingribs:Theseareribs1112.THebasiccartilagesoftheseribsdonotconnectatalltothesternum.Theyendinthe
posteriorabdominalmusculature.

Musclesofthethorax
Name.
Pectoralis
major.
Pectoralis

Position.

Origin.

Insertion.

Action.

NerveSupply.

Flexesarm,raises
Upperandforepartof Anteriorsurfaceofsternum,
Outermarginoccipital bodytoarms,
chest,andinfrontof clavicle,sevenuppercostal
grooveofhumerus.
rotatesinwards,
axilla.
cartilages.
adducts.

Externalanterior
thoracic.

Underpectoralis
major.

Third,fourth,fifthribs.

Coracoidprocess
scapula.

Internalanterior
thoracic.

Betweenclavicleand
firstrib.

Cartilage,firstrib.

Undersurfaceclavicle. Drawsdownclavicle.

Betweenribsand
scapulaatupperpart
andsideofchest.

Eightupperribs.

Vertebralborderof
scapula.

Extendsarm
Posterior
forwards,assistsin
raisingribsin
thoracic.
inspiration.

Fillsintercostalspaces. Inferiorbordersofribs.

Superiorbordersof
ribsbelow.

Raisesribsin
expiration.

Intercostal.

Fillsintercostalspaces. Inferiorbordersofribs.

Superiorbordersof
ribsbelow.

Depressesribsin
inspiration.

Intercostal.

Depressespointof
shoulder.

minor.
Subclavius.
Serratus
magnus.
External
intercostals
(elevenin
number).
Internal
intercostals
(elevenin
number).
Triangularis

Innerwalloffrontof
chest.

sterni.
Onthebackbetween
seventhcervicaland
Levators
costarum(twelve elevenupperdorsal
vertebrae.
innumber).
Diaphragm.

Fromfifthand
sixthcervical.

Lowerthird,posterior
Bydigitationsinto
Drawsdowncostal
surfaceofsternum,ensiform lowerbordersofcostal
cartilagesin
cartilage,costalcartilageof cartilagesofsecondto
expiration.
fourlowertrueribs.
sixthrib.

Intercostal.

Transverseprocess,seventh
Raiseribsin
cervicalandelevenupper
Eachtotheribbelow.
inspiration.
dorsalvertebrae.

Intercostal.

Ensiformcartilage,sixlower
Formsfloorofthorax
ribs,bodiesoflumbar
intocentraltendon.
androofofabdomen.
vertebrae.

Respirationand
expulsion.

Phrenic,lower
intercostals,and
phrenicflexus.

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Jointsofthethorax
MOORE:7981
Costovertebraljoints
Atypicalribarticulateswithtthevertebralcolumnattwojoints.

Jointsoftheheadsoftheribs:Theheadofeachtypicalribarticulateswithdemifacetsorcostalfacetsoftwoadjacentthoracic
vertebraeandtheintervertebraldiscbetweenthem.Theheadarcitulateswiththesuperiorpartofthecorresponding(same
number)vertebrae.Anarticularcapsulesurroundseachjointandconnectstheheadoftheribwiththecircumferenceofthe
jointcavity.Thefibrouscapsuleisstrongestanteriourlywhereitformsaradiateligamentthatfansouttoformtheanterior
marginofthetheheadoftheribtothesidesofthebodiesofthetwovertebraeandtheIVdiscbetweenthem.
Costotransversejoints:Thetubercleofatypicalribarticulateswiththetransversecostalfacetontheanteriorsurfaceofthe
endofthetransverseprocessofitsownvertebra.Thesesmallsynovialjointsaresurroundedbythinarticularcapsulethat
attachestotheedgesofthearticularfacets.Acostotranserveligamentpassingfromthenecktotheribandthentothe
transverseprocess,andalateralcostotransverseligamentpassingfromthetubercleoftheribtothetipofthetransverse
process.Finally,alateralcostotransverseligamentgoesfromthetipofthetransverseprocess,straighteningtheanteriorand
theposterioraspectofthejoint.

Costochondraljoints
Thecostochondralarticulationsarehyalinecartilaginousjoints.Eachribhasacupshaped
depressioninitssternalendintowhichthecostalcartilagefits.Theribanditscartilagearefirmly
boundtogetherbythecontinuityoftheperiosteumoftheribwiththeperichondriumofthe
cartilage.Nomovementusuallyoccursatthesejoints.
Interchondrialjoints
Thesearticulationsbetweentheadjacentbordersofthe6th7th,8th8thand9thcostalcartilage
areplanesynovialjoints.Eachofthesejointsusuallyhaveasynovialcavitythatisenclosedbyan
articularcapsule.Thejointsarestrengthenedbyanarticularcapsule.Thejointsarealso
strenghtenedbyinterchondrialligaments.Thearticulationbetweenthe9thand10thcostal
cartilagesisafibrousjoint.
Sternocostaljoints
The1stto7thribsarticulatewiththeircostalcartilageswiththelateralbordersofthesternumas
folllows.The1stpairofthecartilagesarticulatewiththemanubriumonly.The2ndpairofcartilages
articulateswiththemanubriumandthe1ststernalsegment.The3rdto5thpairsofcartilages
articulatewiththe2ndand3rdsternalsegment.The6thpairofcartilagesarticulateswiththe4th
sternalsegmentonly.Andfinally,the7thpairofcartilagesarticulateswiththe4thsternalsegment
andthexiphoisprocess.

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4.Extrinsicandintrinsicmusclesoftheback(withtheexceptionofthe
nuchalregion).
MOORE::482,484488

Theextrinsicmusclesoftheback
MOORE::482

Thesemusclesaresuppliedbytheventralramiofcervicalnerves,notbydorsal
rami.Theexplanationforthisisthatthesuperficialbackmusclesdevelopin
theembryoasaventrolateralsheetthatmigratesposteriorlytogain
attachmenttothevertebralcolumn.
TheTrapeziusmuscle
Thisisalarge,flat,triangularmusclethatcoverstheposterioraspectoftheneckandsuperiorhalfof
thetrunk.Itwasgivenitsnamebecausethemusclesofthetwosidesformatrapezion(G.irregular
foursidedfigure).Thetrapeziusmuscleattachesthepectoralgirdletotheskullandthevertebral
columnandassistsinsuspendingit.

Medialattachmentsare:medialthirdofsuperiornuchalline;externaloccipitalprotuberance,ligamentumnuchae,spinous
processesofC7toC12vertebrae.
Lateralattachmentsare:lateralthirdofclavicle,acromionandspineofscapula.
Innervation:spinalrootofaccessorynerve(CNXI)andcervicaln.(C3andC4).

Thesuperiorfibresofthetrapeziuselevate the scapula;itsmiddlefibresretract the scapula,

anditsinferiorfibresdepress the scapula and lower the shoulder.Thesuperiorandinferior
fibresacttogetherinthesuperiorrotationofthescapula.Thetrapeziusmusclesbracetheshoulders
bypullingthescapulaeposteriorly,henceweaknessofthesemusclesresultindroopingofthe
shoulders.
TheLatissimusDorsiMuscle
ThenameofthismuscleisderivedfromtheLatinmeaning"widestoftheback".Thisislarge,wide,
fanshapedmusclepassesbetweenthetrunkandthehumerusandactsontheshoulderjointand
indirectlyonthepectoralgirdle.

Medialattachmentsare:spinousprocessesoftheinferiorsixthoracicvertebrae,thoracolumbarfascia,iliaccrest,andinferior3
or4ribs.
Lateralattachmentsare:floorofintertuberculargrooveofhumerus.
Innervation:thoracodorsaln.(C6,C7,andC8).

Thelatissimusdorsiextends,adducts,andmediallyrotatesthehumerusattheshoulderjoint.
Whenclimbing,thesemusclesraisethetrunk.Inconjunctionwiththepectoralismajormuscle,the
latissimusdorsimuscleraisesthetrunktothearm,whichoccurswhenperformingchipups.

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TheLevatorScapulaeMuscle
Thesuperiorthirdofthisstraplikemuscleliesdeeptothesternocleidomastoidmuscle;theinferior
thirdisdeeptothetrapezius.

Medialattachmentsare:posteriortuberclesoftransverseprocessesofC1orC4vertebrae.
Lateralattachmentsare:superiorpartofmedialborderofscapula.
Innervation:dorsalscapular(C5)andcervical(C3andC4)nerves.

Thelevatorscapulaeelevatesthescapulaandhelpstotiltitsglenoidfossainferiorlybyrotatingthe
scapula.Italsohelpstoretractthescapulaandfixitagainstthetrunkandtoflextheneck.

Theintrinsicmusclesoftheback
MOORE::484488

Theintrinsicordeepmusclesofthebackareconcernedwiththemaintenance
ofpostureandmovementsofthevertebralcolumnandhead.Themusclesare
namedaccordingtotheirrelationshiptothesurface:(1)asuperficiallayer,(2)
anintermediatelayer,and(3)adeeplayer.
TheSpleniusMuscles(Superficiallayer)
Thesearebandagelikemuscles(G.splenion,bandage)are
appliedtothesidesandbackoftheneck,somewhatlikespiral
bandages.Theyascendfromthemedialplaneoftheneckand
thetransverseprocessesofthesuperiorcervicalvertebraeto
thebaseoftheskull.Eachmuscleisdividedintoacranial
portion(latin:spleniuscapitis)andacervicalportion(latin:
spleniuscervicis).

Origin:inferiorhalfoftheligamentumnuchaeandthespinousprocessesofT1toT6vertebrae.
Insertion:spleniuscapitisinsertsintothelateralaspectofthemastoidprocessandthelateralthirdofthesuperiornuchalline
oftheoccipitalbone(deeptothesternocleidomastoidmuscle).Spleniuscervicisinsetsintotheposteriortuberclesofthe
transverseprocessesofC1toC4vertebrae(posteriortothelevatorscapulaemuscle).
Innervation:dorsalramiofinferiorcervicalnerves.

Actingalone,thespleniusmuscleslaterallyflexandrotatetheheadandnecktothesameside.
Actingtogether,theyextendtheheadandneck.
TheErectorSpinaeMuscle(Intermediatelayer)
Thismassivemuscleformsaprominentbulgeoneachsideofthevertebralcolumn.Itlieswithina
fascialcompartmentbetweentheposteriorandanteriorlayersofthethoracolumbarfascia.The
erectorspinaeisarrangedinthreeverticalcolumns:

iliocostalis(lateralcolumn);
longissimus(intermediatecolumn);
spinalis(medialcolumn).

Thecommonoriginofthethreecolumnsisthoughabroadtendonthatisattachedinferiorlytothe
posteriorpartoftheiliaccrest,theposterioraspectofthesacrum,thesacroiliacligaments,andthe
sacralandinferiorlumbarspinousprocesses.

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TheIliocostalisMuscle(Intermediatelayer)
Thisisthelateralcolumnoftheerectorspinaeanditarisesfromthecommonoriginandinsertsinto
theanglesoftheribs.Itmaybedividedintothreepartsaccordingtotheregioninvolved.

Iliocostalislumborumisattachedtotheinferiorsixribs;
iliocostalisthoracisisattachedtoalltheribs;
iliocostaliscervicisisattachedtothesuperiorsixribsandtheposteriortuberclesofC4toC6vertebrae.

TheLongissimusMuscle(Intermediatelayer)
Thisistheintermediatecolumnoftheerectorspinaemuscleanditarisesfromthecommonorigin
andisattachedtothetransverseprocessesofthethoracicandcervicalvertebrae,andthemastoid
processofthetemporalboneoftheskull.Thisgivesthismuscleaherringboneappearance.
Thelongissimuscanalsobedividedintothreepartsaccordingtotheregionsittraverses.

Longissimusthoracisinsertsintothetipsofthetransverseprocessesofallofthethoracicvertebrae,andintothetuberclesof
theinferiorninetotenribs;
longissimuscervicisextendsfromthesuperiorthoracictransverseprocessestothecervicaltransverseprocesses;
longissimuscapitisarisesincommonwiththecervicalpartandattachestothemastoidprocessofthetemporalbone.

TheSpinalisMuscle(Intermediatelayer)
Thisisthenarrowmedialcolumnoftheerectorspinaemuscleandisrelativelyinsignificant.Itarises
fromthecommonoriginandextendsfromthespinousprocessesinthesuperiorlumbarandinferior
thoracicregionstothespinousprocessesinthesuperiorthoracicregion.Itmayalsobedividedinto
threeparts

spinalisthoracis
spinaliscervicis
spinaliscapitis

ActionsoftheErectorSpinaeMuscles
Actingbilaterally,allthreecolumnsoftheerectorspinaeextendtheheadandpartorallofthe
vertebralcolumn.Actingunilaterally,theerectorspinaelaterallyflexestheheadorthevertebral
column.Inaddition,thelongissimuscapitismusclerotatestheheadsothatitisturnedtothesame
side.Theerectorspinaemusclesarethechiefflexorsofthevertebralcolumn.Theystraightenthe
flexedcolumnandcanbenditposteriorly.Theyalso"payout"(release)duringitsflexionsothatthe
movementisslowandcontrolled.

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5.Partsofthecranium;calvaria,fontanelles,parietalbone
MOORE::21,822,838,840(CALVARIA),28,839,840(FONTANELLES),823,829,869

Calvaria
MOORE::21,822,838,840

Fontanelles
MOORE::28,839,840

Parietalbone
MOORE::823,829,869

Anatomy::Theskull

6.Anteriorcranialfossa.Frontalbone
MOORE::822827
TheCranialbasecanbedividedintothreestairs/stepsorthe
anterior,posteriorandmiddlecranialfossae.TheAnteriorcranial
fossaisthetopicofdiscussioninthissegment.
Westartthetopicbydefiningthebonybordersthatdefinethe
anteriorcranialfossa.
Borders

Anterior:Squamuspartofthefrontalbone
Posterior:Posteriorfreeedgeofthesphenoidboneexcludingtheanteriorclinoidprocess,upperborderoftheopticcanal,
limbusofthesphenoidbone
Floor:Cerebralsurfaceoftheorbitalpartofthefrontalbone,cribiformplateoftheethmoidbone,thecerebralsurfaceof
thelesserwingofthesphenoidbone.

Structures
TheChristagalli/doramateranchorshere.Thecribriformplate,whichformsthefloor13oneither
sideoftheChristaGalli,andtheverynarrowroofofthenasalcavity,has22holes.11oneachsideof
thecrhistagalli,6inthemedialand5inthelateralrow.Thereisaconnectionbetweenthenasal
cavityandtheanteriorcranialfossa.Thefilaolfactoria,anteriorethmoidartery,vein,nerveenter
throughit.
Theanteriorethmoidalforemanprovidesaconnectionbetweentheorbitandtheanteriorcranial
fossa.Itcontainstheanteriorethmoidalartery,vein,nerve.Themeningealbranchessupplythedura
mater,thenasalbranchesenterthenasalcavitythroughthecribiformplate.
Posteriorethmoidalforemanprovidesaconnectionbetweentheorbitandtheanteriorcranial
fossa.Itscontentistheposteriorethmoidalartery,vein,nerve.
Openings
Weneedtolookatthreeopeningsthatpassforwards,twoopeningsthatpassdownardsandone
thatpassesinanobliquemannerbackwards.
StructuresthatpassforwardsaretheOpticcanal(opticnerve),locatedjustinfrontoftheanterior
clinoidprocess.LateraltotheopticcanalwefindtheSuperiorOrbitalFissure(numerousnervesand
vesselspassthroughit,intotheorbit).BelowtheSuperiorOrbitalFissurewefindtheForamen
Rotundum(maxillarybranchofthetrigeminalnerve).TheForamenRotundumdoesnotgointothe
orbit14.
TheopeningsthatpassdownardsaretheForamenOvale(Mandibularbranchofthetrigeminal
nerve)whichcomesoutjustnexttothelateralpterygoidplate,andbehindandlateraltoit,the
ForamenSpinosum(Middlemeningealartery)whichexitsbehindandabitlateraltotheexitofthe
ForamenOvale.

13
14

Wecanalsocallit,thedepression,onbothsides.
Itgoesintothepterygoidmaxillaryfissure

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Thefifthopening(theobliqueone)istheForamenLacerum(Internalcarotidartery).Theforamen
appearstopassstraightdown,butitdoesnot.Inthelivingbodytheinferioropeningisfilledwith
densecartilageandfibroustissue.Whenthethecartilageisinplace(inthelivingbody)theforamen
takesinamorecircularshapetheopeningoftheCarotidcanal.Theexit(inferiourly)ofthiscanalis
justmedialtotheStyloidprocess.Infrontoftheopeningofthecanal(ontheinferiorside)thereis
anotheropeninginfrontofit,theopeningoftheAuditoryTube.TheAuditorytubespasses
backwardsandlaterallyandemergesinthemiddleear.Inthelivingbodythetubeislonger,because
itisextendedwithCartilageoftheAuditoryTube.Theauditorytubeopensintothenasalpharynx.

Thefrontalbone
MOORE::822,823824,892
Thefrontalboneisaverylargebone.Thelowerpartofthe
frontalboneformsthebeginningoftherootofthenose,the
upperpartoftheorbitalmargin,asmallpartofthetemporal
fossaandalargepartoftheroofoftheorbit.Thefrontal
bonealsoformsthelargestpartofthefloor,oftheanterior
cranialfossa.
Thepartofthefrontalbonewhichisnearthemidline,is
hollow.Thisspaceiscalledthefrontalsinus15.

15

Oneofparanasalsinuses

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7.Middlecranialfossa.Temporalbone
MOORE::822827,823,829

Borders

Anterior:Istheposteriorfreeedgeofthesphenoidbone,excludingtheanteriorclinoidprocess,upperborderoftheoptic
canal,limbusofthesphenoidbone.
Posterior:Superiormarginofthepyramid,posteriorclinoidprocessanddorsumsallae.
Floor:Lateralandanteriorpartofthepyramid,portionoftheSquamuspartofthetemporalbone,cerebralsurfaceofthe
greaterwingofthesphenoidbone.MiddleandlateralpartsofthewallsofthebodyofSphenoidboneandsellaturcia.

Thecomplicatedandraisedareainthemiddleofthecranialfossa,istheSellaTurcica(Turkish
saddle).Themainfeaturesofthearea,arethedeepdepressioncalledPituitaryFossa16,ashallow
grooveforthetwoopticnervesandthe4projections(AnteriorClinoidprocesses/Posterior
Clinoidprocesses).TheposteriorsurfaceofthisareaiscalledDorsumSellaeandthissurfaceis
continouswiththebaseoftheocciputbone.
Aswecanseeonthefloordefinitionforthisregionhereabove,thefloorofthisregionismarked
withtheopeningsofvariousnervesandbloodvessels.

Structuresopenings
Superiororbitalfissure
Itislocatedbetweenthelesserandgreaterwingsofthesphenoidbones.Connectionbetween
Middlecranialfossaandtheorbit.Itconsistsof:oculomotor(III),trochlear(IV),ophtalmic(V/1),
abducensnerves
superiorophthalmicvein.
Opticcanal
ItservesasaconnectionbetweenthemiddlecranialfossaandOrbit.Itconsistsof:optic(II)nerve,
opthalmicartery.
Foremanrotundum
ItistheconnectionbetweenthemiddlecranialfossaandthePteryopalatinefossa.Contains:
Maxillary(V/2)nerve
Foremanovale
Itistheconnectionbetweenthemiddlecranialfossaandinfratemporalfossa.Contains:
Mandibularnerve(V/3)
lesserpetrosalnerve(branchfromBlossophanyngealnerve)
accessorymengingealartery.

16

ForthePituitarygland

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Foremanspinosum
Connectionbetweenmiddlecranialfossaandinfratemporalfossa.
Middlemeningealartery
meningealbranchofmandibularnerve
Foremanlascerum
Betweenmiddlecranialfossaandinfratemporalfossa.Invivothisopeningisclosedbythe
synchodrosisspehnopetrosa(fibrouscartilage).Borders:thebodyofsphenoidbone(medial),the
greatwingofthesphenoid(lateral),andthepyramidofthetemporalbone.
Greaterpetrosalnerve(fromtheVIInerve).
Exitofthecarotidcanal
Betweentheexternalcranialbaseandthemiddlecranialfossa.
Internalcarotidartery,
carotidnerveplexus(sympathetic)
Hiatusforlesserpetrosalcanal
Betweenthetympaniccavityandthemiddlecranialfossa.
Lesserpetrosalnerve
Hiatusforthegreaterpetrosalnerve
Betweenthefacialcanalandthemiddlecranialfossa
GreaterPetrosalnerve
Sellaturcica(Eng:TheTurkishsaddle)
Formedbymiddleclinoidprocess,hypophysealfossa,posteriorclinoidprocess,tuberculumand
thedorsumsellae.
Content
Hypophysis.Otherstructuresfoundhereaswell:Fissuresphenopetrosa17,Tegmantympani18,
Arcuteeminence19,Trigemnianimpression20

TheTemporalbone
MOORE::823,829

17

Lateraledgeofthef.Lacerum.
Roofofthetympanycavity
19
Thisistheanteriorpartofthepyramid
20
Locatedonthetopofthepyramid
18

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8.Posteriorcranialfossa.Occipitalbone.
MOORE::822827,493,495,831,869,986,1032

Theposteriorcranialfossa
MOORE::822827

Occipitalbone
MOORE::822827,493,495,831,869,986,1032
TheOccipitalboneisasaucershapedlargebone,whichformstheposteriorinferiorpartofthe
cranialbase,theocciputandthemajorityoftheposteriorcranialfossa.
Ontheinferioraspectithasalargeovalopening,theforemanmagnum,throughwhichthecranial
cavitycommunicateswiththevertebralcanal.Also,theoccipitalcondylesarelocatedforarticulation
withtheAtlas(C1).
Theoccipitalboneconsistsof4parts.TheSquamuspart,thegreaterpartofthebone,whichlies
behindtheforemanmagnum.Twolateralparts,oneachsideoftheforemanmagnum.Andfinally,a
basilarpartwhichislocatedinfrontoftheforemanmagnum.
Squamuspart
Articulateswiththeparietalboneatthelambdoidsutureandalsowiththemastoidprocessofthe
temporalbone(occipitomastoidsuture).Thatbonyregionthatliesatthelambdoidsutureiscalled
thesuperiorangle.Thepartthatliesattheasterion(wherethesuturesoftheparietal,temporaland
occipitalbonemeet)isthelateralangle.
Externalsurface

Externaloccipitalprotrubrence
Externaloccipitalcrest
Highest/supremenuchalline
Superiornuchalline
Inferiornuchalline

Internalsurface(dividedinto4surfaces)

2upperfossaearecalledthecerebralfossa(foroccipitallobesofthebrain)
2lowerfossaearecalledthecerebellarfossae
o
Internaloccipitalprotruberence
o
Grooveforthesuperiorsaggitalsinus
o
Groovesforthetransversesinuses
o
Groovesforthesigmoidsinus
o
Internaloccipitalcrest

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Lateralpart

OccipitalcondyleswhicharticulatewiththeAtlas(atlatooccipitaljoint)
Hypoglossalcanal
Condylarfossa
o
Condylarcanal
o
Interjugularspine
o
Jugularnotch
o
Jugulartubercle
o
Grooveforsigmoidsinus

Basilarpart
Itisfusedwithethebodyofthesphenoidbone(sphenooccipitalsynchondrosis21).Itossifies
completelybytheageof25.Atthesides,itarticulateswiththepetrouspartofthetemporalbones
(petrooccipitalsynchondrosis).Structurestobespottedinthispartare:

Clivus
Groovefortheinteriorpetrosalsinus
Pharyngealtubercle

21

Synchondrosisarejointswheretwobonesareconnectedbyapieceofcartilage.

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9.Externalsurfaceofthecranialbase
MOORE::829830
Structuresweneedtopinpointatthecranialbase.
Externaloccipitalprotuberance
LocatedontheSquamouspartoftheoccipitalbone.Thetrapeziusmuscleoriginateshere.
Superiornuchalline
Passesthroughtheexternaloccipitalprotuberancehorizontally.
Inferiornuchalline
Inferiortothesupernuchalline.
Theneckmusclesinsertonboththesuperiorandtheinferiornuchallines.
Occipitalcrest
Longitudinalbonycrestfortheattachmentofthemucalligament.Locatedbetweentheexternal
occipitalprotuberanceandtheforamenmagnum(atthemidline).
Foramanmagnum
Surroundedbythesquamous,lateralandbasilarypartsoftheoccipitalbone.
Occipitalcondyles
Ovoidshapearticularsurfacefortheattachmentoftheatals.
Condylarfossa
Depressionjustbehindthecondyles.Thecondylarcanalopenshere.Thiscanalcontainstheemissary
veins.
Mastoidprocess
Locatedatthemastoidpartofthetemporalbone.Thesternocleidomastoidmuscleandtheposterior
bellyofthedigastricmusclesoriginatehere.Theprocesscontainsmastoidaircellswhichopensinto
themiddleear.
Mastoidnotch
Itislocatedjustlateraltothemastoidprocess.Thepostbellyofthedigastricmuscleoriginateshere.
Mastoidforamen
Opensattheposterolateralsideofthemastoidprocess.Communicateswithttheposteriorcranial
fossaandcontainsanemissaryvein.
Styloidprocess
Isalong,slenderandtoothshapedprocess.Thestylomusclesoriginatehere.
Styloglossusandstylopharnygenusmuscles.
Styleomastoidforamen
Locatedbetweenthestyloidandthemastoidprocesses.Itistheexitofthefacialcanal.Insideit,we
findthefacialnerve.

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Hypoglossalcanal
Locatedbetweentheoccipitalcondyles.
Jugularfossa
Locatedattheinferioraspectofthejugularforamen.Formedpartiallybythepyramidandpartially
bythelateralpartoftheoccipitalbone.Insideit,wefindtheGlossoparyngealnerve,Vagusnerve
andaccessorynerve.WealsofindtheInternaljugularvein.
Fossulapetrosa
Tinyfossalocatedbetweenthejugularfossaandtheentranceofthecarotidcanal.Theinferior
ganglionoftheglossopharingealnerveishere.Attheroofofthefossulaatinycanaliculeoriginates,
whichconnectstheECBwithtthetympaniccavity.ThisistheTympaniccanalicule.Thetympanic
nerveiswithinthiscanal.
Thetympanicnerveentersthetympaniccavityandformsanerveplexuswithinit.Oneofits
branchesexitsthetympaniccavitythroughthecanalforthelesserpetrosalnerveasthelesser
petrosalnerve.
Thetympanicnerveisabranchoftheglossopharyngealnerve,andoriginatesat(from)theinferior
ganglionoftheglossopharangealnerve.
Cochlearcanalicule
Locatedslightlylateraltothefossulapetrosa.Itcontainsthecochlearduct,whichcontainsthe
perilymph.
Carotidcanal
Roundopeningjustmedialtothestyloidprocess.Theinternalcarotidarteryentersthiscanalto
reachtheMCF.Itsfunctionistoreducethepulsationwaveoftheblood.Insidethecanalwefind
InternalcarotidarteryandtheCarotidplexus.
Foremanlacerum
Thisopeningdoesntexistinvivo;itiscoveredbythesynchondrosissphenopetrosa.Locatedatthe
jointbetweentheapexofthepyramid,bodyofthesphenoidandthebacillarypartoftheoccipital
bone.Insideitwefindthegreaterandlesserpetrosalnerves.
Scaphoidfossa
Locatedattheroofofthemedialplateofthepterygoldprocess.Themedialplateoriginateswiththe
tworoots,andasmallfossacanbefoundbetweentheseroots,thescaphoidfossa.
Groovefortheauditorytube
Formsthescaphoidfossa,ashallowgrooveextendstowardsthemiddletothebaseofthepyramid.
Musculotubariancanal
ThiscanalsleadsfromtheECBtotheinternalear.Itissubdividedintotwohalfcanals,theupper
semicanalforthetensortympanimuscleandthelowersemicanalfortheauditorytube.
Pterygoidcanal
Thepterygoidcanalislocatedbetweenthemedialandlateralplatesofthepterygoidprocess.

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Mandibularfossa
Thefossalocatedattheroofofthezygomaticarch.Theheadofthemandibulaarticulateshere.At
theborderbetweenthetympanicandSquamouspartofthetemporalbone,wecanseeaslitlike
opening.Carefulobservationrevealsatinycrest,theTegmantympani(tegmentalcrest).
BetweentheSquamouspartofthetemporalboneandthetegmentalcrest,wecanfindanarrowslit
likeopening,thepetrosquamousfissure.
Betweenthetegmentalcrestandthetympanicpart,wecanseethepetrotympanicfissure.The
chordatympani,abranchofthefacialnerve,exitstheskullthroughthisfissure.
Inferiororbitalfissure
Thisslitlikeopeningislocatedbetweenthebodyofthemaxillaandtheorbitalsurfaceofthegreater
wingofthesphenoidbone.Itsaconnectionbetweentheinfratemporalfossawiththeorbit,and
alsothepterygopalativefossawiththeorbit.Insideitwefindinfraorbitalvesselsandthemaxillary
nerve.
Zygomaticotemporalforamen
Seenmedially.Thisistheexitofthezygomaticotemporalcanal,atthetemporalsurfaceofthe
zygomaticbone.Itcontainsthezygomaticotemporalnerve.
Zygomaticofacialforeman
Seenanteriourly.Thisistheexitofthezygomaticofacialcanal,attheanteriorsurfaceofthe
zygomaticbone.Containsthezygomaticofacialnerve.
Greaterpalatinecanals
Originatefromthepterygopalatine.ItcontainstheDescendingpalatinearteryandthegreater
palatinenerve.
Lesserpalatinecanal
Originatefromthegreaterpalatinecanalandopenbesideit,withintheoralcavity.Containsthe
lesserpalatineartery,lesserpalatinevein,lesserpalatinenerve
Incisivecanal
Formedattheanterior,mostareaofthemedianpalatinesuture,betweentheleftandrightpalatine
andalveolarprocessesofthemaxilla.Containsnasopalatineartery,nasopalatinevein,nasopalatine
nerve.
Zygomaticcanal
Isanyshapedcanalrunninginthezygomaticbone.

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10.Temporal,infratemporalandpterygopalatinefossae.

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11.Bonesofthefacialskeleton.Maxilla.
MOORE::823824,825,827,831,952,837
Incommonlanguage,Maxilla,isrefferredtoastheupperjaw.The
Maxillaisthefocusofthistopic,butwealsoneedtoreviewtheother
facialbonesaswell.
The5largestfacialbonesarethefrontalbone,Zygomaticbones,the
Maxilla,theSphenoidboneandtheEthmoidbone.
Someofthefacialboneshavealreadybeendiscussesinthissummary.
Gotothetableofcontentstofinddescriptionforthebonesthatare
leftout(ethmoidetc.).

TheFrontalbone
Lowerpartformstherootofthebeginningoftherootofthenose,upperpartoftheorbitalmargin,
smallpartofthetemporalfossaandalargepartoftheroofoftheorbit.Thefrontalbonealsoforms
mostoftheflooroftheanteriorcranialfossa.
Zygomaticbone
Formsthebonypartofthecheek,lowerorbitalpartoftheorbitalmarginandapartofthelateral
orbitalwall.Itextendsbackwardstomeetthezygomaticprocessofthetemporalbone,formingthe
Zygomaticarch.
TheSphenoidbone
Extremelycomplex.Extendsfromonesideoftheskulltotheother.
Formsapartoftheorbitandalargepartoftheanteriorfloorofthe
cranium.Ithasacentralpart,thelesserwing,thegreaterwingand
thePterygoidprocess.Thecentralpartishollow

TheMaxilla
Therightandleftmaxilliarejoinedtogetherinthemidline.Oneachsidethemaxilliformthelower
medialpartoftheorbitalmarginandalmostalloftheflooroftheorbit.TheMaxillabearstheupper
teeth.Ontheundersideitformsthebiggestpartofthehardpalate.TheMaxillaishollow.Itcontains
thelargestsinuses.Ifweremovethezygomaticarchweseeacleftbehindit.Thisclefthasavertical
andahorizontalsurfaceandiscalledthePterygomaxillaryFissureandtheinferiorOrbitalFissure,
respectively.Theinferiororbitalfissureseparatestheflooroftheorbitfromitslateralwall.

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12.Bonesofthefacialskeleton.Ethmoidalbone.
MOORE::824,891
Inthistopiciprefertostartbydivingthefacialskeletonintotwocategories.The5largebonesofthe
facialskeletonandthe3smallbonesofthefacialskeleton.Finishingthetopicoffwithadetailed
discussionabouttheEthmoidbone.

The5largestbonesofthefacialskeleton
Frontalbone
Thefrontalboneisaveylargebone.Thelowerpartofthefrontalboneformsthebeginningofthe
rootofthenose,theupperpartoftheorbitalmargin,asmallpartofthetemporalfossaandalarge
partoftheroofoftheorbit.Thefrontalbonealsoformsmostoftheflooroftheanteriorcranial
fossa.Theboneofthefrontalbone,nearthemiddlinecontainsahollowspace,theNasalSinus,
whichisoneoftheparanasalsinuses.
Zygomaticbone
TheZygomaticboneformsthebonyprominenceofthecheek.Italsoformsthelowerlateralpartof
theorbitalmarginandapartofthelateralorbitalwall.TheZygomaticboneextendsbackwardsto
formthezygomaticarchbetweenthezygomaticandthetemporalbone.
Maxilla
TherightandleftpartsoftheMaxillaarejoinedtogetheratthemidline.
Themaxillaformsthelowermedialpartoftheorbitalmarginandalmost
alloftheflooroftheorbit.Themaxillabearstheupperteath.Onthe
underside,itformsmuchofthehardpalate.TheMaxillaishollowandit
containsthelargestoftheparanasalsinuses,theMaxillarysinus.Atthe
posteriorsideofthemaxillawefindacleft.Thisclefthasaverticalpart
andahorizontalpart.TheverticalpartisnamedPterygomaxillaryFissure.Thehorizontalpartis
calledtheinferiorOrbitalFissure.TheinferiorOrbitalFissureseparatestheflooroftheorbitwith
thelateralwall.
Sphenoidbone
TheSphenoidboneisextremelycomplex.Itextendsallthe
wayfromonesideoftheskulltotheother.Itformsimportant
partsoftheundersideandoutsideoftheskull.Italsoformsa
partoftheorbitandalargeandacomplicatedpartofthefloor
ofthemiddlecranialfossa.Thesphenoidbonehasacentral
part,andoneachside,3majorprojections:thelesserwing,
thegreaterwingandthepterygoidprocess.
Thecentralpartoftheboneincludesthefourclinoidprocesses,andthesphenoidfossa.Thecentral
partofthesphenoidboneishollow.Thelesserwing,whichisthehighestpartofthesphenoidbone,
formstheSphenoidRidgewhichseparatesthemiddleandtheanteriorcranialfossae.Theunderside
ofthelesserwingformsasmallbutanimportantpartonthebackoftheorbit.Thegreaterwingof
thesphenoidfomsthefrontwallandpartofthefloorofthemiddlecranialfossa.Ontheoutsidethe

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greaterwingsformsapartoftheupperandinferiortemporalfossae.Italsoformsalargepartofthe
lateralwalloftheorbital.ThegreaterandlesserwingareseparatedmediallybytheSuperiorOrbital
Fissurewhichformsalargeopeningbetweentheorbitandtheinsideofthecranium.
ThePterygoidprocessofthesphenoidboneprojectsdownwardsbehindtheproxilla.ThePterygoid
processincludesthemedialandthelateralpterygoidplates.Theareabetweenthetwoplatesisthe
PterygoidFossa.ThelittlehookattheendofthePterygoidprocessiscalledPterygoidHamulus.

Thethreesmallerfacialbones
Nasalbone
Thethinnasalbonesformjusttheupperpartofthenose.Theirstructuresupportstheprojectionof
thenose,whichismadeofcartilage22.
Lacrimalbone
TheLacrimalboneformsthemostmedialpartoftheorbitalwall.TheopeningbetweentheLacrimal
boneandtheethmoidboneiscalledNasolacrimalductwhichtakestearsfromtheeyeandmoves
themtothenasalcavity.
Palatinebone
Oneachside,thePalatineboneformstheposteriorpartofthehardpalateandpartofthesidewall
ofthenasalcavity.

Ethmoidalbone
TheEthmoidboneisafragilecoalitionofparts.
Theethmoidalboneisalittlebitdifficulttounderstandatfirst,because,on
anintactskull,itisnearlyoutofview.
ThePerpendicularPlateoftheethmoidboneformsalargepartofthe
bonynasalseptum.Theuppermostprojectionontopoftheseptumisthe
beginningoftheCristaGalli.OneachsiteoftheCristagalliarethe
cribriformplates.Themostlateralpartoftheethmoidboneisthepaper
thinLaminaPapyraceawhichformsapartofthemedialwalloftheorbit.
BetwentheLaminapapyraceaandtheupperpartofthenasalcavity,we
findtheethmoidaircells.TheSuperiorandmiddleconchaearealsoapart
oftheethmoidbone.
Theethmoidboneisjoinedtothefrontalboneabove,themaxillabelowandthecentralpartofthe
sphenoidbonebehind.

22

Histology:Elasticcartilage.

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13.Wallsandopeningsonthewallsoftheorbit.
MOORE::891,952,889,905907,892,894895

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14.Nasalcavity,paranasalsinuses.
MOORE::823824
Entrance:Piriformicaperture
Borders

Above:Nasalbone
Lateral:frontalprocessofthemaxilla
Inferior/lateral:alveolarprocessofthemaxilla
Inferior:anteriornasalspine

Superiorwall(Anterior>posteriordirection)

Nasalbone
Nasalpartofthefrontalbone(nasalspine)
Cribiformplateoftheethmoidbone
Anteriorandinferiorwallofthebodyofthesphenoid
Wingofthewomer

Connections

Cribiformplate:FilaolfactoriaconnectionbetweentheACFandthenasalcavity.
Sphenoethmoidrecess:sphenoidsinuswithtwoopenings.

Sphenoethmoidrecessthesphenoethnoidrecessistheanglebetweenthelesserwingofthe
sphenoidboneandtheanteriorwallofthebodyofthesphenoidbone.Itislocatedattheroofofthe
nasalcavity.
Inferiorwall(Hardplate)

Palatineprocessofthemaxilla
Horizontalplateofthepalatineborder

Ontheinferiorwallwefindtheincisivecanalwhichprovidesaconnectionbetweentheoralnasal
cavities.Theincisivecanalcontainsthenasopalatinenerve,arteryandvein
Lateralwall

Frontalprocessofthemaxilla
Nasalsurfaceofthebodyofthemaxilla
Lacrimalbone
Laminapapryacea(labyrinth)oftheethmoidbone
Perpendicularpalteofthepalatinebone
Medialplateofthepterygoidcanal
Inferiornasalconcha

Structures

Bullaethmoidalis
Uncinateprocess
Semilunarhiatus
Superior,middleandinferiornasalconcha
Superior,middleandinferiornasalmeatus
Sphenopalatineforeman
Nasolacrimalduct

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Connections

Frontalsinus:Throughtheethmoidinfundibulum.Itopensattheanteriorpartofthesemilunarhiatus.
Maxillarysinus:Opensattheposteriorpartofthesemilunarhiatus
Anteriorandmiddleethmoidaircells:opensatthebulaethmoidalis
Posteriorethmoidaircells:Superiornasalmeatus
Nasolacrimalcanal:containsnasolacrimalduct.Connectionsbetweenorbitandnasalcavity.
Sphenopalatineforamen:Containssphenopalatineartery,andposteriorsuperiornasalnerves.

Thenasalcavity
TheopeningintothenasalcavityiscalledthePiriformaperture.Insideitwefindtwonasalcavities,
separatedinthemiddlebythenasalseptum.Theseptum,isalittleofcentre,resultinginthe
cavitiesbeingofdifferentsize.Thefloorofthenasalcavityandthewallformedbytheseptumhave
nofeaturesandaresmooth.Bycontrast,thelateralwallhasanumberoffeatures,mostnotable3
deligateprojections,knownastheConchae(Turbinatebones)23.Thethreeconchaepartiallydivide
theairpassageintothreeparts,theinferiormeatus,middlemeatusandthesuperiormeatus.Atthe
top(mediallytotheorbitcavity)thenasalcavitybecomesmuchnarrower.Thenarrowingiscaused
theexistanceofsmall,hollowspaces,theethmoidaircells.
Alargepartoftheseptumisformedbytheethmoidbone,orthePerpendicularplateofEthmoid.An
inferiorandsmallerpartisformedbyanother,smallbone,thevomer.Thelowestpartisformedby
theMaxilla(anteriourly)andposteriourlybythePalatinebone.
Theroofofthenasalcavityreachesitshighestheightinthecribriformplate.Inthelateralwallthere
areseveralopenings.Theyarepartlyhiddenbytheconchae.Thelateralwallitselfispartlyformedby
themaxilla,ethmoidboneandpartlybythepalatinebone.Furtherback,wherethenasalcavity
becomesthenasalpharynx,thewallisformedbythemedialpterygoidplate.
Allthelargefacialbonesthatsurroundthenasalcavity,arehollowtosomeextent.Thehollow
spacesinthesebonescontaintheparanasalsinuses,which,inahealthylivingbody,arefilledwith
air.Alltheparanasalsinusescommunicatewiththenasalcavity.Thesinusesweneedtoknoware
Theright/leftfrontalsinus,Maxillarysinus(thelargestsinus,extendsbackwardstothefissureand
downards,almosttotherootsoftheuppermolars.)24,Left/rightSphenoidsinuses(occupythe
centralspaceofthesphenoidbone),Ethmoidaircells25(extendtotheback,behindthemedialwall
oftheorbitandtheupperpartofthenasalcavity).
NasalMeati
Thethreenasiaconchaformthreeairpassagesbelowthem.Thesepassagesarethenasalmeati.The
nasalmeatiareimportantinmoisturingandwarminguptheairbreathedin.Theyarethesuperior,
middleandinferiornasalmeatus.
Afourthairpassag,thecommonnasalmeatusisalsoformedbetweentheconchaeandthemedial
wallofthenasalcavity.
Structuresopeningintothenasalmeati

23

Inferior,middleandsuperior(smallestofthethree)concha
AlsoknownastheMaxillaryAntrum
25
Alsoreferredtoastheethmoidsinus
24

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Superiornasalmeatus
o
o
o

Middlenasalmeatus
o
o
o

Maxillarysinus
Frontalsinus
Anteriorandmiddleethmoidaircells

Inferiornasalmeatus
o

Posteriorethmoidaircells
Sphenoidalsinus
Sphenopalatineforamen

Nasolacrimalcanal

Commonnasalmeatus
o
o

Sphenoidprocess(atsphenoidrecess)
Incisivecanal

Medialwall
Formedbythenasalseptum.Itconsistsofthreeparts.Herelistedinaposterior>anterior
direction.

Bonynasalseptum
Carilagenousnasalseptum
Membranousnasalseptum

Thebodyofthenasalseptumisformedbytheperpendicularpalteoftheethmoidboneandthe
bladeofthevomer.
Exitofthenasalcavity
Borders

Superior:inferiorsurfaceofthebodyofthesphenoidandthewingofthewomer.
Lateral:medialplateofthepterygoidbone
Inferior:horizontalplateofthepalatinebone
Medial:bladeofthewomer

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Paranasalsinuses
Paranasalsinusesareaircontainingcavitieslocatedwithinthebonesofthe
skull.Thesecavitiesarelinedbyepithiliumofthenasalcavity.
Sphenoidsinus
Locatedwithinthebodyofthesphenoidbone.Thissinusispartiallydividedintotwopartsonthe
midline(incompletelydivided).Eachofthepartshasaseparateexit.Openstosphenoethmoid
recess.
Maxillarysinus
Thisislargestofthesinuses.Locatedwithinthebodyofthemaxilla.Itopensattheposteriorportion
ofthesemilunarhiatus.Theexitofthesinusisnotatthebottomofit,butatthemidwayofthe
medialsurfaceofthebone.
Asaresult,incaseofinfection,pusaccumulateswithinthesinusandneedstobewashedout.
Frontalsinus
LocatedatthebaseoftheSquamuspartofthefrontalbone.Opensattheanteriorpartofthe
semilunarhiatusthroughtheinfudibulumoftheethmoidbone.
Ethmoidsinus
Thissinusisactuallynotanaircontainingspace,butagroupofaircells.

Posteriorethmoidcells:opensatsuperiornasalmeatus
Middleandanteriorethmoidaircells:Openatthemiddlenasalmeatus,onthebulla
ethmoidalis.

CLINICAL::
BACTERIALINFECTIONOFTHESINUSISVERYCOMMON.SINUSITUS

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15.Mandible.Temporomandibularjoint.
MOORE::827,945,986,1022,922,923
Inpractise,whenwespeakaboutthejawsinplural,weare
referringtoboththemaxilla(theupperjaw)andthemandible
(thelowerjaw).Whenwespeakofthejawwearealways
referringtothemandible.
Themandibledevelopsfrom2individuallyseparatebones.
TheyfusetogetherattheSymphysisoftheMandible.
TheMandibleisproperlydescribedbyreferringtoitsbodyanditsleftanrightRamus.Thecorner
betweenthebodyandtheRamus,istheAngleoftheMandible(roughontheoutsideandthe
inside).TheroundedprojectionsthatarticulatewithetheTemporalbonearetheCondyle(orthe
Condylarprocess).ThenarrowingbelowthecondyleistheNeckoftheMandible.Thesharpand
slenderprojectioninfrontofthecondyleistheCoronoidprocess.Rightbehindit,wefindthe
condylarnotch.
ThebodyoftheMandibleisdescribedbyitssegments,
theBaseandtheAlveolarprocess26.Ontheinsideof
thejaw,weseethatthealveolarprocessbulges
medially,thisiscausedbytheSubmandibularFossa.
Belowthecentralteethwefindaprojection,the
MentalProtuberance(chin).Ontheinside,belowthe
centralteethaswell,wefindtheMentalSpine.Behind
themostposteriorpairofmolars(the8thpair),wefind
theButtress(ontheinneraspectofthejaw).Onthe
insideoftheRamusaswell,wefindtheMandibular
Foramen(atthesamehorizontallevelastheteeth).Justinfrontofit,thereisanupwards
projection,theLingula.TheMandibularforamenisthestartofatunnelfortheinferioralveolar
nerveandbloodvessels.Amajorbranchofthenervemergesfromtheoutside,throughtheMental
Foramen.

TheTemporomandibularjoint
ItenablestheMandibletomove.ItisaSynovialjointwhichmeansthatwefindarticularsurfaceson
thebonesandajointcapsulethatenclosesthesynovialfluid.Itisadoublejointsincewehavetwo
separatesynovialcavities,withoneabovetheother.Thecavitiesareseparatedbyanarticulardisk27
whichisbothflexibleandhighlymovable.Thisarrangementpermitstwokindsofmovements.
Thearticularsurfaceofthecondyle(oftheMandible)iscurved
sharplyfromthefronttotheback.Itisalmostpointyonthe
top.ThearticularsurfaceoftheTemporalbonehasadouble
curve.Theconcavepartofit,istheMandibularFossawhilethe
convexpartofitiscalledArticularTubercle.

26
27

TheAlveolarprocessprovidesthebonysocketforourteeth.
Madeoffibroustissue.Itsthinatthefrontandthickbehind.Itsprettyflexible

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Mostofthejointcapsuleisthinandloose.Thisarrangementallowsmoremovement.Onthelateral
aspect,thejointcapsuleismorethick.
Theligamentsassociatedwiththisjointsare:

Thefibrouscapsuleisthickenedlaterallytoformthelateral(temporomandibular)ligament.Itreinforcesthelateralpartofthis
capsule.
Thebaseofthistriangularligamentisattachedtothezygomaticprocessofthetemporalboneandthearticulartubercle.
Itsapexisfixedtothelateralsideoftheneckofthemandible.
Twootherligamentsconnectthemandibletothecraniumbutneitherprovidesmuchstrength.
Thestylomandibularligamentisathickenedbandofdeepcervicalfascia.
Itrunsfromthestyloidprocessofthetemporalbonetotheangleofthemandibleandseparatestheparotidandsubmandibular
salivaryglands.
Thesphenomandibularligamentisalongmembranousbandthatliesmedialtothejoint.
Thisligamentrunsfromthespineofthesphenoidbonetothelingulaonthemedialaspectofthemandible.

Movementsatthejoint
ThetwotypesofmovementpossiblefortheMandibleareaHingingmovement(topimage
totheright)andaforward/backwardsgliding(loweimagetotheright)movement.
TheHingingmovementtakesplacebetweenthecondylesandthearticulatedisk.Theback
wardandforwardmovementmainlytakesplacebetweenthediskandtheTemporal
surface.Anormalopening/closingmovementofthejaw,isacombinationofthetwo
movements.
Detailedmovementoverview

Thetwomovementsthatoccuratthisjointareanteriorglidingandahingelikerotation.
Whenthemandibleisdepressedduringopeningofthemouth,theheadofthemandibleandarticulardiscmoveanteriorlyon
thearticularsurfaceuntiltheheadliesinferiortothearticulartubercle.
Asthisanteriorglidingoccurs,theheadofthemandiblerotatesontheinferiorsurfaceofthearticulardisc.
Thispermitssimplechewingorgrindingmovementsoverasmallrange.
Movementsthatareseeninthisjointare:depression,elevation,protrusion,retractionandgrinding.

Musclesthatmovethejaw
Themusclesarenotrequiredfortheselfcontrol.
Aswithmostpretators,themusclesthatclosethejawaremuchmorepowerfulthanthosewho
openit.Alligatorsareanexcellentexampleofspecieshavingveryweakopenfunctionmusclesanda
verystrongclosingfunctionmuscles.
Closingthejawisajobperformedby3strongmusclesoneachside.

Movementsofthetemporomandibularjointarechieflyfromtheactionofthemusclesofmastication.
Thetemporalis,masseter,andmedialpterygoidmusclesproducebitingmovements.
Thelateralpterygoidmusclesprotrudethemandiblewiththehelpfromthemedialpterygoidmusclesandretrudedlargelyby
theposteriorfibresofthetemporalismuscle.
Gravityissufficienttodepressthemandible,butifthereisresistance,thelateralpterygoid,suprahyoidandinfrahyoid,
mylohyoidandanteriordigastricmusclesareactivated.

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TheTemporalisMuscle
Thisisanextensivefanshapedmusclethatcoversthetemporalregion.Itisapowerfulmasticatory
musclethatcaneasilybeseenandfeltduringclosureofthemandible.

Origin:flooroftemporalfossaanddeepsurfaceoftemporalfascia.
Insertion:tipandmedialsurfaceofcoronoidprocessandanteriorborderoframusofmandible.
3

Innervation:deeptemporalbranchesofmandibularnerve(CNV ).
Thetemporaliselevatesthemandible,closingthejaws;anditsposteriorfibresretrudethemandibleafterprotrusion.

TheMasseterMuscle
Thisisaquadrangularmusclethatcoversthelateralaspectoftheramusandthecoronoidprocessof
themandible.

Origin:inferiorborderandmedialsurfaceofzygomaticarch.
Insertion:lateralsurfaceoframusofmandibleanditscoronoidprocess.
Innervation:mandibularnerveviamassetericnervethatentersitsdeepsurface.
Itelevatesandprotrudesthemandible,closesthejawsandthedeepfibresretrudeit.

TheLateralPterygoidMuscle
Thisisashort,thickmusclethathastwoheadsororigin.Itisaconical
musclewithitsapexpointingposteriorly.Actingtogether,thesemuscles
protrudethemandibleanddepressthechin.Actingaloneand
alternately,theyproducesidetosidemovementsofthemandible.

Origin:superiorheadinfratemporalsurfaceandinfratemporalcrestofthegreaterwingofthesphenoidbone,inferiorhead
lateralsurfaceoflateralpterygoidplate.
Insertion:neckofmandible,articulardisc,andcapsuleoftemporomandibularjoint.
Innervation:mandibularnervevialateralpterygoidnervefromanteriortrunk,whichentersitdeepsurface.

TheMedialPterygoidMuscle
Thisisathick,quadrilateralmusclethatalsohastwoheadsororigin.It
embracestheinferiorheadofthelateralpterygoidmuscle.Itislocated
deeptotheramusofthemandible.Ithelpstoelevatethemandibleand
closesthejaws.Actingtogether,theyhelptoprotrudethemandible.
Actingalone,itprotrudesthesideofthejaw.Actingalternately,they
produceagrindingmotion.

Origin:deepheadmedialsurfaceoflateralpterygoidplateandpyramidalprocessofpalatinebone,superficialhead
tuberosityofmaxilla.
Insertion:medialsurfaceoframusofmandible,inferiortomandibularforamen.
Innervation:mandibularnerveviamedialpterygoidnerve.

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Additionalinformation
Thecranialnerves
I. Olfactorynerve(cribiformplate)
II. Opticnerve(opticcanal)
III. Oculometernerve(superiororbitalfissure)
IV. Trochlearnerve(superiororbitalfissre)
V. Trigeminalnerve28
VI. Abducentnerve(superiororbitalfissure)
VII. Facialnerve(internalacousticmeatus)
VIII. Vestibulocochlearnerve(internalacousticmeatus)
IX. Glossopharyngealnerve(jugularforeman)
X. Vagusnerve(jugularforeman)
XI. Accessorynerve(jugularforeman)
XII. Hypoglossalnerve(hypoglossalcanal)

Notestakendownfromhereandthere
Movingthehead,thoracicandcervicalvertebrae,upperribs,theclaviclesandtheocciputpartof
skull.
Skullconsistsofthecraniumandthefacialskeleton.Craniumisthebonycontainerforthebrainand
thefoundationforthefacialskeleton.Madeupoftheseveralbones,connectedbysutures,which
showthejointsofthejoints.
Principalbonesthatformthecranium,occipitalbone,theparietalbone,temporalbonex2,
sphenoidbone,andfrontalbone.
Occipitalbone
ThemoststrikingfeatureoftheoccipitalboneistheforamenMagnum,alargeopening,through
whichthespinalchordanditsaccompaniedstructuresgothrough.Thepartinfrontoftheopening
iscalledtheBasilarPartoftheOccipitalbone(Baseoftheocciput).
TheoccipitalcondylesinteractwiththevertebraetocreatetheAtlantooccipitaljoints.
Thesquamouspartoftheoccipitalboneformstheposterioroverhang(theposteriorextensionof
theskull,behindthevertebrae/behindforamenMagnum).Theneckmusclesconnecttothispartof
theOccipitalbone.HerewefindtheExternaloccipitalProtuberanceandthesuperiorandinferior
Nuchalline.
Temporalbone
TheTemporalboneisdividedintotwoparts,thePetrousandSquamousparts.Ithasaprominent
feature,theMastoidprocess.TheTemporalboneparticipatesintheformationofthezygomatic
arch.TherootofthearchformstheTemporomandibularjoint.TheExternalauditorymeatuswhich
leadstothemiddleearisalsofoundonthetemporalbone.Also,youneedtorecognizetheStyloid

28

V/1opthalmicnerve(superiororbitalfissure),V/2Maxillarynerve(foramenroteundum),V/3Mandibular
nerve(foramenovale).

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process,alongandsharpprocess.TheStylomastoidForamenisalsofoundhereandthefacial
nervegoesthroughhere.Medialtothestyloidprocessthereare2majoropeningsforbloodvessels.
ThesearetheCarotidcanal(internalcarotidartery)andJugularforamen(internaljugularvein).
Hypoglossalcanalisjustabovethosestructures(Hypoglossalnerve)
InsideviewoftheTemporalandOccipitalbone
ThePetrouspartoftheTemporalbonecontainsthestructuresoftheinnerandmiddleear.Thereisa
largegroovenearthejugularforamen,itcontainsthemainvenousdrainageforthebrain.Above
thejugularforamenwecanseetheinternalauditorymeatus

CranialForaminaandapertures
Belowisasummaryforthenervesandarteriesassociatedwiththethreedifferentfossaefoundin
theskull.
AnteriorCranialFossa

MiddleCranialFossa

PosteriorCranialFossa

Foraminaincribiformplatesof
theethmoidbone
Anteriorandposterior
ethmoidalforamina
Opticcanal

Axonsofolfactorycells

Vesselsandnerveswiththe
samename
OpticnerveandOphthalmic
artery
Superiororbitalfissure
Ophthalmicvein,Ophthalmic
nerve(CNV1),Oculomotor
nerve(CNIII),Trochlearnerve
(CNIV),Abducentnerve(CNVI)
andsympatheticfibres.
Foramenrotundum
Maxillarynerve(CNV2)
Foramenovale
Mandibularnerve(CNV3),
Lesserpetrosalnerve
Foramenspinosum
Middlemeningealarteryand
vein,Meningealbranchof
mandibularnerve
Foramenlacerum
internalcarotidartery
Hiatusofgreaterpetrosalnerve Greaterpetrosalnerve
Foramenmagnum
Medullaandmeninges,

vertebralarteries,Spinalroot
ofaccessorynerve(CNXI)
Jugularforamen
Glossopharyngealnerve(CN
IX),Vagusnerve(CNX),
Accessorynerve(CNXI),
Superiorbulbofinternal
jugularvein,Inferiorpetrosal
andsigmoidsinuses
Hypoglossalcanal
Hypoglossalnerve(CNXII)

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