1. SKULL SESSION- bones rigidly connected by sutures to protect brain; attach, move eyes
I. CALVARIUM = SKULL CAP-
Consists of bones linked
by sutures
FRONTAL (1)

2. BONES OF CALVARIUM PARIETAL (2) FRONTAL (1) SPHENOID (1) OCCIPITAL (1)
NOSE
TEMPORAL (2)

3. C. LANDMARKS B. SUTURES 1. CORONAL SUTURE
NOSE
C. LANDMARKS
B. SUTURES
1. CORONAL SUTURE
1. BREGMA - MID POINT OF CORONAL SUTURE
2. SAGITTAL SUTURE
2. LAMBDA - MID POINT OF LAMBDOIDAL SUTURE
3. LAMBDOIDAL SUTURE

4. D. FONTANELLES – MEMBRANES LINK BONES AT BIRTH
1. ANTERIOR FONTANELLE AT BREGMA
- FONTANELLES PERMIT CRANIAL COMPRESSION AT BIRTH - CRANIAL GROWTH
3. LATERAL FONTANELLE AT PTERION
2. POSTERIOR FONTANELLE - AT LAMBDA

5. LANDMARKS CORONAL SUTURE 3. PTERION
- JUNCTION OF TEMPORAL SPHENOID PARIETAL & FRONTAL BONES
NOSE

6. 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

7. E. INTERNAL STRUCTURE OF CALVARIUM
OUTER
MIDDLE
INNER
1. INNER & OUTER TABLES - HARD CORTICAL BONE
MIDDLE LAYER - SOFT SPONGY BONE CALLED DIPLOE (DOUBLE IN GREEK)

8. 2. DIPLOIC VEINS
COURSE IN DIPLOE -CONNECT BOTH TO CRANIAL CAVITY & SURFACE OF SKULL
- CAN TRANSMIT INFECTION FROM SCALP TO BRAIN VIA EMISSARY VEINS

9. PARIETAL EMISSARY FORAMINA
MASTOID
EMISSARY FORAMINA

10. II. LANDMARKS AND BONES 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

11. 1. FRONT OF SKULL SUPRAORBITAL FORAMEN – IN MAXILLARY BONE
ZYGOMATICO-FACIAL FORAMEN – IN ZYGOMATIC BONE
INFRAORBITAL FORAMEN - IN MAXILLARY BONE
MENTAL FORAMEN- IN MANDIBLE BELOW SECOND PREMOLAR TOOTH

12. 2. LATERAL VIEW OF SKULL ZYGOMATIC ARCH- 1)ZYGOMATIC BONE
2)MAXILLARY BONE ZYGOMATIC PROCESS
3)TEMPORAL BONE ZYGOMATIC PROCESS
TEMPORAL BONE - PARTS
1)MASTOID PROCESS - hard
2)SQUAMOUS PART- flat 3)TYMPANIC PART - ANT. TO EXTERNAL AUDITORY MEATUS
TEMPORO-MANDIBULAR JOINT- FROM RAMUS OF MANDIBLE
4)PETROUS PART – inside skull

13. 4. BASE OF SKULL - COMPLEX
HARD
PALATE
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

14. V. CRANIAL CAVITY- DIVIDED INTO DEPRESSIONS (FOSSAE)
ANTERIOR CRANIAL FOSSA (ROOF OF NASAL CAVITY, ORBIT)
MIDDLE CRANIAL FOSSA (ORBIT, NASAL CAVITY, FACE)
POSTERIOR CRANIAL FOSSA (FACE, ORAL CAVITY, NECK)

15. 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

16. 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

17. CRANIAL NERVES I II III, IV, V1, VI V2 V3 Middle Meningeal A.
NOSE
CRANIAL NERVES
ANTERIOR I II
III, IV, V1, VI V2 V3
Middle Meningeal A.
VII, VIII
IX, X, XI
XII
POSTERIOR

18. CRANIAL NERVES
 I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulo‑cochlear
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal

19. CRISTA GALLI OF ETHMOID
OLFACTORY
FORAMEN –
CN I
OLFACTORY NERVE

20. OPTIC
FORAMEN
CN II
OPTIC NERVE

21. SUPERIOR
ORBITAL
FISSURE –
CN III, IV V1, VI
OPHTHALMIC
VEINS

22. CAVERNOUS
SINUS
SELLA TURCICA

23. 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 bone
Sup. drains to Transverse
Inf. Drains to Internal Jugular

24. FORAMEN
ROTUNDUM –
CN V2

25. FORAMEN
OVALE –
CN V3
FORAMEN
SPINOSUM

26. 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

27. OPENING OF
CAROTID
CANAL
(FORAMEN
LACERUM)

28. BASE OF CRANIUM FROM EXTERNAL SIDE
HARD
PALATE
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

29. MEDIAL AND
LATERAL
PTERYGOID
PLATES
EXTERNAL
AUDITORY
MEATUS

30. FORAMEN
OVALE
FORAMEN
SPINOSUM

31. CAROTID
CANAL –
OPENS TO
FORAMEN
LACERUM
INSIDE
MIDDLE
CRANIAL
FOSSA

32. OPENING OF
CAROTID
CANAL
(FORAMEN
LACERUM)

33. INTERNAL CAROTID ARTERY: ENTERS SKULL
PASSES
THROUGH
CAVERNOUS
SINUS
INTERNAL
CAROTID
ARTERY

34. 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 bone
Sup. drains to Transverse
Inf. Drains to Internal Jugular

35. DIAGRAM OF CAVERNOUS SINUS

37. SYMPATHETICS TO HEAD
- First neuron
Out T1, T2
Ascends
Chain

38. Superior Cervical Ganglia SYMPATHETICS TO HEAD Second neuron In
Joins Plexus on
Internal and External
Carotid Arteries
1) Unnamed branches
2) Few named branches
Ex. Deep Petrosal N.

39. INTERNAL CAROTID ARTERY
SYMPATHETIC PLEXUS ON
INTERNAL CAROTID ARTERY
PLEXUS
ON INT.
CAROTID
SUP.
CERVICAL
GANGLION
PATHWAY:
- Preganglionic: OUT T1, T2
- Ascend Sympathetic Chain
- synapse in Superior Cervical Ganglion
- Postganglionic: Distributed with Arteries
Forms Plexus on Internal and External
Carotid Arteries
SYMPATHETIC
CHAIN
OUT
SPINAL
CORD
T1,T2

40. 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

41. CAVERNOUS SINUS SYNDROME SYMPTOMS
1) 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, V2
Facial pain (pressure on nerves)
3) Sympathetics on Internal Carotid
Ptosis (drooping eyelid)
Miosis (constricted pupil)
SPREAD OF INFECTION TO
CAVERNOUS SINUS

42. INTERNAL AUDITORY MEATUS –
VII, VIII

43. JUGULAR
FORAMEN –
CN IX, X, XI

44. HYPOGLOSSAL
CANAL –
CN XII
FORAMEN
MAGNUM

45. CRANIAL NERVES
 I. Olfactory
II. Optic
III. Oculomotor
IV. Trochlear
V. Trigeminal
VI. Abducens
VII. Facial
VIII. Vestibulo‑cochlear
IX. Glossopharyngeal
X. Vagus
XI. Accessory
XII. Hypoglossal

46. OPTIC
FORAMEN
CN II
OPTIC NERVE

47. FORAMINA OF ORBIT: OPTIC FORAMEN
AND CANAL

48. SUPERIOR
ORBITAL
FISSURE –
CN III, IV V1, VI,
OPHTHALMIC
VEINS

49. SUPERIOR ORBITAL FISSURE
INFERIOR
ORBITAL
FISSURE

50. 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

51. 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.)

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

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

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

55. OTHER FORAMINA OF ORBIT
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