Skull

Bones and joints

Joints of the skull:
 Fibrous joints
o Sutures (seen between most cranial bones)
o Gomphosis /peg and socket joint (seen between teeth and the maxilla/mandible)

 Synovial joints - seen only in

o Temporomandibular joint (TMJ)
 Functional classification - modified hinge joint

o Atlantooccipital joint
 Functional classification - Ellipsoid/Condyloid joint
Bones of the viscerocranium ("facial skeleton")

Bones of the neurocranium

Question 1: List the cranial bones that belong to both the neurocranium and the viscerocranium
(“facial skeleton”)
 Ethmoid
 Sphenoid
 Sometimes hyoid?

Question 2: Name the cranial bones that have been labelled and classify them as belonging to either
the neurocranium or viscerocranium
 1. Maxillae (viscerocranium)
2. Frontal (neurocranium)
3. Nasal bone (viscerocranium)

Cranial bones
 Frontal
 Parietal
 Sphenoid
 Temporal

Parts of temporal bone

 Petrous part
 Squamous part
 Zygomatic process
 Mastoid process

Parts of sphenoid
 Lesser wing
 Greater wing
 Body
Parts of sphenoid and temporal bones
 Parts of sphenoid
o Pterygoid hamulus
o Lateral pterygoid plate
o Medial pterygoid plate
 Parts of temporal
o Styloid process
o Petrous part

Question 3: Please label the skull diagrams found in your manual,

complete your learning objectives and post any questions
that you may have on the discussion forum.
DO THIS

Anatomical spaces and their communications

Anatomical spaces
 Tympanic cavity (also known as the middle ear cavity) = Anatomical space within the petrous
part of temporal bone
 Anterior cranial fossa
 Middle cranial fossa
 Posterior cranial fossa

 Infratemporal fossa
o Communicates with temporal fossa

Anatomical principles
 A1 - An anatomical space is defined by boundaries and has openings for communication with
other regions of the body.
 A4 - The functions of a space relate to the structures within it or passing through it.

Application of principle
 Middle cranial fossa
o Anterior: lesser wing of sphenoid
o Posterior: petrous part of temporal bone
o Medially: body of sphenoid
o Laterally: temporal and parietal bones
o Lodges temporal lobe of cerebral hemisphere
  Temporal fossa
o Superior: temporal lines
o Anterior: Frontal and zygomatic bones
o Inferior: Zygomatic arch
o Contains temporalis

Communications
 Optic canal
o Associated with sphenoid bone
o Location: seen within the sphenoid bone
o Communications: middle cranial fossa to the orbit
o Structure traversing: e.g. Optic nerve

 Jugular foramen
 o Location: seen between the petrous part of temporal bone (anteriorly) and the
occipital bone (posteriorly)
o Communications: posterior cranial fossa and the neck
o Contains: Glossopharyngeal nerve (CNIX), vagus nerve (CNX), descending portion of
the spinal accessory nerve (CNXI), internal jugular vein

 Foramen ovale
o Location: greater wing of sphenoid
o Communications: middle cranial fossa and the infratemporal fossa
o Contains: Mandibular division of the trigeminal nerve (CN V3), accessory meningeal
branch of maxillary artery, emissary vein (, lesser petrosal nerve)

Foramen spinosum
 Posterior to foramen ovale
 Location: posteromedial part of greater wing of sphenoid bone posterolateral to foramen
ovale
 Communicates: middle cranial fossa and inferotemporal fossa?
 Contains: Middle meningeal artery

Internal acoustic meatus (IAM)

 Superior to jugular foramen
 Location: petrous part of temporal bone, superior to jugular foramen
 Communicates: posterior cranial fossa and external acoustic meatus
 Contains: Facial nerve (CNVII) and Vestibulocochlear nerve (CNVIII)
Meninges
Protective 'devices' in the neurocranium
1. Meninges (three layers)
o Outer layer: Duramater (toughest)
 Made of dense irregular connective tissue
 Cranial cavity
 Endosteal layer
 Meningeal layer
 Vertebral canal
 Only one layer
o Middle layer: Arachnoid mater (avascular)
 sends off extensions towards dura and pia
 keeps the two layers intact
o Innermost layer: Pia mater
 Most delicate
 Highly vascular
 Intimately attached to the surface of either the brain or spinal cord

2. Cerebrospinal fluid (CSF)

o Produced by the choroid plexus (specialised structures) in the ventricles (cavities) of
the brain
o Seen in the subarachnoid space (between arachnoid mater and pia mater) and
ventricles
o Coronal section:
Cranial duramater
 Meningeal layer - modified to form septa
1. Falx cerebri (falx = sickle shaped)
o Separates cerebral hemispheres
o Creates tent over posterior cranial fossa
o Extends from crista galli of ethmoid bone anteriorly to inner occipital protuberance
posteriorly and projects over longitudinal cerebral fissure
o Anteriorly: crista galli of ethmoid bone
o Posteriorly: superior surface of tentorium cerebelli
2. Tentorium cerebelli
o Creates tent over cerebellum
o Free margin
o Attached margin: petrous part pf temporal bone and transverse sulcus of the
occipital bone

Question 1: Describe how the dural partitions (falx cerebri and tentorium
cerebelli) are formed (with reference to particular layers of the
meninges).
They are formed by the inner meningeal layer reflecting away from the fixed periosteal dural layer
Question 2: What do you think is the function of the dural partitions?
To limit the rotational displacement of the brain.

Question 3: What is the relationship of the falx cerebri and the anterior and middle cranial fossae?

Question 4: What is the relationship of the tentorium cerebelli and the posterior cranial fossa?

Skull Sutures

Dural Venous Sinuses

Topography and nomenclature
Dural venous sinuses - overview
 Definition of a dural venous sinus:
o A space enclosed in dura that transmits venous blood
o Note relationship to meninges
o Arachnoid granulations allow the CSF to drain into the venous blood of the superior
sagittal sinus
Cerebrospinal fluid and the dural venous sinus
 Cerebrospinal fluid (CSF)
o Formed in the choroid plexus of the ventricles 400-500 mls per day
o Fills the subarachnoid space and circulates around the brain and spinal cord
o Function
 Some nutrition
 Shock absorbing layer
 Buoyancy of brain

Dural folds - the falx and tentorium

 Flax (sickle) cerebri - sickle shaped - (located in midline)
 Tentorium cerebelli - forms a tent over the cerebellum
o Extends over posterior cranial fossa
o Attaches anterior to clinoid processes
o Has a hole called the tentorial notch or tentorial incisor
Dural venous sinuses - the falx and tentorium
 Endosteal dura mater
 Meningeal layer of dura mater
 Dural venous sinus
 Arachnoid mater

Dural venous sinuses - nomenclature and topography

 The DVS:
o Are named according to their topography and shape
o Are connected and therefore communicate with one another allowing retrograde
blood flow
o Receive cerebral veins (to drain blood from the brain and some cranial structures i.e.
Orbit)
 Singular sinus:
o Superior sagittal
o Inferior sagittal
o Straight sinus
o Confluence of sinuses
 Paired sinuses:
o Transverse
o Sigmoid
o Greater petrosal
o Lesser petrosal
 Venous communications:
o Basilar plexus
o Emissary veins
o Pterygoid venous plexus (covered in another session)

Dural venous sinuses - topography

 Nomenclature of the DVS
o Relationship of dural venous sinuses to one another
The cavernous sinuses - topography
 Located lateral to the sella turcica
 Contains the internal carotid artery and CN III, IV, V and VI

Activity 1 - Draw and label

Functional and applied

Veins and dural venous sinuses
 Veins -> DVS. The endothelial lining of DVS is continuous with veins
 Structures drained:
o Brain - cerebral veins enter DVS (via cerebral lacunae)
o Meninges
o Orbital structures
o Scalp
 Communication with extracranial veins
o Emissary veins (scalp)*
o Pterygoid venous plexus (infratemporal fossa - oral cavity and orbit)
o Basilar and vertebral venous plexus (vertebral column)
 *potential drainage route
Dural venous sinuses - intracranial drainage
 Venous drainage route
o From anterior to postero-inferior
 SSS, SS ISS -> CS
 CoS -> TS (60% R) -> SS
 CS -> SS
o Sigmoid sinus to bulb of internal jugular vein (IJV)
 Jugular foramen -> IJV

Intra cranial venous drainage

 DVS drain the internal neurocranium and orbit
 Extra cranial drainage via superficial veins:
o Scalp, head and face
o Neck

Activity 2
Functional and applied clinical implications
Dural venous sinuses - clinical complications
 Venous route allows all sinuses to connect
o No valves present*
o Retrograde flow
o Spread of infection
o Infection of meninges - meningitis
 Great cerebral vein - why not to shake an older person's head
 Venous rupture due to trauma - impact, tensile loading, rapid translator movement
 Potential rupture of veins with trauma
o Bleeding in cranial cavity
o Compression of the brain
 Injury to the dura. Does it hurt?

Neurovascular supply of dura

 Vascular supply of dura
o Supply the bone of neurocranium
o Middle meningeal a & v
 Dura is innervated by sensory meningeal components of:
o Trigeminal nerve
o C2-4 spinal segments
o Neurons hitchhike on arteries
Dural venous sinuses - innervation

Activity 3:

Don't get confused between the types of sinuses

 Para nasal sinuses
o Air fills space in bone
o Surround the nasal cavity
o Lined with endothelium
  Dural venous sinuses
o Spaces in dura mater to transmit venous blood

Temporomandibular joint
TMJ: Articular surfaces and capsule
Temporomandibular joint
 Consists of
o Mandibular condyle
o Mandibular eminence
o Mandibular fossa

TMJ structure
 Histological classification - synovial
o Articular surfaces
 Mandibular (=glenoid) fossa and eminence (vs articular tubercle)
 Mandibular condyle (head)
 Lined with fibrocartilage and proliferative tissue
 Why line the articular surfaces with fibrocartilage rather than the usual hyaline cartilage?
o Hyaline cartilage is ...
o Fibrous cartilage is ...

TMJ: articular disc

 Articular disc
 o Fibrocartilaginous with variable thickness
o Biconcave (condyle and eminence are convex)
o Attaches to condyle, capsule, retrodiscal tissue and lateral pterygoid muscle
o Superior and inferior joint cavities
o Provides stability and congruence to the joint

TMJ ligament
 Capsule
o Loose attachments above disk (to temporal bone)
o Tight attachments below disk (to mandible)
 Ligaments
o Temporomandibular
 Lateral - prevents lateral displacement
o Sphenomandibular
 Medial
o Stylomandibular
 Posterior
o All ligaments have common orientation: _____
 Therefore common function is to prevent _________ movement of
_____________ caused by ___________

TMJ: Movements
TMJ function
 Two joints must function together
 Classification by shape
o Hinge (inferior cavity)
o Gliding (superior cavity)
o 'modified hinge' or 'hinge with movable sockets'
 Movements possible
o Elevation and depression
 o Protrusion (protraction) and retrusion (retraction)
o Side-to-side (latera deviation)
o Wide opening of mouth requires protrusion in upper cavity and depression in lower
cavity
 May lead to dislocation anteriorly

Opening and closing the mouth

Opening of the mouth

Lateral deviation to the right (inferior view)

 The movement occurring at the left (= contralateral) TMJ is ____

Lateral deviation to the left (superior view)

  Deviation to left
o Right TMJ protrudes
o Left TMJ rotates

TMJ: Primary muscles of mastication

Muscles of mastication
 Primary muscles
o Attachments
 Insertion on mandible
 Origin on other bones of skull
o Temporalis
o Masseter
o Medial and lateral pterygoids
 All innervated by CN V3

Primary muscles of mastication 1

 Temporalis
o Origin
 Temporal fossa - radiating fibres
o Insertion
 Coronoid process of mandible
 Masseter
o Origin
 Zygomatic arch
o Insertion
 Angle and ramus of mandible

Pterygoid muscles
 Lateral pterygoid
o Origin
 Lateral surface of lateral pterygoid plate (and sphenoid)
o Insertion
  Neck of mandible and capsule/articular disk
 Medial pterygoid
o Origin
 Medial surface of lateral pterygoid plate (and maxilla)
o Insertion
 Medial surface of angle of mandible

TMJ - transverse section

Actions of primary muscles

Opening Closing Protrusion Retrusion Lateral
(depression) (elevation) deviation
Temporalis
Masseter
Medial
pterygoid
Lateral Yes Yes x 2?
pterygoid

TMJ: Accessory muscles of mastication

Accessory muscles
 Mylohyoid
 Geniohyoid
 Digastric
Accessory muscles: derivation of names
Name Derivation
Digastric Has __ bellies
Mylohyoid Attaches to ____ ____ of ____ and _____
Geniohyoid Attaches to _____ _____ of ____ and _____

Accessory muscles
 Assist with depression of mandible, opening of mouth

TMJ: Innervation
CNV3 - Trigeminal nerve
 Nerve type: mixed
o Motor to muscles of mastication
o General sensation to anterior head
 Cutaneous
 Lower lip, chin
 Sensory to deeper structures
 Muscles of mastication and facial expression
 Oral cavity
 Mandible and lower teeth
 TMJ
Referred pain
 New principle
o P17: Nociceptive input carried by a particular branch of a particular nerve arising
from pathology in one organ or region of the body may be perceived by the brain as
coming from another organ or region of the body supplied by another branch of the
same parent nerve
 Trigeminal nerve has a common sensory ganglion for all three divisions
o Pain may refer from maxillary sinuses or upper teeth (innervated by CNV2) to TMJ
(innervated by CNV3)
o TMJ pain may refer to teeth and jaw

Trigeminal nerve Facial nerve

Innervates muscles of mastication Innervates muscles of facial expression
 Temporalis
 Masseter
 Lateral pterygoid
 Medial pterygoid
Sensory: cutaneous innervation Pierces parotid gland
3 branches: 5 branches
 Ophthalmic  Temporal
 Mandibular  Zygomatic
 Maxillary  Buccal
 Mandibular
 Cervical