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CHAPTER Head OVERVIEW / 822 ■ TABLE 7.5. Superficial Arteries of Face 7 and Scalp / 855 CRANIUM / 822 ■ TABLE 7.6. Veins of Face and Scalp / 857 Facial Aspect of Cranium / 822 Surface Anatomy of Face / 859 Lateral Aspect of Cranium / 827 ■ BLUE BOX: Face and Scalp. Facial Lacerations ■ TABLE 7.1. Craniometric Points and Incisions; Scalp Injuries; Scalp Wounds; of Cranium / 828 Scalp Infections; Sebaceous Cysts; Occipital Aspect of Cranium / 828 Cephalohematoma; Flaring of Nostrils; Paralysis of Facial Muscles; Infra-Orbital Nerve Superior Aspect of Cranium / 829 Block; Mental and Incisive Nerve Blocks; External Surface of Cranial Base / 829 Buccal Nerve Block; Trigeminal Neuralgia; Lesions of Trigeminal Nerve; Herpes Zoster Internal Surface of Cranial Base / 830 Infection of Trigeminal Ganglion; Testing ■ TABLE 7.2. Foramina and Other Apertures of Sensory Function of CN V; Injuries to Facial Cranial Fossae and Contents / 833 Nerve; Compression of Facial Artery; Pulses of Arteries of Face and Scalp; Stenosis of Internal Walls of Cranial Cavity / 835 Carotid Artery; Scalp Lacerations; Squamous Regions of Head / 836 Cell Carcinoma of Lip / 860 CRANIAL MENINGES / 865 ■ BLUE BOX: Cranium. Head Injuries; Head- aches and Facial Pain; Injury to Superciliary Dura Mater / 865 Arches; Malar Flush; Fractures of the Maxillae and Associated Bones; Fractures of Mandible; Arachnoid Mater and Pia Mater / 872 Resorption of Alveolar Bone; Fractures of Meningeal Spaces / 872 Calvaria; Surgical Access to Cranial Cavity: ■ Bone Flaps; Development of Cranium; Age BLUE BOX: Cranial Cavity and Meninges. Changes in Face; Obliteration of Cranial Fracture of Pterion; Thrombophlebitis of Sutures; Age Changes in Cranium; Craniosyn- Facial Vein; Blunt Trauma to Head; Tentorial ostosis and Cranial Malformations / 837 Herniation; Bulging of Diaphragma Sellae; Occlusion of Cerebral Veins and Dural FACE AND SCALP / 842 Venous Sinuses; Metastasis of Tumor Cells Face / 842 to Dural Venous Sinuses; Fractures of Cranial Base; Dural Origin of Headaches; Scalp / 843 Leptomeningitis; Head Injuries and Intracranial Hemorrhage / 874 Muscles of Face and Scalp / 844 BRAIN / 878 ■ TABLE 7.3. Muscles of Scalp and Face / 845 Parts of Brain / 878 Nerves of Face and Scalp / 849 Ventricular System of Brain / 878 ■ TABLE 7.4. Cutaneous Nerves of Face and Scalp / 851 Arterial Blood Supply of Brain / 882 Superficial Vasculature of Face and Scalp / 855 Venous Drainage of Brain / 883 820 Chapter 7 • Head 821 ■ TABLE 7.7. Arterial Blood Supply of Cerebral ORAL REGION / 928 Hemispheres / 885 Oral Cavity / 928 ■ BLUE BOX: Brain. Cerebral Injuries; Cisternal Puncture; Lips, Cheeks, and Gingivae / 928 Hydrocephalus; Leakage of Cerebrospinal Fluid; Anastomoses of Cerebral Arteries and Cerebral Embolism; Teeth / 930 Variations of Cerebral Arterial Circle; Strokes; Brain ■ Infarction; Transient Ischemic Attacks / 885 TABLE 7.13. Deciduous and Permanent Teeth / 933 EYE, ORBIT, ORBITAL REGION, AND EYEBALL / 889 Palate / 934 ■ Orbits / 889 TABLE 7.14. Muscles of Soft Palate / 938 Eyelids and Lacrimal Apparatus / 891 Tongue / 938 ■ Eyeball / 893 TABLE 7.15. Muscles of Tongue / 942 Extraocular Muscles of Orbit / 898 Salivary Glands / 943 ■ ■ TABLE 7.8. Extraocular Muscles of Orbit / 900 BLUE BOX: Oral Region. Cleft Lip; Cyanosis of Lips; Large Labial Frenulum; Gingivitis; Dental Caries, Pulpitis, and Nerves of Orbit / 903 Tooth Abscesses; Supernumerary Teeth (Hyperdontia); Vasculature of Orbit / 905 Extraction of Teeth; Dental Implants; Nasopalatine Block; Greater Palatine Block; Cleft Palate; Gag Reflex; Paralysis ■ TABLE 7.9. Arteries of Orbit / 906 of Genioglossus; Injury to Hypoglossal Nerve; Sublingual Absorption of Drugs; Lingual Carcinoma; Frenectomy; Surface Anatomy of Eye and Lacrimal Apparatus / 907 Excision of Submandibular Gland and Removal of a ■ BLUE BOX: Orbital Region, Orbit, and Eyeball. Fractures Calculus; Sialography of Submandibular Ducts / 946 of Orbit; Orbital Tumors; Injury to Nerves Supplying PTERYGOPALATINE FOSSA / 951 Eyelids; Inflammation of Palpebral Glands; Hyperemia of Conjunctiva; Subconjunctival Hemorrhages; Pterygopalatine Part of Maxillary Artery / 951 Development of Retina; Retinal Detachment; Pupillary Light Reflex; Uveitis; Ophthalmoscopy; Papilledema; Maxillary Nerve / 951 Presbyopia and Cataracts; Coloboma of Iris; Glaucoma; ■ BLUE BOX: Pterygopalatine Fossa. Transantral Approach Hemorrhage into Anterior Chamber; Artificial Eye; to Pterygopalatine Fossa / 954 Corneal Reflex; Corneal Abrasions and Lacerations; Corneal Ulcers and Transplants; Horner Syndrome; NOSE / 955 Paralysis of Extraocular Muscles/Palsies of Orbital External Nose / 955 Nerves; Blockage of Central Artery of Retina; Blockage of Central Vein of Retina / 909 Nasal Cavities / 956 PAROTID AND TEMPORAL REGIONS, INFRATEMPORAL Vasculature and Innervation of Nose / 959 FOSSA, AND TEMPOROMANDIBULAR JOINT / 914 Paranasal Sinuses / 960 Parotid Region / 914 ■ BLUE BOX: Nose. Nasal Fractures; Deviation of Nasal Temporal Region / 916 Septum; Rhinitis; Epistaxis; Sinusitis; Infection of Ethmoidal Cells; Infection of Maxillary Sinuses; Relationship of Teeth Infratemporal Fossa / 916 to Maxillary Sinus; Transillumination of Sinuses / 963 ■ TABLE 7.10. Movements of Temporomandibular Joint / 920 EAR / 966 ■ TABLE 7.11. Muscles Acting on Mandible/ External Ear / 966 Temporomandibular Joint / 922 Middle Ear / 967 ■ TABLE 7.12. Parts and Branches of Maxillary Artery / 924 Internal Ear / 973 ■ BLUE BOX: Parotid and Temporal Regions, Infratemporal Fossa, and Temporomandibular Joint. Parotidectomy; ■ BLUE BOX: Ear. External Ear Injury; Otoscopic Infection of Parotid Gland; Abscess in Parotid Gland; Examination; Acute Otitis Externa; Otitis Media; Sialography of Parotid Duct; Blockage of Parotid Duct; Perforation of Tympanic Membrane; Mastoiditis; Blockage Accessory Parotid Gland; Mandibular Nerve Block; of the Pharyngotympanic Tube; Paralysis of Stapedius; Inferior Alveolar Nerve Block; Dislocation of TMJ; Arthritis Motion Sickness; Dizziness and Hearing Loss: Ménière of TMJ / 926 Syndrome; High Tone Deafness; Otic Barotrauma / 977 822 Chapter 7 • Head OVERVIEW but is primarily part of the viscerocranium (see Fig. 7.7A). The so-called flat bones and flat portions of the bones form- ing the neurocranium are actually curved, with convex exter- The head is the superior part of the body that is attached to nal and concave internal surfaces. the trunk by the neck. It is the control and communications Most calvarial bones are united by fibrous interlocking center as well as the “loading dock” for the body. It houses sutures (Fig. 7.1A & B); however, during childhood, some the brain and, therefore, is the site of our consciousness: bones (sphenoid and occipital) are united by hyaline cartilage ideas, creativity, imagination, responses, decision making, (synchondroses). The spinal cord is continuous with the brain and memory. It includes special sensory receivers (eyes, ears, through the foramen magnum, a large opening in the cranial mouth, and nose), broadcast devices for voice and expression, base (Fig. 7.1C). and portals for the intake of fuel (food), water, and oxygen The viscerocranium (facial skeleton) comprises the facial and the exhaust of carbon dioxide. bones that mainly develop in the mesenchyme of the embry- The head consists of the brain and its protective coverings, onic pharyngeal arches (Moore and Persaud, 2008). The visce- the ears, and the face. The face includes openings and pas- rocranium forms the anterior part of the cranium and consists sageways, with lubricating glands and valves (seals) to close of the bones surrounding the mouth (upper and lower jaws), some of them, the masticatory (chewing) devices, and the nose/nasal cavity, and most of the orbits (eye sockets or orbital orbits that house the visual apparatus. The face also provides cavities) (Figs. 7.2 and 7.3). our identity as individuals. Disease, malformation, or trauma The viscerocranium consists of 15 irregular bones: 3 sin- of structures in the head form the bases of many specialties, gular bones centered on or lying in the midline (mandible, including dentistry, maxillofacial surgery, neurology, neuro- ethmoid, and vomer) and 6 bones occurring as bilateral pairs radiology, neurosurgery, ophthalmology, oral surgery, otol- (maxillae; inferior nasal conchae; and zygomatic, palatine, ogy, rhinology, and psychiatry. nasal, and lacrimal bones) (Figs. 7.1A and 7.4A). The maxil- lae and mandible house the teeth—that is, they provide the CRANIUM sockets and supporting bone for the maxillary and mandibu- lar teeth. The maxillae contribute the greatest part of the upper facial skeleton, forming the skeleton of the upper jaw, 1 The cranium (skull ) is the skeleton of the head (Fig. 7.1A). which is fixed to the cranial base. The mandible forms the A series of bones form its two parts, the neurocranium skeleton of the lower jaw, which is movable because it artic- and viscerocranium (Fig. 7.1B). The neurocranium is the ulates with the cranial base at the temporomandibular joints bony case of the brain and its membranous coverings, (Figs. 7.1A and 7.2). the cranial meninges. It also contains proximal parts of the Several bones of the cranium (frontal, temporal, sphenoid, cranial nerves and the vasculature of the brain. The neuro- and ethmoid bones) are pneumatized bones, which contain cranium in adults is formed by a series of eight bones: four air spaces (air cells or large sinuses), presumably to decrease singular bones centered on the midline (frontal,
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  • Skull / Cranium

    Skull / Cranium

    Important! 1. Memorizing these pages only does not guarantee the succesfull passing of the midterm test or the semifinal exam. 2. The handout has not been supervised, and I can not guarantee, that these pages are absolutely free from mistakes. If you find any, please, report to me! SKULL / CRANIUM BONES OF THE NEUROCRANIUM (7) Occipital bone (1) Sphenoid bone (1) Temporal bone (2) Frontal bone (1) Parietal bone (2) BONES OF THE VISCEROCRANIUM (15) Ethmoid bone (1) Maxilla (2) Mandible (1) Zygomatic bone (2) Nasal bone (2) Lacrimal bone (2) Inferior nasalis concha (2) Vomer (1) Palatine bone (2) Compiled by: Dr. Czigner Andrea 1 FRONTAL BONE MAIN PARTS: FRONTAL SQUAMA ORBITAL PARTS NASAL PART FRONTAL SQUAMA Parietal margin Sphenoid margin Supraorbital margin External surface Frontal tubercle Temporal surface Superciliary arch Zygomatic process Glabella Supraorbital margin Frontal notch Supraorbital foramen Internal surface Frontal crest Sulcus for superior sagittal sinus Foramen caecum ORBITAL PARTS Ethmoidal notch Cerebral surface impresiones digitatae Orbital surface Fossa for lacrimal gland Trochlear notch / fovea Anterior ethmoidal foramen Posterior ethmoidal foramen NASAL PART nasal spine nasal margin frontal sinus Compiled by: Dr. Czigner Andrea 2 SPHENOID BONE MAIN PARTS: CORPUS / BODY GREATER WINGS LESSER WINGS PTERYGOID PROCESSES CORPUS / BODY Sphenoid sinus Septum of sphenoid sinus Sphenoidal crest Sphenoidal concha Apertura sinus sphenoidalis / Opening of sphenoid sinus Sella turcica Hypophyseal fossa Dorsum sellae Posterior clinoid process Praechiasmatic sulcus Carotid sulcus GREATER WINGS Cerebral surface • Foramen rotundum • Framen ovale • Foramen spinosum Temporal surface Infratemporalis crest Infratemporal surface Orbital surface Maxillary surface LESSER WINGS Anterior clinoid process Superior orbital fissure Optic canal PTERYGOID PROCESSES Lateral plate Medial plate Pterygoid hamulus Pterygoid fossa Pterygoid sulcus Scaphoid fossa Pterygoid notch Pterygoid canal (Vidian canal) Compiled by: Dr.
  • Microsurgical Anatomy of the Dural Arteries

    Microsurgical Anatomy of the Dural Arteries

    ANATOMIC REPORT MICROSURGICAL ANATOMY OF THE DURAL ARTERIES Carolina Martins, M.D. OBJECTIVE: The objective was to examine the microsurgical anatomy basic to the Department of Neurological microsurgical and endovascular management of lesions involving the dural arteries. Surgery, University of Florida, Gainesville, Florida METHODS: Adult cadaveric heads and skulls were examined using the magnification provided by the surgical microscope to define the origin, course, and distribution of Alexandre Yasuda, M.D. the individual dural arteries. Department of Neurological RESULTS: The pattern of arterial supply of the dura covering the cranial base is more Surgery, University of Florida, complex than over the cerebral convexity. The internal carotid system supplies the Gainesville, Florida midline dura of the anterior and middle fossae and the anterior limit of the posterior Alvaro Campero, M.D. fossa; the external carotid system supplies the lateral segment of the three cranial Department of Neurological fossae; and the vertebrobasilar system supplies the midline structures of the posterior Surgery, University of Florida, fossa and the area of the foramen magnum. Dural territories often have overlapping Gainesville, Florida supply from several sources. Areas supplied from several overlapping sources are the parasellar dura, tentorium, and falx. The tentorium and falx also receive a contribution Arthur J. Ulm, M.D. from the cerebral arteries, making these structures an anastomotic pathway between Department of Neurological Surgery, University of Florida, the dural and parenchymal arteries. A reciprocal relationship, in which the territories Gainesville, Florida of one artery expand if the adjacent arteries are small, is common. CONCLUSION: The carotid and vertebrobasilar arterial systems give rise to multiple Necmettin Tanriover, M.D.