Head and Neck Dr Adel Bondok 1

Head & Neck

Dr Adel Bondok
Professor of Anatomy
 2 Head and Neck Dr Adel Bondok

SKULL
NORMA FRONTALIS
Identify the bones:
1. Frontal bone: upper part
2. Nasal bones: above the nasal opening
3. Zygomatic bones: one on each side below & lateral to the orbital opening
4. Maxillae: forming the upper jaw.
5. Mandible: forming the lower jaw.
NOTE:
 The frontal bone has: maxillary process, zygomatic process & orbital plate
 The zygomatic bone has: frontal, maxillary & temporal processes.
 The maxilla has: frontal, zygomatic & alveolar processes.
Identify the cavities:
1. Orbital cavity: one on each side.
2. Nasal cavity: in the midline.
Identify the sutures:
1. Coronal suture: between the frontal and parietal bones
2. Metopic suture: is present in infant skull between the two halves of the
frontal bone. It disappears at the age of 2 - 6 years. The lower part persists in
about 8% of adult skulls and may be mistaken for a fracture line in X-ray
3. Frontonasal suture
4. Internasal and other sutures.
Identify the bony landmarks:
1. Frontal eminence: site of the center of ossification.
2. Superciliary arch: above the orbit, more prominent in male than in female.
3. Glabella: elevation between the 2 superciliary arches.
4. Nazion: depression at the frontonasal suture.
5. Nasal septum (vomer and perpendicular plate of ethmoid)
6. Middle and inferior nasal conchae
7. Anterior nasal spine
8. Canine eminence: produced by the root of the canine tooth. It separates the
canine fossa laterally from the incisive fossa medially.
Identify the foramina:
1. Supraorbital notch or foramen: transmits: supraorbital nerve & vessels
2. Infraorbital foramen: transmits: infraorbital nerve & vessels
3. Mental foramen: transmits: mental nerve & vessels
4. Zygomaticofacial foramen: transmits: zygomaticofacial nerve & vessels.
Digitally signed by Dr Adel Bondok
DN: cn=Dr Adel Bondok gn=Dr Adel Bondok c=Egypt l=EG o=Mansoura University ou=Faculty

Dr Adel Bondok of Medicine [email protected]

Reason: I am the author of this document
Location:
Date: 2023-04-21 01:01+02:00
Head and Neck Dr Adel Bondok 3
 4 Head and Neck Dr Adel Bondok

NORMA VERTICALIS EXTERNA

Identify the bones:
1. Frontal bone: anterior.
2. Occipital bone: posterior.
3. Right and left parietal bones: sides (laterally).
Identify the sutures:
1. Coronal suture: between the frontal bone and the parietal bones.
2. Sagittal suture: between the 2 parietal bones
3. Lambdoid suture: between the 2 parietal bones and the occipital bone.
4. May be metopic: if present, between the 2 halves of the frontal bone.
Identify the bony landmarks:
1. Parietal eminence: site of the center of ossification.
2. Bregma: point of meeting of the sagittal and coronal sutures.
It is the site of the anterior fontanelle. It ossifies at the age of 18 months.
3. Lambda: point of meeting of the sagittal and lambdoid sutures.
It is the site of the posterior fontanelle. It ossifies at the age of 6 months.
4. Vertex: is the highest point of the skull. It lies behind the bregma.
5. Obelion: the flat part of the sagittal suture opposite the parietal foramen.
Identify the parietal foramen:
It transmits: emissary vein connecting the superior sagittal sinus with the
veins of the scalp.

NORMA VERTICALIS INTERNA

Identify the bones:

1. Frontal bone: anterior.
2. Occipital bone: posterior.
3. 2 parietal bones: one on each side.
Identify the sutures:
Coronal, sagittal and lambdoid suture.
Identify the bony landmarks:
1. Frontal crest: gives attachment to the falx cerebri.
2. Groove for the superior sagittal sinus.
3. Grooves for the branches of the middle meningeal vessels.
4. Granular foveolae: made by the arachnoid granulations.
Head and Neck Dr Adel Bondok 5
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NORMA LATERALIS

Identify the bones:

1. Above: frontal, parietal and occipital bones.
2. Below: zygomatic, greater wing of sphenoid, squamous temporal & mastoid process.
3. Zygomatic arch: formed of the zygomatic process of temporal bone and the
temporal process of zygomatic bone.
4. Below the zygomatic arch:
a. Articular tubercle & mandibular fossa (form the temporomandibular joint).
b. Tympanic plate, external auditory meatus and styloid process.
c. Infratemporal fossa: is the space deep to the ramus of the mandible.
d. Pterygomaxillary fissure: connects the infratemporal fossa with the
pterygopalatine fossa. It is continuous with the inferior orbital fissure.
5. Bones of the face: frontal, nasal, zygomatic and maxillary bones.
Identify the sutures:
1. Coronal suture: between the frontal bone and the parietal bones.
2. Lambdoid suture: between the parietal bone and the occipital bone.
3. Squamosal suture: between the parietal & temporal bones.
4. Occipito-mastoid suture and the mastoid foramen.
5. Parieto-mastoid and fronto-zygomatic sutures.
 Head and Neck Dr Adel Bondok 7

Identify the bony landmarks:

1. Superior temporal line: gives attachment to epicranial aponeurosis & temporal fascia.
2. Inferior temporal line: gives origin to the temporalis muscle.
3. Temporal fossa: between the superior temporal line & the zygomatic arch.
 Gives origin to the temporalis muscle.
 Has a groove for the middle temporal artery.
4. Suprameatal crest: continuous with the superior temporal line.
5. Mastoid foramen: at the occipito-mastoid suture. It transmits:
a. Mastoid emissary vein between sigmoid sinus and occipital veins.
b. Meningeal branch of the occipital artery.
6. Suprameatal triangle:
 Bounded by:
a. Superior: supramastoid crest.
b. Anterior: external auditory meatus.
c. Posterior: line along posterior border of the external auditory meatus.
 Clinical importance: it forms the lateral wall of the tympanic antrum.
7. Pterion: H-shaped suture formed by 4 bones:
the frontal, parietal, greater wing of the
sphenoid and the squamous temporal bone.
 Site in newborn: anterolateral fontanelle.
 Ossification: at the age of 3 month.
 Clinical importance: lies opposite the
anterior branch of the middle meningeal
artery. Fracture can cause injury of the
artery & extradural hemorrhage.
 Surface anatomy: 1cm above and 1 inch behind the fronto-zygomatic suture.
8. Asterion: point of meeting of 3 bones: the parietal, occipital and mastoid bones.
 Site in newborn: posterolateral fontanelle. Ossification: at the age of 3 month.
 8 Head and Neck Dr Adel Bondok

NORMA OCCIPITALIS

Identify the different bones:

1. Right and left parietal bones.
2. Squamous part of the occipital bone.
3. Mastoid process: has digastric (mastoid) notch on its medial side.
Identify the sutures:
1. Sagittal suture.
2. Lambdoid suture.
3. Occipito-mastoid and parieto-mastoid sutures.
Identify the bony landmarks:
1. External occipital protuberance: its prominent point is called inion.
2. External occipital crest: extends from the external occipital protuberance to the
foramen magnum.
3. The 3 nuchal lines:
a. Highest nuchal line: small; extends from the external occipital protuberance.
b. Superior nuchal line: extends from the external occipital protuberance to the
mastoid process.
c. Inferior nuchal line: extends from the external occipital crest.
4. The lambda: site of the posterior fontanelle.
5. The asterion: site of the posterolateral fontanelle.
6. Mastoid foramen: close to the occipito-mastoid suture.
 Head and Neck Dr Adel Bondok 9

NEWBORN SKULL

Fontanelles of the Skull

Fontanelle Site & Shape In Adult Ossification
• Diamond shaped
Anterior Bregma 18 months
• Between frontal & parietal bones

• Triangular in shape
Posterior Lambda 6 months
• Between parietal & occipital bones

Between frontal, parietal, greater wing

Anterolateral of sphenoid and temporal bones
Pterion 3 monthes

Between parietal bone, petrous part of

Posterolateral Asterion 3 monthes
temporal bone and occipital bone
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NORMA BASALIS EXTERNA

Identify the 3 Parts of Norma Basalis Externa

1. Anterior part: hard palate.
2. Middle part: between hard palate and the anterior margin of foramen magnum
3. Posterior part: behind the anterior margin of foramen magnum.
A: Hard Palate
 Formed of:
1. Anterior 2/3: palatine process of the maxilla
2. Posterior 1/3: horizontal plate of the palatine bone
 Identify:
1. Median palatine suture: in the midline
2. Incisive fossa: at the anterior end of the median palatine suture.
transmits: the sphenopalatine vessels and the nasopalatine nerve.
3. Palatomaxillary suture: between the maxilla and the palatine bone.
4. Greater palatine foramen transmits the greater palatine nerve and vessels.
5. Lesser palatine foramina transmit the lesser palatine nerve and vessels.
6. Posterior nasal spine: in the middle of the free posterior border.
 Head and Neck Dr Adel Bondok 11

B: Middle Part
 In midline: from before backward:
1. Vomer.
2. Body of the sphenoid
3. Occipito-sphenoid suture (ossifies at 25 years)
4. Basilar part of the occipital bone and pharyngeal tubercle.
 Laterally (on each side):
1. Greater wing of sphenoid: has 2 foramina: foramen ovale & foramen spinosum
2. Groove for auditory tube: immediately behind foramen ovale & spinosum
3. Spine of sphenoid
4. Medial and lateral pterygoid plates: identify:
a. Pterygoid fossa: between the 2 pteygoid plates.
b. Scaphoid fossa: at the upper end of the medial pterygoid plate.
c. Pterygoid hamulus: process at the lower end of the medial pterygoid plate.
5. Petrous part of temporal bone: identify:
a. Foramen lacerum: at the apex
b. Carotid canal: behind foramen lacerum.
c. Jugular foramen: between the petrous part and the occipital bone.
d. Styloid process.
6. Articular tubercle and articular (mandibular) fossa.
7. Tympanic plate: separates the mandibular fossa from the external auditory meatus.

C: Posterior Part: Occipital Bone & Mastoid Process

 Identify the occipital bone: divided by the foramen magnum into 3 parts:
1. Basilar part: in front of the foramen magnum
2. Squamous part: behind the foramen magnum.
3. Condylar part: 2 occipital condyles, lateral to the foramen magnum.
 Identify the foramina in the occipital bone:
1. Hypoglossal canal: above the occipital condyle.
2. Posterior condylar canal or fossa: behind the occipital condyle.
 Identify the mastoid process:
1. Stylomastoid foramen: between the mastoid process and the styloid process.
2. Mastoid foramen: at the occipito-mastoid suture.
3. Mastoid groove or notch: on the medial side.
4. Groove for occipital artery.
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NORMA BASALIS INTERNA

Anterior Cranial Fossa
Bones:
1. Frontal crest, foramen cecum, crista galli
2. Cribriform plate of ethmoid bone
3. Orbital plate of frontal bone
4. Lesser wing of the sphenoid bone.
Canals: anterior and posterior ethmoidal canals.
Middle Cranial Fossa
Bones:
1. Tuberulum sellae, hypophyseal fossa (sella
turcica) & dorsum sellae
2. Anterior and posterior clinoid processes
3. Greater wing of the sphenoid.
4. Anterior surface of the petrous temporal
bone: containing 3 structures:
a. Depression for the trigeminal ganglion
b. Arcuate eminence: sup semicircular canal.
c. Tegmen tympani: roof of the middle ear
Foramina and Fissures:
1. Optic canal
2. Foramen rotundum, ovale & spinosum
3. Foramen lacerum
4. Superior orbital fissure: between the lesser
and greater wing of the sphenoid
Grooves for the:
1. Optic chiasma (sulcus chiasmaticus).
2. Internal carotid artery: on each side of the
body of the sphenoid.
3. Middle meningeal vessels & petrosal nerves
Posterior Cranial Fossa
Bones:
1. Clivus (formed of sphenoid & occipital parts)
2. Basilar & squamous parts of the occipital bone
3. Internal occipital protuberance and internal occipital crest
Foramina and Grooves for Dural Sinuses:
1. Foramen magnum & jugular foramen between the occipital & petrous temporal bone.
2. Hypoglossal canal (anterior condylar canal) and posterior condylar canal.
3. Mastoid foramen: opening in the groove for the sigmoid sinus.
4. Internal auditory meatus: in the posterior surface of the petrous temporal bone
5. Superior and inferior petrosal sinuses, transverse, sigmoid and occipital sinuses
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Foramina of the Norma Basalis of the Skull

Foramen Structures Passing Through It (Contents)
Foramen cecum Emissary vein between nasal veins and superior sagittal sinus
Cribriform plate (ethmoid) Olfactory nerves
Anterior ethmoidal canal Anterior ethmoidal nerve and vessels
Posterior ethmoidal canal Posterior ethmoidal nerve and vessels
Optic canal 1. Optic nerve. 2. Ophthalmic artery.
From above downwards: (Live Free To See No Insult AT All)
Lacrimal nerve, Frontal nerve, Trochlear nerve, Superior division
Superior orbital fissure
of the oculomotor nerve, Nasociliary nerve, Inferior division of
the oculomotor nerve, Abducent nerve and ophthalmic veins
Foramen rotundum Maxillary nerve
1. Mandibular nerve.
Foramen ovale 2. Accessory meningeal artery.
(MALE) 3. Lesser superficial petrosal nerve.
4. Emissary vein between cavernous sinus & pterygoid plexus
1. Middle meningeal artery and vein.
Foramen spinosum
2. Nervus spinosus (meningeal branch of mandibular nerve).
Carotid and pterygoid canals open into it. It transmits:
1. Internal carotid artery in the carotid canal.
2. Deep petrosal nerve (from sympathetic plexus around ICA)
Foramen lacerum
3. Nerve of pterygoid canal (deep petrosal + greater petrosal)
4. It is closed inferiorly by fibrocartilage. It transmits emissary
vein from cavernous sinus to pharyngeal plexus.
Hiatus of greater petrosal 1. Greater superficial petrosal nerve (branch of facial nerve).
nerve 2. Petrosal branch of the middle meningeal artery.
1. Facial nerve (VII) and vestibulocochlear nerve (VIII).
Internal auditory meatus
2. Labyrinthine vessels.
1. Anterior compartment: inferior petrosal sinus.
2. Middle compartment:
Jugular foramen 1. Nerves: glossopharyngeal, vagus & accessory nerves.
2. Meningeal arteries of ascending pharyngeal & occipital.
3. Posterior compartment: sigmoid sinus (internal jugular vein)
1. 3 nervous structures:
1. Medulla to continue as the spinal cord.
2. Spinal roots of the accessory nerves.
Foramen magnum
3. Meningeal branches of upper cervical nerves.
2. 3 arteries: vertebral, anterior and posterior spinal arteries.
3. 3 meningeal layers: dura, arachnoid and pia mater.
Hypoglossal canal Hypoglossal nerve.
Condylar canal Emissary vein from sigmoid sinus to suboccipital venous plexus
1. Mastoid emissary vein from sigmoid sinus to occipital veins.
Mastoid foramen:
2. Meningeal branch of the occipital artery.
‫‪14‬‬ ‫‪Head and Neck‬‬ ‫‪Dr Adel Bondok‬‬

‫حقـوق الطبـع محفـوظـة للمؤلف‪.‬‬ ‫•‬

‫هذا الكتـاب محمي بقانـون حمـاية الملكيـة الفكريـة وحقـوق النشـر‪.‬‬ ‫•‬
‫ممنـوع منعا باتا نسـخ أو توزيـع هذا الكتـــاب أو أج زـــزه منـ بــرون ت ــــري‬ ‫•‬
‫كتـابي من المؤلف‪.‬‬
‫مخـــالفة هــذا القانـــون ســـيعر المخـــالف للمســـاهلة القانـــونية مــع ر ـــع‬ ‫•‬
‫التعـوي المناسـب للمؤلف‪.‬‬
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