Skull

Handout version

Helen KW Law
Assistant Professor
Health Technology & Informatics
FHSS, Hong Kong Polytechnic University
23rd Nov., 2016 Week #12
1
 Revision
Common Names

Suture

Protuberance

2
Revision
The cranium & the brain

3
Revision
Sutures

Bregma

Lambda
4
 Revision
Fetal Fontanelles

Anterior (Frontal)

Bregma

Pterion Anterolateral
Lambda
Posterior (Sphenoid)
(Occipital)

Asterion
Posterolateral
(Mastoid)

5
 Skull – 22 bones! Which are the cranial bones?

Revision

6
 Median Section of the skull

Revision
7
Simple skull fracture

Fracture line

8
 Skull X-ray (Lateral) Sutures

Frontal
Parietal Bone
bone

Coronal
Lambdoid suture
suture

Occipital Groove of the

bone middle
meningeal
artery

9
 Skull X-ray (Lateral) Air sinuses

Frontal
Sphenoid sinus
sinus

Mastoid
air cells
= sinus Ethmoid
sinus

Maxillary
sinus
10
 Skull X-ray (Lateral) Bones

Sphenoid
Calvarium
bone
(Cranial vault)
Frontal
bone

Ethmoid
External
auditory
Maxilla
meatus
Palatine

Mandible 11
 Revision
Median Section of the skull

Clivus = slope

Sella turcica = Pituitary fossa + dorsum sellae 12

 Skull X-ray (Lateral) Pituitary fossa

Dorsum Anterior
sellae Cranial
Fossa

Sphenoid
sinus

Clivus

Posterior clinoid process Anterior clinoid process

13
 Skull X-ray (Lateral) Nasal bone

Frontal
bone

Frontonasal suture

Nasal bone

Anterior nasal spine

Hard Palate
Maxilla

Palatine

14
Skull – 22 bones! Which are the facial bones?

Nasion Revision

Palatine = posterior part of palate

15
Revision
Ethmoid bone

16
Revision
Temporal bone

17
Revision
Sphenoid bone

18
 Landmarks
Occipito-frontal 10°projection
Anterior
Crista galli
cranial fossa

Lesser wing
Supraorbital
of sphenoid
margin
Greater wing
of sphenoid
Superior orbital
Petrous ridge fissure

10° Nasal septum

19
 Air sinuses
Occipito-frontal 10°projection

Frontal
air sinus

expect係呢個位
? Sphenoid sinus
Ethmoid
sinus

Maxillary sinus
Foramen
rotundum
for CN V2 Mastoid sinus

20
 Practice
Occipito-frontal 10°projection

Frontal
air sinus

Sphenoid sinus
Ethmoid
sinus

Mandibile: Maxillary sinus

condyle
coronoid process
ramus Mastoid sinus
body
Petrous ridge

21
 Practice
Occipito-frontal projection

Frontal
air sinus

Sphenoid sinus
Ethmoid
sinus

Mandibile: Maxillary sinus

condyle
coronoid process
ramus Mastoid sinus
body
Petrous ridge

22
 30-35° fronto-occipital (Townes’) projection Good，dorusm
sellae IS seen

Lambdoid suture
Occipital
bone

Sulcus of Foramen
venous sinuses magnum

Petrous part
Dorsum of temporal
sellae bone

23
 Practice
30-35° fronto-occipital (Townes’) projection

Lambdoid suture
Occipital
bone

Sulcus of
venous sinuses
Foramen
magnum
Dorsum
sellae
Petrous part
of temporal
bone

Mastoid sinus

24
 Practice
Occipital bone

Lambdoid
suture

Occipital
bone

Sulcus of
venous sinuses

Petrous ridge
Foramen
magnum

Zygomatic arch

Condyle of the mandible

25
 dorsum sellae is not shown Dorsum sellae should
be projected in the
An overtilted Townes’ projection!! foramen magnum!

26
Revision
Orbit - Which 7 bones?

27
 Orbit

Lesser Frontal
wing of sinus
sphenoid
Supra-
orbital
Greater margin
wing of
Superior
sphenoid
orbital
fissure
Lateral
wall Infra-
orbital
Petrous Maxillary Z margin
ridge bone
no, aside can
Optic
Hard
foramen?
Palate
Zygomatic
Mastoid bone
sinus 28
Revision
Optic foramen

Optic nerve passes through the optic foramen

29
Revision
Sinuses

Anterior
Cranial
Fossa

Sphenoid
Sinus

30
 Occipito-mental projection

Frontal
sinus
Nasal
septum

Maxillary Infraorbital
foramen
sinus

Foramen
Mandibile: rotundum
condyle
coronoid
process
ramus
body 31
 Occipito-mental projection Practice

Nasal
Frontal septum
sinus

Maxillary
sinus

Foramen
rotundum Petrous
ridge
Mandibile:
condyle Mastoid
coronoid process sinus
ramus
body
32
 Revision
Mandible

講明在mandible

incisors (central, lateral), canine, pre-molar (#1,#2), molar (#1,#2,#3)

33
 Mandible - lateral

condyle

coronoid process

ramus

body

mental foramen

34
 Mandible - AP

Supra-
orbital
margin

Petrous
ridge

Lateral mass
of atlas

Zygomatic
arch

Mandibile:
condyle
coronoid process
ramus
body
35
 Temporomandibular Joint

Close

sinus
Open
EAM

anat. part
36
Revision
Arterial blood supply in H & N

Vertebral artery

Brain

Internal carotid
artery
enters the carotid canal
at the petrous part of the
temporal bone.

37
 Inferior view
Revision
Blood supply to the brain of the brain
Anterior
Olfactory bulb

Cut surface Optic Chiasm

Pituitary gland

Pons

Cerebellum
R L
38
Revision
The circulus arteriosus (Circle of Willis)

Anterior Anterior cerebral artery

cerebrum (medial surface)
communicating
artery Internal carotid artery

Middle cerebral artery

cerebrum (supero-lateral)
Posterior
communicating Posterior cerebral artery
artery (x2) Temporal lobe (inferior)

Basilar artery
Cerebellum
Foramen
magnum
Vertebral artery

The cerebral arterial circle is located within the subarachnoid space. 39

Revision
Dura venous sinuses

Superior sagittal sinus

Transverse
sinus

40
Revision
Venous drainage in H & N

41
Revision
Venous drainage in the brain

42
http://cmp-manual.wbs.cz/trombosa_splavu/pictures/picture6_-_vein_anatomy_original.jpg
 Digital Subtraction Angiography – Rt carotid artery

Watch @
Home

01_DSA_AP_Rt_Carotid Artery.avi 03_DSA_LAT_Rt_Carotid Artery.avi

43
Digital Subtraction Angiography – Rt carotid artery

Watch @
Home

02_DSA_AP_Rt_Carotid Artery-3D.avi

44
 Digital Subtraction Angiography – Rt carotid artery

06_DSA-AP_Rt Carotid Artery.jpg 07_DSA-AP_Rt Carotid Artery_venous phase.jpg

Anterior
cerebral artery Superior sagittal
sinus

Transverse sinus

Middle cerebral Sigmoid sinus

artery

Internal carotid artery Internal jugular vein

45
 Digital Subtraction Angiography – Rt carotid artery

08_DSA-LAT _Rt Carotid Artery.jpg 09_DSA-LAT _Rt Carotid Artery_venous phase.jpg

Anterior
cerebral artery

Superior sagittal
sinus

Transverse sinus

Middle cerebral Sigmoid sinus

artery
Ant.

Internal carotid artery Internal jugular vein

46
 Digital Subtraction Angiography – Rt vertebral artery

Watch @
Home

04_DSA_AP_Rt_Vertebral Artery.avi 05_DSA_LAT_Rt_Vertebral Artery.avi

47
 Digital Subtraction Angiography – Rt vertebral artery

10_DSA-AP_Rt Vertebral Artery.jpg 11_DSA-AP_Rt Vertebral Artery_venous phase.jpg

Posterior Transverse sinus

cerebral artery
Sigmoid sinus

Vertebral artery Internal jugular vein

48
 Digital Subtraction Angiography – Rt vertebral artery

12_DSA-LAT_Rt Vertebral Artery.jpg 13_DSA-LAT_Rt Vertebral Artery_venous phase.jpg

Transverse sinus

Sigmoid sinus

Posterior
cerebral artery
posterior

Vertebral artery Internal jugular vein

49
Digital Subtraction Angiography – Both vertebral arteries

14_DSA-AP Both Vertebral Artery.jpg

Left posterior
cerebral artery

Basilar artery

Left vertebral artery

50
Magnetic Resonance Imaging – carotid angiography

Anterior cerebral artery

Anterior communicating artery

Internal carotid artery

Middle cerebral artery

Posterior communicating artery

Posterior cerebral artery

15_MRI_Axial Circle of Willis.jpg 51

 Magnetic Resonance Imaging – carotid venography

Superior
sagittal
sinus

Confluence of sinuses

Transverse sinus

Sigmoid sinus

Internal jugular vein

16_MRI_Coronal Venous sinuses.jpg 52

 Reading List & References

Saladin KS. Human Anatomy (4th edition).

McGraw Hill, 2014
E. Reif. Pocket Atlas of Radiographic
Anatomy (3rd Edition). Thieme Medical
Publisher, 2010.
Martensen KM. Radiographic Image
Analysis (3rd Edition). Saunders
Elsevier, 2011.
Weir J. et al. Imaging Altas of Human
Anatomy (4th edition). Edinburgh:
Mosby Elsevier, 2011

+ Other internet resources

53
 Week 13 …. Neuroanatomy

Final Exam 20-Dec-2016 (12:30-14:30pm)

54
 For Reference
Submento-vertical view only

Lateral border Maxillary

of orbit antrum

Sphenoidal
Anterior border
sinus
of middle
cranial fossa

Atlas
Axis Petrous part
of temporal bone

Mastoid
air cells

55
 For Reference
only Submento-vertical view Practice

Lateral border Maxillary antrum

of orbit

Zygomatic arch
Sphenoid sinus
Anterior border
of middle Foramen ovale
cranial fossa
Foramen spinosum

Atlas Petrous
Axis temporal bone
Mastoid
air cells

56
 Jugular view for nasopharyngeal carcinoma

Soft tissue

Jugular foramen

Atlas
Axis

Vertebral foramen

Mandibile:
condyle
coronoid process
ramus
body For Reference
only
57