Inferior Skull

KEY DEFINITIONS

  • Foramina are holes that allow neurovascular structures to pass through the bone.
  • Processes serve as muscle attachment sites.

Maxilla:

  • Palatine process
    • Portion of the maxilla that extends posteriorly, towards the palatine.
  • Incisive foramen
    • A small opening for neurovascular structures; its name reflects its location posterior to the incisors (the front teeth).
    • The nasopalatine nerve and sphenopalatine artery (and vein) pass through the incisive foramen to serve the palate and associated structures.
  • Alveolar margin (aka, ridge)
    • The border of the maxilla where the upper teeth reside.

Sphenoid:

  • Pterygoid process
    • Gives rise to the medial and lateral pterygoid plates, which are extensions where muscles of mastication (aka, chewing) attach.
  • Foramen ovale
    • Petrosal nerve, mandibular nerve, and accessory meningeal artery.
  • Foramen spinosum
    • Middle meningeal artery and meningeal branch of the mandibular nerve.

Temporal bone:

  • Mandibular fossa
    • Shallow depression where the mandible (the bone of the lower jaw) articulates with the cranium.
  • External auditory meatus
    • External opening of the ear.
  • Styloid process
    • A pointy projection for attachment of muscles.
  • Mastoid process
    • Larger, roughened cone-shaped projection for muscle attachment (sternocleidomastoid).
  • Opening of the carotid canal
    • Internal carotid artery enters the cranium to supply the brain via this opening.
  • Stylomastoid foramen
    • Lies between the styloid and mastoid processes.
    • CN VII (facial nerve).

Occipital bone:

  • Foramen magnum
    • A large hole where the spinal cord enters the cranium to become the brainstem.
    • The brainstem, vertebral arteries, and CN XI (accessory nerve) pass through the foramen magnum;
  • Occipital condyles
    • Lie on either side of the foramen magnum; these rounded surfaces articulate with the vertebral column.
  • Hypoglossal canal
    • A small opening near the foramen magnum and the occipital condyles.
    • CN XII (hypoglossal nerve)
  • External occipital crest
    • Extends from the posterior edge of the foramen magnum, and terminates at the external occipital protuberance
  • External occipital protuberance
    • A roughened elevation; it serves as a muscle attachment site and is usually larger in adult males.
  • Inferior and superior nuchal lines
    • Extend horizontally from the crest; they serve as muscle attachment sites.
  • Foramen lacerum
    • Lies between the occipital, sphenoid, and temporal bones; it is irregularly shaped.
    • Greater petrosal nerve; it is a branch of the facial nerve (CN VII).
  • Jugular foramen
    – Lies between occipital and temporal bones; it is named for the jugular vein, which exits through this space.
    • CNs IX (glossopharyngeal nerve), X (vagus), and XI (accessory), and the jugular vein

Lateral Skull

CRANIAL BONES

  • Enclose and protect the brain

Frontal bone

  • Comprises the forehead and the superior portion of the eye orbit

Parietal bone

  • Comprises the superior portion of the lateral skull

Sphenoid bone

  • Only small portion visible in lateral view
  • Gives rise to pterygoid processes

Temporal bone

  • Forms inferior boundary of lateral skull
  • Squamous portion is area inferior to squamous suture
  • Tympanic portion surrounds the external auditory meatus
  • External auditory meatus is the external opening of the ear
  • Mastoid process is the large bony projection near the occipital bone
  • Styloid process is a long, pointy projection
  • Mandibular fossa is a depressed area of the temporal bone that articulates with the mandible to form the temporomandibular joint

Occipital bone

  • Comprises posterior and inferior portion of cranium

FACIAL BONES

  • Form the face and protect the entrances to the oral and nasal cavities.

Zygomatic

  • Contributes to the lateral eye orbits and cheeks

Nasal

  • Forms the bony component of the external nose

Maxilla

  • Contributes to the medial eye orbit, cheeks, and upper jaw
    *Anterior nasal spine is the projection of the maxillae that contributes to the inferior border of the opening of the nasal cavity.

Ethmoid

  • Contributes to medial eye orbit

Lacrimal

  • Contributes to medial eye orbit
  • Fossa for the lacrimal sac, through which tears pass from the eye to the nasal cavity. This connection explains why your nose runs when you cry.

Mandible

  • Bone of the lower jaw; it houses the lower teeth.
  • Condyle (aka, head) articulates with the mandibular fossa of the temporal bone posteriorly
  • Coronoid process provides an attachment site for temporalis, a powerful muscle of the jaw.
  • Mandibular notch lies between condyle and coronoid process
  • Ramus is the vertical portion
  • Body is anterior and lateral base
  • Angle lies between body and ramus, posteriorly
  • Mental protuberance, which forms the chin

FOUR MAJOR SUTURES:

  • Sutures are the immoveable joints between the skull bones.

Coronal suture

  • Lies between the frontal bone, anteriorly, and the parietal bones, posteriorly;

Sagittal suture

  • Lies between the right and left parietal bones;

Squamous suture

  • Lies between the temporal and parietal bones.

Lambdoid suture

  • Lies between the parietal and occipital bones.

Sutural bones (formerly called Wormian bones)

  • Small, irregularly shaped bones that form between the major skull bones.

Pterion

  • Where the temporal, sphenoid, parietal, and frontal bones meet
  • Overlies the middle meningeal artery; thus, injury to the pterion is a common cause of intracranial epidural hematoma.

Additional Features:

Paranasal sinuses

  • Spaces within the frontal, ethmoid, sphenoid, and maxilla; they are continuous with the nasal cavity (and are addressed in detail with the respiratory system).

Zygomatic arch

  • The zygomatic process, which is a projection of the temporal bone
  • The temporal process, which is a projection of the zygomatic bone

Anterior Skull

Key functions of the skull:

  • Protects the brain and associated sensory organs.
  • Provides attachment sites for the facial and neck muscles.

The skull itself comprises:

  • 8 Cranial bones that enclose the brain
  • 14 Facial bones that protect entryway to nasal and oral cavities, and provide muscle attachment sites.

The cranial bones include:

The unpaired bones:

Frontal

  • Forms the forehead and superior rim of eye orbits.
  • Supraorbital margin is the bony ridge framing the orbit superiorly
  • Supraorbital notch/foramen provides passageway for neurovascular structures.

Occipital

  • Contributes to the posterior and inferior surface and base of the skull.

Sphenoid

  • A bat-shaped bone that spans the width of the skull.

Ethmoid

  • An irregularly shaped bone that lies deep within the skull.
  • Contributes superior and middle nasal conchae.

The paired bones:

Parietal

  • Comprise the superior and lateral aspects of the skull.

Temporal

  • Comprise the inferior portion of the lateral skull.

The facial bones include:

The unpaired bones:

Vomer

  • Contributes to the nasal septum.

Mandible

  • The bone of the lower jaw.
  • Alveolar margin houses lower teeth.
  • Mental foramen for neurovascular structures.

The paired:

Zygomatic

  • Form the inferior margins of the orbits and the lateral cheekbones.

Lacrimal

  • Contribute to the medial walls of the orbits.

Nasal

  • Comprise the bridge of the nose.

Inferior nasal conchae

  • Lie within the nasal cavity.

Palatine

  • Contribute a small portion to the medial orbit wall (but chiefly contribute to the hard palate of the oral cavity).

Maxilla

  • Fuse at the midline of the face to form the medial and inferior orbit walls, cheeks, and upper jaw.
  • Infraorbital foramen for neurovascular structures.
  • Alveolar margin is the border of the maxilla where the upper teeth are housed.

Spaces within the eye orbit:

  • The superior orbital fissure is a wide space within the sphenoid (specifically, between the greater and lesser wings).
  • The inferior orbital fissure is the space between the sphenoid, zygomatic, and maxillary bones.
  • The optic foramen is the opening to the optic canal, through which the optic nerve (cranial nerve II) passes.

Features of the nasal cavity:

  • Nasal septum separates the nasal cavity into right and left sides.
    • Comprises two different bones:
      Superiorly: Perpendicular plate of the ethmoid bone.
      Inferiorly: The vomer bone comprises the inferior portion.

Joint Types

Two articulation classification systems

Functional and Structural

Functional classification

  • Determined by the degree of movement permitted by the joint. An inverse relationship exists between joint mobility and stability.

The functional classification types are:

  • Synarthrosis joints, which are immovable and stable.
  • Amphiarthrosis joints, which are slightly moveable and slightly stable.
  • Diarthrosis, which are freely moveable and very unstable.

Structural classification

  • Determined by the joint’s connective tissue type and whether there is a cavity within the joint.

The structural classification types are:

  • Fibrous joints, which are connected by fibrous connective tissue.
    Three subtypes of fibrous joints:
    Syndemosis (as between the bones of the forearm)
    Suture (as between the bones of the skull)
    Gomphosis (as between the teeth and the bones of the jaws)
  • Cartilaginous, which are connected via cartilage.
    Two subtypes of cartilaginous joints:
    Symphysis joints (joined via a fibrocartilage pad, as the two pubic bones)
    Synchondrosis joints (joined by hyaline cartilage, as between the ribs and the sternum)

Synovial

  • Comprises an articular cavity enclosed in a deep synovial membrane and a superficial fibrous membrane. The synovial and fibrous membranes comprise the articular capsule.
    There are several subtypes of synovial joints:
  • Gliding joints occur where flat surfaces meet to allow sliding and twisting. The wrist bones, or carpals, are joined by gliding joints.
  • Pivot joints form where a round projection fits inside a ring to allow rotation. The first and second cervical vertebrae articulate via a pivot joint.
  • Condylar joints occur where one bone fits into an oval-shaped depression in another bone, such as where the radius cradles the carpals.
  • Saddle joints occur when the saddle-shaped region of one bone articulates with a depression on another bone, such as where the carpal and first metacarpal (the thumb) meet.
  • Ball-and-socket joints form where a ball-like process fits inside a cup-like depression, which allows maximum freedom of motion, such as between the head of the humerus and the glenoid cavity of the scapula.

Clinical Correlation:

  • Synovitis is a painful inflammatory condition of the synovial membrane that commonly occurs in rheumatologic conditions such as rheumatoid arthritis, lupus, gout, or simply by overuse injury.

Anatomic Divisions and Terms

The 206 bones of the body divide into two major groups

  • Axial bones – comprise the vertical axis of the skeleton; 80 bones.
  • Appendicular bones – bones that append (aka attach) to the axial skeleton; 126 bones.

Anatomical position

  • The vertebral column is vertical, the arms are extended with palms facing anteriorly, and the legs are extended with toes pointing anteriorly (towards the front of the body).

Axial skeleton

Skull

  • Encloses and protects brain

Hyoid bone

  • U-shaped bone; muscles of speech and swallowing attach to the hyoid bone

Vertebral column

Bones of the spine, terminates in the sacrum

Thoracic cage

  • Sternum – breast bone
  • Ribs – form the lateral walls of the thoracic cage

Appendicular skeleton

Pectoral girdle

  • Comprises the scapula (aka shoulder blade), which articulates with the humerus; and, the clavicle, which articulates with the sternum and scapula

Arm

  • The humerus articulates with the scapula

Forearm

  • The radius (laterally)
  • The ulna (medially)

Hand

  • Carpals (wrist)
  • Metacarpals (palm)
  • Phalanges (fingers)

Pelvic girdle

  • Bilateral os coxa bones (aka hip bone), articulate with the sacrum posteriorly

Thigh

  • Femur (aka thigh bone) articulates with the lateral side of the coxal bone; it is the longest and strongest bone in the body

Leg

  • Fibula, laterally; very slim, attachment site for muscles
  • Tibia, medially (“shin” bone); thick, weight-bearing bone of the leg

Kneecap

  • Patella; encased within tendons that pass over the knee, so is a sesamoid bone

Foot

  • Tarsals (ankle)
  • Metatarsals (foot base)
  • Phalanges (toes)

Directional nomenclature

Proximal

  • Closer to the center of the body or limb attachment

Distal

  • Further from the center of the body or limb attachment

Contralateral

  • On opposite sides of the body

Ipsilateral

  • On same side of the body

Intermediate

  • A structure between two others

Superior

  • Towards the top of the head

Inferior

  • Towards the feet

Medial

  • Towards the midline of the body

Lateral

  • Away from the midline of the body

Sagittal plane

  • Divides body into right and left sides

Transverse plane

  • Divides body into superior and inferior divisions

Superficial

  • Structure that is close to the surface of the body

Deep

  • A structure that is near the center of the body

Bone Functions and Features

Skeletal system

  • Comprises bones, their membranous linings, and cartilage.
  • Bones are living organs; they comprise connective tissue, nervous tissue, and epithelium.

Key features of bones:

  • Crest — a narrow ridge
  • Tubercle — a small irregular projection
  • Tuberosity — a large raised, roughened bony region.
  • Spine — a sharp raised projection
  • Notch — an indentation in bone
  • Trochanters — large irregular projections
  • Line or linea — a long narrow ridge
  • Head — an enlarged region of bone
  • Fovea — a small pit
  • Condyles — rounded ends or projections of bone
  • Epicondyle — a projection above a condyle (epi = on or above)
  • Facets — smooth articular surfaces
  • Meatus — a tubular passage
  • Fossa — shallow depression
  • Groove — a long narrow depression
  • Sinus — a hollow cavity within a bone
  • Process — a bony projection
  • Fissure — a long narrow opening
  • Foramen — a round opening in the bone through which nerves or blood vessels traverse
  • Ramus — an extension of bone

Functions

  • Features that serve as projections that form joints:
    Head (femur, rib)
    Condyle (femur)
    Facet (rib)
    Ramus (skull)
  • Features that serve as projections that attach muscle/ligaments:
    Tuberosity (os coxa)
    Tubercle (os coxa)
    Crest (os coxa)
    Spine (os coxa)
    Trochanter (femur)
    Line (linea) (femur)
    Epicondyle (femur)
    Process (skull)
  • Features that serve as depressions or openings:
    Meatus (skull)
    Sinus (skull)
    Fossa (skull)
    Groove or sulcus (skull)
    Fissure (skull)
    Foramen (skull)
    Notch (os coxa, skull)
    Fontanel (membranous covering; not shown)
    Fovea (small depression; not shown)

6 Key Functions of Bone:

  • Support: Forms the framework for physical form; attachment sites for muscles and connective tissues.
  • Movement: Acts as a series of levers when muscles contract to allow movement of body.
  • Protection: Protects vital organs from injury. For example: the skull protects the brain and the thoracic cage protects the heart and lungs.
  • Mineral storage: Provides a reservoir for calcium and phosphorus.
  • Blood cell production: Hematopoiesis occurs in red bone marrow.
  • Energy storage: Lipids are stored in adipose cells of yellow marrow.

Cartilage – Biology and Development

Key points:

  • Cartilage is connective tissue with a semi-solid extracellular matrix that comprises collagen fibers and ground substance, which provides both support and protection for other body tissues.
  • Three types covered here: hyaline, fibrous, and elastic.

Hyaline cartilage

  • Most abundant type of cartilage in the body.
  • Hyaline cartilage forms most of the fetal skeleton and is important in endochondral bone growth until the end of adolescence.
  • In the adult, it persists in the nose, trachea, and larynx, thorax, and also covers the articular surfaces of long bones (where it has no perichondrium).
  • Degeneration and calcification of hyaline cartilage may either be physiologic or pathologic. It is physiologic in the case of endochondral bone formation but it is pathologic in the case of osteoarthritis, which leads to pain and restricted joint movement. There are other forms of arthritis, such as rheumatoid arthritis, which is an inflammatory form of arthritis in which the immune system aggressively attacks the cartilage, bone, and synovial membranes of the joints
  • Calcification (the processes by which cartilage is replaced by osseous tissue) is common in hyaline cartilage, but very rare in elastic or fibrous cartilages.

Hyaline Cartilage Layers:

  • Perichondrium, outer surface
  • Matrix

Perichondrium

  • Comprises inner and outer layers (although in slow-growing or inactive perichondrium, it is not always possible to visually distinguish two separate layers).
  • Inner layer is the chondrogenic (aka cellular) layer; it comprises chondrogenic cells.
  • Outer layer it he fibrous layer; it comprises Type I collagen fibers, blood vessels, which supply nutrients to the cartilage below, and, fibroblasts, which are thought to produce collagen fibers and/or chondroblasts (although intertextual variation exists regarding this point).

Matrix

  • Appears glass-like under the microscope.
  • Is basophilic and stains purple on H & E section
  • Contains territorial matrixes that comprise the proteoglycan-rich, dark staining area around the lacunae.
  • Ground substance of the matrix, which is gel-like, comprises the following components:
    Proteoglycan aggregates, which are bound to collagen fibrils, and which provide a semi-solid structure to cartilage,
    Chondronectin, which adheres collagen fibers to chondrocytes, and,
    Itercellular Water, which is 60-80% of net weight of the cartilage (varies by location).
  • Matrix comprises type II collagen fibers, which are invisible in standard histologic preparations.
  • Houses lacunae, which are spaces in the matrix.
  • Inside the lacunae are the chondrocytes, which are mature cartilage cells that generate and maintain the matrix.
  • Chondroblasts are derived from chondrogenic cells, and eventually mature into chondrocytes.
  • Clusters of chondrocytes are called isogenous groups.
  • Interterritorial matrix outside of the isogenic groups; it stains lightly.

Elastic Cartilage

  • Also known as yellow fibrocartilage.
  • Shares many similarities to hyaline cartilage (for instance, it also has perichondrium and contains invisible type II collagen fibers within the matrix).
  • Helpful distinguishing feature of elastic cartilage are its interwoven elastic fibers, which provide flexibility.
  • Elastic cartilage provides flexibility and resistance to permanent deformation.
  • Present in the external ear, the auditory (Eustachian) tube, and the epiglottis.

Fibrous Cartilage

  • Also shares many similarities with hyaline cartilage
  • Two helpful distinguishing features are its lack of perichondrium and its rows of chondrocytes that have type I and type II fibers in between them.
  • The bundles of type 1 and type II collagen fibers provide strength and durability for shock absorption.
  • The matrix is dense and contains relatively little ground substance.
  • The type of joint and person’s age determine the relative proportions of these two collagen fiber types within the fibrous cartilage.
  • NO perichondrium is present in fibrous cartilage.
  • Fibrous cartilage is found, most notably, in intervertebral discs, pubic symphysis, menisci of the knee, and tendons where properties of stress resistance are particularly important.

Formation and Growth of Cartilage

  • Two types of growth:
    Interstitial and appositional growth; both types occur simultaneously during early development; the relative rate of each type of growth determines the shape and structure of the cartilage.

Interstitial growth:

  • Interstitial growth occurs during early stages of cartilage formation, and in the growth plates and articular cartilages of growing long bones.
  • Cells divide within matrix to produce daughter cells that secrete their own matrix.

Appositional growth

  • New matrix forms at the periphery of the cartilage.
  • Chondrogenic cells in perichondrium differentiate to become chondroblasts
  • Chondroblasts secrete new matrix, eventually become chondrocytes.
  • Older chondrocytes remain active and maintain matrix.

Clincal Correlation:

Hyaline cartilage that has been only nominally damaged can slowly repair itself via appositional growth, but severely damaged cartilage is often replaced by tougher, more fibrous connective tissue.

Lastly, let’s address specific hormones that impact the growth of hyaline cartilage.
Denote that the following hormonal substances stimulate cartilage histogenesis: thyroxine, testosterone, and somatotropin.
Denote that the following hormonal substances inhibit cartilage histogenesis: cortisone, hydrocortisone, and estradiol.
For reference, consider how the following nutritional states affect bone growth:
Hypovitaminosis A diminishes the thickness of epiphyseal plates; decrease in growth rate.
Hypervitaminosis A accelerates ossification of epiphyseal plates; short stature (dwarfism).
Hypovitaminosis C inhibits matrix production and distorts cartilage columns in epiphyseal plates (bones are weak, repair of fractures obstructed; scurvy develops)
Hypovitaminosis D inhibits calcification of matrix, causing softening of the bones (osteomalacia); in children, growing bones become bowed (rickets)

Bone Growth

BONE GROWTH

  • Bone growth at the epiphyseal growth plate is endochondral (aka interstitial) is linear.
  • Bone growth that is periosteal (aka appositional) is via thickening (widening).

ENDOCHONDRAL OSSIFICATION

Hyaline cartilaginous model (template).

  • The diaphysis is the shaft.
  • The epiphyses are the articulating ends of the long bone.
  • The metaphyses separate the diaphysis and epiphysis.
  • The medullary cavity forms as the primary ossification center, degenerates, cavitates and remodels via interstitial growth. Endochondrium delineates it – which forms a layer of lamellar bone and osteoprogenitor cells.
  • The marrow cavity is filled with hematopoetic marrow (which comprises red and white blood cell precursors)
  • Vasculature invades the cavity to fill it with marrow.

EPIPHYSEAL GROWTH PLATE

Reserve zone

  • Filled with typical fetal hyaline cartilage cells, responsible for growth in length – these cells “lead the growth pack,” in essence.

Proliferative zone

  • Filled with chrondrocytes that proliferate but do NOT hypertrophy, regulated by Indian hedgehog – this prevents the growth plates from inactivating until puberty when the child reaches full growth the growth plates degenerate to epiphyseal lines.

Hypertrophic zone

  • Filled with hypertrophic chondrocytes (we can identify their nuclei and lipid droplets) – they undergo apoptotic enlargement and are the future site of ossification (bony matrix extension).
  • They mineralize the surrounding cartilage, attract vasculature via VEGF (vascular endothelial growth factor), and that vasculature then recruits chondroclasts to degrade the carilage and form osteoblasts, which secrete the osteoid (bony matrix).

Vascular Invasion.

HISTOLOGICAL SLIDE

From epiphysis to diaphysis, we label the…

  • Reserve zone (filled with fetal hyaline cartilage cells)
  • Proliferative zone (filled with mitotically active chondrocytes)
  • Hypertrophic zone (which undergo apoptotic enlargement)
  • Zone of vascular invasion (which provides the osteoprogenitor cells for bone proliferation).

PERIOSTEAL (APPOSITIONAL) GROWTH

From central to external…

  • The hematopoetic marrow of the marrow cavity.
  • The endosteum, which delineates the marrow cavity, itself.
    -The endosteum comprises the inner circumferential lamellae, which distinguishes this inner bony layer from the compact bone external to it.
    -The osteoprogenitor cells that line the endosteum and form the lamellae that derive the spongy bone that form the trabecular meshwork of the primary ossification center.
  • External to the endosteum, lies layer of compact bone, which, namely, comprises osteons that encompasses circular layers of lamellae around a Haversian (aka central) canal.
  • We show, for reference, an osteocyte trapped between lamellae.
  • A collagenous layer of periosteum surrounds the compact bone.
  • Periosteum divides into an outer, collagenous layer, and inner, osteogenic layer.
  • Osteoblasts from the periosteum create new osteons along the longitudinal grooves and ridges within what is referred to as the outer circumferential lamellae: it forms concentric osteons (with Haversian canals), and it also forms interstitial lamellae, which fill the spaces between osteons.
  • The inner circumferential lamellae thickens, as well.

HISTOLOGICAL SLIDE: BONE MATRIX

From marrow to periosteum, label the…

  • Hematopoetic marrow
  • Inner circumferential lamellae
  • Osteon within the compact bone (indicate its Haversian canal).
  • Periosteum external to the compact bone.
  • An osteon in the process of being formed – In time, bone matrix will be released and the deep pink of the bony matrix would be observed as this region of growth takes on a biology of bone matrix.

BONE MATRIX

  • principal inorganic substance (mineral) is hydroxyapatite, which is hydroxylated calcium/phosphate. Other constituents include magnesium, potassium, sodium, bicarbonate, and citrate.
    The principal organic substances are collagen type 1 fibers and ground substance.