The Scalp, cranial cavity

and dural sinuses

Abayomi Ajayi, Ph.D

Professor of Anatomy & Structural Biology
abajayi2003@yahoo.com
08153784489
The Scalp
 DEFINITION STRUCTURE
The scalp consists of:
• Skin (normally hair-
bearing) and
• Subcutaneous tissue
• it covers the calvaria
It extends:
• Posteriorly, from the
superior nuchal lines
of the occipital bone
• Anteriorly, from the
supraorbital margin of
the frontal bone
• Laterally, over the
temporal fascia, to the
zygomatic arches The SCALP consists of five layers:
• Skin
• Connective tissue
• Aponeurosis
• Loose areolar tissue
• Pericranium
SKIN
• Thick
• Hairs
• Hair follicles
• Sebaceous
gland
• Sweat glands
 CONNECTIVE TISSUE
• fibro-fatty
• fibrous septa
connect the skin
to the underlying
aponeurosis of
the
occipitofrontalis
muscle.
• numerous
arteries and
veins (the
superficial
veins of the
scalp)
• the arteries are branches of the external and internal
carotid arteries, and a free anastomosis takes place
between them.
APONEUROSIS
• name: epicranial
aponeurosis,
galea
aponeurotica
• thin, tendinous
sheet
• unites the
occipital and
frontal bellies of
the occipito-
frontalis muscle
• The lateral
margins of the
epicranial
aponeurosis are
attached to the
temporal fascia
LOOSE AREOLAR TISSUE
• Occupies the
subapo-neurotic
space
• loosely connects
the epicranial
aponeurosis to
the periosteum
of the skull (the
pericranium)
• contains a few
small arteries
• contains some
important
emissary veins
 PERICRANIUM

• It is the
periosteum
covering the
outer surface
of the skull
bones

• at the sutures between individual skull bones, the periosteum on

the outer surface of the bones is continuous with the periosteum
on the inner surface of the skull bones
MUSCLES OF THE SCALP
Occipitofrontalis (epicranius)
• Origin: It consists of four bellies,
two occipital and two frontal,
connected by an aponeurosis.
• The occipital bellies are smaller and
arise from the highest nuchal line
on the occipital bone and pass
forward to be attached to the
aponeurosis.
• The frontal bellies are larger and
closer to each other in the middle
line
• The arise from the skin and
superficial fascia of the eyebrow
and pass backward to be attached
to the aponeurosis.
Nerve supply:
• The occipital belly is supplied by the
posterior auricular branch of the
facial nerve;
• the frontal belly is supplied by the
temporal branch of the facial nerve.
 Action
The first three layers of the scalp can be moved forward or
backward, the loose areolar tissue of the fourth layer of the scalp
allowing the aponeurosis to move on the pericranium.
(e.g. layers 1, 2, 3 will slide together as ONE LAYER)
SENSORY NERVE SUPPLY OF THE SCALP
The main trunks of the
sensory nerves lie in the
superficial fascia.
• supra-trochlear
nerve
• supra-orbital nerve
• auricu-lotemporal
nerve.
• zygoma-
ticotemporal nerve
• lesser occipital nerve
• greater occipital
nerve
ARTERIAL SUPPLY OF THE SCALP
• The scalp has a rich supply of blood
to nourish the hair follicles, and, for
this reason, the smallest cut bleeds
profusely.
• The arteries lie in the superficial
fascia.
• supratrochlear artery
• supraorbital artery
• superficial temporal artery
• posterior auricular artery
• occipital artery
 VENOUS DRAINAGE OF THE SCALP

The veins of the scalp freely anastomose

with one another.
The veins of the scalp are connected to
the diploic veins of the skull bones and
the intracranial venous sinuses by the
valveless emissary veins
The supra-trochlear and
supraorbital veins unite at
the medial margin of the
orbit to form the facial
vein.
The superficial temporal
vein unites with the
maxillary vein in the
substance of the parotid
gland to form the
retroman-dibular vein.
The posterior auricular
vein unites with the
posterior division of the
retromandibular vein, just
below the parotid gland, to
form the external jugular
vein.
 The occipital
vein drains into
the suboccipital
venous plexus,
which lies
beneath the
floor of the
upper part of
the posterior
triangle.
The suboccipital
venous plexus in
turn drains into
the vertebral
veins or the
internal jugular
vein.

prof. Makarem
 LYMPHATIC DRAINAGE OF THE SCALP
• Lymph vessels in the anterior
part of the scalp and forehead
drain into the submandibular
lymph nodes.
• Drainage from the lateral part
of the scalp above the ear is
into the superficial parotid
(preauricular) nodes;
• lymph vessels in the part of
the scalp above and behind
the ear drain into the mastoid
nodes.
• Vessels in the back of the scalp
drain into the occipital nodes.
• All these groups of lymph
nodes are drained into the
deep cervical group of lymph
nodes.
Applied Anatomy
 Sebaceous Cyst
 The skin, the subcutaneous tissue, and the epicranial
aponeurosis are closely united to one another and are
separated from the periosteum by loose areolar tissue

 The skin of the scalp possesses numerous sebaceous glands

 The ducts are prone to infection and damage by combs

 Therefore sebaceous cysts of the scalp are common

 Lacerations of the Scalp

 The scalp has a profuse blood supply to nourish the hair follicles

 Even a small laceration of the scalp can cause severe blood loss

 It is difficult to stop the bleeding because the arterial walls are attached to
fibrous septa in the subcutaneous tissue

 Are unable to contract or retract to allow blood clotting to take place

 Local pressure applied to the scalp is the only satisfactory method to stop
the bleeding
Life-Threatening Scalp Hemorrhage

 All the superficial arteries supplying the scalp ascend from the
face and the neck

 In an emergency situation, encircle the head just above the

ears and eyebrows with a tie, shoelaces, or even a piece of
string and tie it tight

 Insert a pen, pencil, or stick into the loop and rotate it so that
the tourniquet exerts pressure on the arteries
 Scalp Infection
 Infections of the scalp tend to remain localized

 Are usually painful because of the abundant fibrous tissue in the

subcutaneous layer

 Infection may spreads by the emissary veins, causing osteomyelitis

 Infected blood may travel by the emissary veins into the venous sinuses
and produce venous sinus thrombosis

 Blood or pus may collect in the potential space beneath the epicranial
aponeurosis
 Cranial Cavity

The cranial cavity contains the brain and its

surrounding meninges, portions of the cranial
nerves, arteries, veins, and venous sinuses
Bones that make up the cranial cavity

Cranial cavity is contained by the

frontal, parietal, sphenoid,
temporal and occipital bones, and
in part the ethmoid, all covered by
endosteal layer of dura mater
 A Quick Review
Skull:
Cranium
Mandible

Cranial cavity:
Roof of the skull: skull cap (calvaria)
Floor of the skull: base (basis cranii)
• Skull:
Neurocranium: frontal
parietal
temporal
occipital
sphenoidal

Viscerocranium: maxilla
mandible
ethmoidal
zygomatic
nasal
lacrimal
palatine
vomer
inf. nasal concha
 Temporal bone

squamous part

mastoid part
 Temporal bone

squamous part

petrosal part

mastoid part
 Sphenoidal bone

lesser wing

greater wing

body: sella turcica

pterygoid process
Ethmoidal bone

Cribriforme plate
Mandible
Mandible
Temproromandibular joint
Sutures: (syndesmosis)

 coronal: frontal and parietal

 sagittal:Lparietal

 Lambdoid:parietal and
occipital

 parieto-mastoid:parietal and
temporal

 occipitomastoid:occipital and
temporal
Fontanelles: (fonticulus)

 anterior

 posterior

 anterolateral (sphenoidal)

 posterolateral (mastoid)
• Bregma: middline meeting place of the bones

• Pterion: lateral meeting point (parietal, frontal,

squama of the temporal, greater wing of
sphenoidal)

• Asterion: mastoid region meets the occipital

and parietal bones
The cranial cavity is divided into three cranial fossa
1. Anterior cranial fossa which accommodates the anterior lobe
of brain.

2. Middle cranial fossa, much wider than the anterior cranial

fossa contain the 2 temporal lobes of brain.

3. Posterior cranial fossa is much shallower and wider than the

middle cranial fossa and it accommodates the occipital lobes of
the brain.
 Key factsTable quiz

Foramen caecum Emissary veins

Olfactory foramina Olfactory nerve

Optic canal Optic nerve (CNII), ophthalmic artery, dural sheath of optic nerve

Superior orbital fissure Oculomotor nerve (CNIII), trochlear nerve (CN IV), ophthalmic division of the trigeminal nerve (CNV1), abducent
nerve (CNVI), ophthalmic veins

Foramen rotundum Maxillary division of the trigeminal nerve (CN V2)

Foramen ovale Mandibular division of the trigeminal nerve (CN V3), accessory meningeal branch of maxillary artery, emissary vein
(, lesser petrosal nerve)

Foramen spinosum Middle meningeal artery

Foramen lacerum Greater petrosal nerve

Carotid canal Internal carotid artery

Internal acoustic foramen Facial nerve (CNVII), Vestibulocochlear nerve (CNVIII)

Jugular foramen Glossopharyngeal nerve (CNIX), vagus nerve (CNX), descending portion of the spinal accessory nerve (CNXI),
internal jugular vein

Hypoglossal canal Hypoglossal nerve (CNXII)

Foramen magnum Brainstem/spinal cord, vertebral arteries, ascending portion of the spinal accessory nerve (CNXI)

10/17/2024
 Skull: inferior view
palatine process of
the maxilla
palatine bone zygomatic arch

sphenoidal bone:
pterygoid process choana

mandibular fossa

external opening of the

foramen magnum carotid canal
jugular foramen
and fossa
occipital condyle
Anterior cranial fossa
Boundaries
Anteriorly and laterally
Frontal bone
Floor:
Orbital plate of frontal bone, ethmiod cribriform plate ,
anterior border of sphenoid’s lesser wings and crista galli
Posteriorly:
Posterior border of lesser wing of sphenoid, anterior clinoid
process and sulcus chiasmaticus.
NB
Crista galli
It is a sharp upward projection of ethmoid bone in the midline,
for the attachment of falx cerebri.
Foramen cecum
Small aperture between the crista galli and the crest of the
frontal bone
Middle cranial fossa
Boundaries
Anteriorly
Post border of the lesser wings of sphenoid, anterior clinoid
processes and sulcus chiasmaticus.
Posteriorly
Superior borders of petrous part of temporal and sphenoids
dorsum sella.
Laterally
Squamous part of temporal and some part if parietal and greater
wings of sphenoid.
Floor
Greater wing of sphenoid and petrous and squamous parts of the
temporal bone.
In the centre, floor is formed by the sella tursica of body of
sphenoid.
Posterior cranial fossa
Boundaries
Anteriorly
Superior border of the petrous part of temporal bone
and dorsum sallae.
Posteriorly
Internal surface of squamous part of the occipital bone.
Floor
Basilar, squamous & condylor parts of the occipital
bone & mastoid part
foramen magnum forms the central part of the floor.
Dura mater
Arachnoid
Pia mater
Dura Mater
The dura mater is conventionally described as two layers: the
endosteal layer and the meningeal layer. These are closely
united except along certain lines, where they separate to form
venous sinuses.
The endosteal layer is nothing more than the ordinary
periosteum covering the inner surface of the skull bones. It
does not extend through the foramen magnum to become
continuous with the dura mater of the spinal cord. Around the
margins of all the foramina in the skull it becomes continuous
with the periosteum on the outside of the skull bones. At the
sutures it is continuous with the sutural ligaments.

endosteal layer

meningeal layer
 Dural infolding
The meningeal layer sends inward four septa that divide the cranial cavity into freely
communicating spaces lodging the subdivisions of the brain. The function of these septa is
to restrict the rotatory displacement of the brain

Falx cerebri

Tentorium cerebelli

Falx cerebelli

Diaphragma sellae
 Falx Cerebri
The falx cerebri is a sickle-shaped
fold of dura mater that lies in the
midline between the two cerebral
hemispheres. Its narrow end in
front is attached to the internal
frontal crest and the crista galli. Its
broad posterior part blends in the
midline with the upper surface of
the tentorium cerebelli. The
superior sagittal sinus runs in its
upper fixed margin, the inferior
sagittal sinus runs in its lower
concave free margin, and the
straight sinus runs along its
attachment to the tentorium
cerebelli.
 Tentorium Cerebelli
The tentorium cerebelli is a
crescent-shaped fold of
dura mater that roofs over
the posterior cranial fossa.
It covers the upper surface
of the cerebellum and
supports the occipital lobes
of the cerebral
hemispheres. In front is a
gap, the tentorial notch
 Falx Cerebelli
The falx cerebelli is a
small, sickle-shaped
fold of dura mater that
is attached to the
internal occipital crest
and projects forward
between the two
cerebellar
hemispheres. Its
posterior fixed margin
contains the occipital
sinus.
 Diaphragma sellae
The diaphragma
sellae is a small
circular fold of
dura mater that
forms the roof for
the sella turcica. A
small opening in
its center allows
passage of the
stalk of the
pituitary gland.
 Dural Nerve Supply

Branches of the trigeminal, vagus, and first three cervical nerves and branches
from the sympathetic system pass to the dura.
 Dural Blood Supply

Internal carotid, maxillary, ascending pharyngeal, occipital, and vertebral arteries.

From a clinical standpoint, the most important is the middle meningeal artery, which is
commonly damaged in head injuries.
 Arachnoid Mater
The arachnoid mater is a delicate,
Subdural Space impermeable membrane covering the brain
and lying between the pia mater internally
and the dura mater externally. It is separated
Subarachnoid Space CSF from the dura by a potential space, the
subdural space, and from the pia by the
subarachnoid space, which is filled with
cerebrospinal fluid.
Arachnoid Villi

Arachnoid Granulation
 Pia Mater

The pia mater is a vascular membrane that closely invests the brain, covering the
gyri and descending into the deepest sulci. It extends over the cranial nerves and
fuses with their epineurium. The cerebral arteries entering the substance of the
brain carry a sheath of pia with them.
 Meningeal Spaces
Dura-skull extradural/epidural
Meningeal Spaces
Dura-arachnoid subdural
Meningeal Spaces
Arachnoid-pia subarachnoid
Dura Sinuses
 Venous Blood Sinuses
They are blood-filled spaces situated
between the layers of the dura mater.
They are lined by endothelium.
Their walls are thick and composed
of fibrous tissue. They have no
muscular tissue. They have no valves.
They receive tributaries from the
brain; the diploic veins of the skull;
the orbit and the internal ear.
Inferior Sagittal Sinus
It occupies the free lower margin of
the falx cerebri.
It runs backward and joins the great
cerebral vein which is formed by the
union of the 2 internal cerebral veins
at the free margin of the tentorium
cerebelli to form the straight sinus.
It receives cerebral veins from the
medial surface of the cerebral hemisphere.
N.B:
Veins have no valves ; no muscular tissue
in their wall and drain into venous sinuses
 Superior Sagittal Sinus
It occupies the upper fixed border of the
falx cerebri. It begins in the front at the
foramen cecum where it receives a vein
from the nasal cavity.
It runs backward, grooving the vault of
the skull and at the internal occipital
protuberance it deviates to one side
( usually the right ) and becomes
continuous with the transverse sinus.
It communicates through small openings
with 2 or 3 venous lacunae on each side.
Numerous arachnoid villi and
granulations project into these lacunae
which also receive the diploic; emissary
and meningeal veins.
It receives the superior cerebral veins .
At the internal occipital protuberance it is
dilated to form the confluence of the
sinuses which is connected to the
opposite transverse sinus and receives
the occipital sinus.
 Straight Sinus
It occupies the line of
junction of the falx cerebri
with the tentorium cerebelli.
It is formed by the union of
the inferior sagittal sinus
with the great cerebral vein.
It ends by turning to the left
( sometimes to the right ) to
form the transverse sinus.
 Occipital Sinus
It is a small sinus occupying the attached margin of the falx cerebelli.
It communicates with the vertebral veins near the foramen magnum.
Superiorly it drains into the confluence of sinuses.
 Transverse Sinus
They are paired and begin at the internal occipital protuberance.
The right sinus usually continuous with the superior sagittal sinus.
The left is continuous with the straight sinus.
Each sinus occupies the attached margin of the tentorium cerebelli , grooving the occipital
bone and posteroinferior angle of the parietal bone.
They receive the superior petrosal sinuses; inferior cerebral and cerebellar veins and diploic
veins.
They end by turning downward as the sigmoid sinuses.
 Superior and Inferior Petrosal Sinuses
They are small and situated on the superior and inferior borders of the petrous
part of the temporal bone on each side.
Each superior sinus drains the cavernous sinus into the transverse sinus.
Each inferior sinus drains the cavernous sinus into the internal jugular vein.
 Sigmoid Sinuses
They are a direct continuation of the transverse sinuses. Each sinus turns
downward and medially and grooves the mastoid part of the temporal bone.
Here it lies behind the mastoid antrum.
It then turns downward through the posterior part of the jugular foramen to
become continuous with the superior bulb of the internal jugular vein.
 Cavernous Sinuses
They are situated in the middle cranial fossa on each side of the body of the
sphenoid bone.
Each sinus extends from the superior orbital fissure in front to the apex of the
petrous part of the temporal bone behind.
The 3rd ; 4th cranial nerves and the ophthalmic & maxillary divisions of the
trigeminal nerve run forward in the lateral wall of this sinus. They lie between the
endothelial and the dura mater .
The internal carotid artery, its sympathetic nerve plexus and abducent nerve run
forward through it. They are separated from the blood by an endothelial covering.
 5
1

The tributaries are 1- Superior ophthalmic vein which communicates it with the facial V
2- Inferior ophthalmic vein. 3- Cerebral veins
4- Central vein of the retina 5- Sphenopareital sinus.
The sinus drains posteriorly into the superior and inferior petrosal sinuses and
inferiorly into the pterygoid venous plexus.
The 2 sinuses communicate with one another by means of the anterior and
posterior intercavernous sinuses which run in the diaphragma sellae in front and
behind the stalk of the hypophysis cerebri.
 Extradural Hemorrhage
It results from injuries of the meningeal
arteries or veins. The most common is
the anterior branch of the middle
meningeal artery.

A minor blow to the side of the head

result in fracture of the anteroinferior
portion of the parietal bone ( pterion ).

The intracranial pressure rises. The

blood clot exerts local pressure on the
underlying motor area in the precentral
gyrus.

Blood may pass out through the

fracture line to form a soft swelling
under the temporalis muscle.

The burr hole through the skull wall

should be placed 2.5 to 4 cm above the
midpoint of the zygomatic arch to ligate
or plug the torn artery or vein.
 Subdural Hemorrhage
It is more common than the middle meningeal artery hemorrhage. It results from tearing of
the superior cerebral veins at their entrance into the superior sagittal sinus.
The cause is a blow on the front or back of the head causing anteroposterior displacement
of the brain within the skull. Blood under low pressure begins to accumulate in the space
between the dura and arachnoid. The case is bilateral in 50 %.
Acute symptoms in the form of vomiting due to rise in the venous pressure may be present.
In the chronic form, over a several months, the small blood clot will attract fluid by osmosis
so a hemorrhagic cyst is formed and gradually expands produces pressure symptoms.
 Intracranial Hemorrhage in the Infant

It occurs during birth and from excessive molding of the head. Bleeding occurs
from cerebral veins or venous sinuses

Excessive anteroposterior compression often tears the anterior attachment of the

falx cerebri from the tentorium cerebelli.

bleeding then takes place from the great cerebral veins; straight sinus or inferior
sagittal sinus.
 Subarachnoid Hemorrahage

It results from leakage or rupture of a

congenital aneurysm on the circle of Willis or
less commonly from an angioma.

The sudden symptoms include severe

headache; stiffness of the neck and loss of
consciousness.

The diagnosis is established by withdrawing

heavily blood- stained CSF fluid through a
lumbar puncture ( spinal tap ).

Cerebral Hemorrhage

It is caused rupture of the thin-walled

lenticulostriate artery, a branch of the middle
cerebral artery. The hemorrhage involves the
vital corticobulbar & corticospinal fibers in
the internal capsule and produces hemiplegia
on the opposite side of the body.
The patient immediately loses consciouness
and paralysis is evident when consciousness
regained.
 Face Infections

 The area of facial skin bounded by the nose, the eye, and the
upper lip is a potentially dangerous zone to have an infection

 A boil in this region can cause thrombosis of the facial vein

 Causing spread of organisms through the inferior ophthalmic

veins to the cavernous sinus

 Resulting cavernous sinus thrombosis may be fatal unless

adequately treated with antibiotics
Nasal Cavity and air
sinuses in the head
 Nose
 The external root

(anterior ) nares
or nostrils, lead
tip
to the nasal ala

cavity. septum
external nares
1
Formed above by:
Bony skeleton 2
 Formed
3
below by
plates of
hyaline
cartilage
.
 Nasal Cavity
• Extends from the
external (anterior) nares
to the posterior nares
(choanae).
• Divided into right & left
halves by the nasal
septum.
• Each half has a:
 Roof
 Lateral wall
 Medial wall (septum)
 Floor
 Roof
Narrow & formed (from
3
4
2 behind forward) by the:
1. Body of sphenoid.
1
2. Cribriform plate of
ethmoid bone.
3. Frontal bone.
4. Nasal bone &
cartilage

Floor
• Separates it from the oral cavity.
• Formed by the hard (bony) palate.
• Medial Wall
(Nasal Septum)
• Osteocartilaginous
partition.
• Formed by:
1. Perpendicular
plate of 1
ethmoid bone.
3
2. Vomer. 2
3. Septal
cartilage.
• Lateral Wall
• Shows three horizontal
bony projections, the
superior, middle & inferior
conchae
• The cavity below each
concha is called a meatus
and are named as
superior, middle &
inferior corresponding to
the conchae.
The small space above the superior concha is the
sphenoethmoidal recess.
The conchae increase the surface area of the nasal
cavity.
The recess & meati receive the openings of the:
 Paranasal sinuses.

 Nasal mucosa
– Olfactory :
– It is delicate and
contains olfactory
nerve cells.
• It is present in the
upper part of nasal
cavity:
• Roof,
• On the lateral wall,
 it lines the upper
surface of the
superior concha and
the sphenoethmoidal
recess.
 On the medial wall, 79
 RESPIRATORY MUCOSA

• It is thick, ciliated highly vascular and contains mucous glands &

goblet cells
• It lines the Lower part of the nasal cavity.
 It functions to moisten, clean and warm the inspired air.
 The air is moistened by the secretion of numerous serous glands.
 It is cleaned by the removal of the dust particles by the ciliary action of the
columnar ciliated epithelium that covers the mucosa.
 The air is warmed by a submucous venous plexus. 80
 The Vestibule is lined by Skin.
Olfactory
Nerve Supply
mucosa
supplied by
olfactory
nerves.
Nerves of
general
sensation are
derived from
• ophthalmic
• maxillary
nerves.
• Autonomic
fibers.
Arterial Supply:
 Branches of the Blood supply
• maxillary,
• facial &
• ophthalmic arteries.
 The arteries make a
rich anastomosis in
the region of the
vestibule, and
anterior portion of the
septum.
Venous Drainage:
 drain into the
• facial,
• ophthalmic, and
• spheno-palatine
veins.
Lymphatic Drainage

The lymphatics
from the:
 Vestibule
drains into the
submandibular
lymph nodes.
 Rest of the
cavity drains
into the upper
deep cervical
lymph nodes.
Air sinuses in the Head
 Air sinuses
 Air-containing cavities in the bones
around nasal cavity.

 Paranasal air sinuses develop as

mucosal diverticulae of nasal cavity,
invading the adjacent bones.

 Paranasal air sinuses perform the

following functions:

• Make the skull lighter.

• Add resonance to the voice.
• Act as air conditioning chambers by
making the inspired air moist and warm.
 Paranasal air sinuses are lined by respiratory epithelium and
• Aid in growth of facial skeleton. respiratory mucosa is highly vascular and contains a large
number of cavernous spaces and sinusoids to warm the air.

 Respiratory mucosa also contains a large number of serous

glands and secretion of these glands makes the air moist.
 Classification
 Paranasal air sinuses are named
after the bones containing them,
viz,

• Frontal air sinuses.

• Ethmoidal air sinuses.
• Maxillary air sinuses.
• Sphenoidal air sinuses.

 All paranasal air sinuses are

present in rudimentary form at birth
except frontal air sinuses.
 Relationship to the Orbit

• Frontal air sinus- above.

• Ethmoidal air sinuses-

medial.

• Maxillary air sinus- below.

• Sphenoidal air sinus-

behind.
 Frontal Air Sinuses
 Frontal air sinuses are not present at birth.
 Start developing 2 or 3 years after birth.
Number- 2.
Shape- Triangular.
 Lie between inner and outer tables of frontal bone.

 Right frontal air sinus is separated from the left by a septum.

 Drainage & Nerve Supply
• Drainage- Drains into anterior part of hiatus semilunaris of middle meatus
through frontonasal duct.

• Nerve Supply- Supraorbital nerve.

Hiatus
Semilunaris
 Measurements
• Height- ~ 3 cm

• Width- 2.5 cm

• Anteroposterior- 1.8 cm
 Relations of Frontal Air Sinus
Anterior-
• Superciliary arch of
Frontal lobe
forehead.
Frontal air sinus
Posterior-
• Meninges and frontal lobe
of brain.

Inferior-
• Roof of nose.
• Roof of orbit (medial part).
 Applied Anatomy
Frontal Headache (Office Headache)
• Headache from frontal sinusitis shows characteristic periodicity.

• It starts on waking, gradually increases and reaches its peak by about midday
and then starts subsiding.
 Applied Anatomy contd…

Frontal Lobe Abscess-

• Infection of frontal air
sinus may spread
posteriorly into frontal lobe
of brain causing
Frontalfrontal
air sinus

lobe abscess.
 Applied Anatomy contd…
Orbital Cellulitis-
• Infection of frontal air sinus may spread inferiorly into orbit causing orbital
cellulitis.
 Maxillary Sinus (Antrum of Highmore)
• Largest paranasal air sinus.
• Present in body of maxilla.
• First to develop.
• Appears around 4th month of intrauterine life.
 Maxillary Sinus contd…
SHAPE- Pyramidal.
Base-
• Directed medially.
• Formed by a part of lateral wall of nose.
• Opening or ostium of the sinus is present in the
upper part of base, close to the roof.
Zygomatic bone
Apex-
• Directed laterally.
• Extends into zygomatic process of maxilla.

Roof-
• Formed by the floor of orbital cavity.
• Infraorbital nerve and artery traverse the roof in a
bony canal.

Floor-
• Formed by the alveolar process of maxilla. Ostium of Maxillary air sinus
 Floor of Maxillary Sinus contd…
• The level of floor corresponds to the
ala of nose.

• Normally the roots of first and second

molar teeth project into the floor.

• Sometimes roots of third molar, first

and second premolars may project
into the floor.

• Rarely, root of canine may project

into the floor.

• Sometimes roots of teeth are

separated from the sinus only by a
thin layer of mucosa.
 Base of Maxillary Sinus
• It is formed by medial surface of body of maxilla and
some other bones.
• In maxilla, medial surface of its body presents a large
maxillary hiatus.
• In the skull, base of maxillary sinus presents a small
opening ( ostium).

Maxillary Hiatus
 Reduction of large maxillary hiatus to small
ostium
• It occurs by the following bones:

• Uncinate process of ethmoid.

• Descending process of lacrimal.

• Ethmoidal process of inferior

nasal concha.

• Perpendicular plate of palatine.

 Maxillary Sinus contd…
Anterior wall-
• Has a curved bony canal for
anterior superior alveolar
nerve – Canalis Sinuosus.

Posterior wall-
• Separates the sinus from
infratemporal and
pterygopalatine fossae.

• It is pierced by the posterior

superior alveolar nerves and
vessels.
 Drainage
• In posterior part of hiatus semilunaris of middle meatus.

Hiatus Semilunaris

Opening of
Maxillary Sinus
 Arterial Supply

• Anterior superior alveolar

artery.

• Middle superior alveolar

artery.

• Posterior superior alveolar

artery.
 Lymphatic Drainage
• Submandibular lymph
nodes.
 Nerve Supply
• Anterior superior alveolar
nerve.

• Middle superior alveolar

nerve.

• Posterior superior alveolar

nerve.
 Applied Anatomy
Maxillary Sinusitis-
• Maxillary sinus is the most commonly infected paranasal air sinus.
• The opening of maxillary sinus is in a disadvantageous position for natural drainage.

Sources of infection:
• Infected nose.
• Carious upper premolar and molar teeth.
• Infected frontal and anterior ethmoidal air sinuses.
 Surgical Drainage of Maxillary Sinus
Antral puncture (Antrostomy)-
• Trocar and canula are passed below the inferior nasal concha in an outward and backward
direction.
Caldwell-Luc operation-
• Maxillary sinus is opened through gingiva-labial sulcus.
 Applied Anatomy contd…
Carcinoma of Maxillary Sinus-
• Arises from mucosa of the sinus.
Clinical Features-
Due to upward invasion:
• Proptosis (protrusion of eyeball).
• Diplopia (double vision).
• Pain and anaesthesia over the face below the orbit.
Due to downward invasion:
• Swelling or even ulceration of palatal roof of oral cavity.
Due to medial invasion:
• Nasal obstruction.
• Epistaxis.
• Epiphora (overflow of tears).
Due to lateral invasion:
• Swelling on the face and palpable mass in gingiva-labial sulcus.
Due to posterior invasion:
• Referred pain to upper teeth.
 Ethmoidal Sinuses
 Present within labyrinth of ethmoid bone.

 Between upper part of lateral nasal wall and orbit.

 3 groups:
• Anterior (up to 11 air cells).
• Middle (1-3 air cells).
• Posterior (1-7 air cells).
 Drainage
• Anterior group drains into middle part of hiatus seminularis of middle meatus.
• Middle group drains on the surface of bulla ethmoidalis of middle meatus.
• Posterior group drains into posterior part of superior meatus.
 Applied Anatomy

Ethmoidal Sinusitis-
• Often asoociated with
infection of other sinuses.

Clinical Features-
Localized pain over bridge
of nose.

Due to invasion into the

orbit-
 Sphenoidal Sinuses
Number-
• 2 (right and left)

 Lie within the body of sphenoid bone.

 Separated from each other by a bony septum.

Bony Septum
 Drainage
• Into sphenoethmoidal recess.
Relations
 Applied Anatomy
Sphenoidal Sinusitis-

• One of The Most Dangerous Sinus

Infection.

• It is rare in isolation.

• It is usually a part of pansinusitis.

• It may be associated with infection

of posterior ethmoidal sinuses.
Oral Cavity, the palate,
Tongue and floor of the
mouth
 Oral Cavity (Mouth)
 Extends from the lips to the
oropharyngeal isthmus
– The oropharyngeal isthmus:
• Is the junction of mouth
and pharynx.
• Is bounded:
– Above by the soft palate
and the palatoglossal
folds
– Below by the dorsum of
the tongue
 Subdivided into Vestibule & Oral
cavity proper
 Vestibule
 Slitlike space between the
cheeks and the gums
 Communicates with the
exterior through the oral fissure
 When the jaws are closed,
communicates with the oral
cavity proper behind the 3rd
molar tooth on each side
 Superiorly and inferiorly limited
by the reflection of mucous
membrane from lips and cheek
onto the gums
 Vestibule cont’d
 The lateral wall of the
vestibule is formed by the
cheek
– The cheek is composed
of Buccinator muscle,
covered laterally by the
skin & medially by the
mucous membrane
 A small papilla on the
mucosa opposite the upper
2nd molar tooth marks the
opening of the duct of the
parotid gland
 Oral Cavity Proper
 It is the cavity within the
alveolar margins of the
maxillae and the mandible
 Its Roof is formed by the hard
palate anteriorly and the soft
palate posteriorly
 Its Floor is formed by the hard
mylohyoid muscle. The
anterior 2/3rd of the tongue soft
lies on the floor. palate

mylohyoi
d
 Floor of the Mouth
 Covered with mucous
membrane
 In the midline, a mucosal fold,
the frenulum, connects the
tongue to the floor of the
mouth
 On each side of frenulum a
small papilla has the opening
of the duct of the
submandibular gland
 A rounded ridge extending
backward & laterally from the
papilla is produced by the
sublingual gland
Nerve Supply
o Sensory
 Roof: by greater palatine and nasopalatine
nerves (branches of maxillary nerve)
 Floor: by lingual nerve (branch of mandibular
nerve)
 Cheek: by buccal nerve (branch of mandibular
nerve)

oMotor
 Muscle in the cheek (buccinator) and the lip
(orbicularis oris) are supplied by the branches of
the facial nerve
 Tongue
 Mass of striated muscles
covered with the mucous
membrane
 Divided into right and left halves
by a median septum
 Three parts:
– Oral (anterior ⅔)
– Pharyngeal (posterior ⅓)
– Root (base)
 Two surfaces:
– Dorsal
– Ventral
 Dorsal Surface
 Divided into anterior two third
and posterior one third by a V-
shaped sulcus terminalis.
 The apex of the sulcus faces
backward and is marked by a
pit called the foramen cecum
 Foramen cecum, an
embryological remnant, marks
the site of the upper end of the
thyroglossal duct
 Dorsal Surface
 Anterior two third: mucosa is
rough, shows three types of
papillae:
 Filliform
 Fungiform
 Vallate
 Posterior one third: No
papillae but shows nodular
surface because of
underlying lymphatic
nodules, the lingual tonsils
 Ventral Surface
 Smooth (no papillae)
 In the midline anteriorly, a
mucosal fold, frenulum
connects the tongue with
the floor of the mouth
 Lateral to frenulum, deep
lingual vein can be seen
through the mucosa
 Lateral to lingual vein, a fold
of mucosa forms the plica
fimbriata
 Muscles

 The tongue is
composed of two
types of muscles:
– Intrinsic
– Extrinsic
 Intrinsic Muscles
 Confined to tongue
 No bony attachment
 Consist of:
– Longitudinal fibers
– Transverse fibers
– Vertical fibers
• Function: Alter the
shape of the tongue
 Extrinsic Muscles
 Connect the tongue to the
surrounding structures: the
soft palate and the bones
(mandible, hyoid bone,
styloid process)
 Include:
– Palatoglossus
– Genioglossus
– Hyoglossus
– Styloglossus
 Function: Help in
movements of the tongue
 Movements
• Protrusion:
 Genioglossus on both sides acting together
• Retraction:
 Styloglossus and hyoglossus on both sides acting together
• Depression:
 Hyoglossus and genioglossus on both sides acting together
• Elevation:
 Styloglossus and palatoglossus on both sides acting together
 Sensory Nerve Supply
 Anterior ⅔:
– General sensations: Lingual
nerve
– Special sensations : chorda
tympani
 Posterior ⅓:
– General & special sensations:
glossopharyngeal nerve
 Base:
– General & special sensations:
internal laryngeal nerve
 Motor Nerve Supply
 Intrinsic muscles:
 Hypoglossal nerve

 Extrinsic muscles:
 All supplied by the
hypoglossal nerve,
except the
palatoglossus

 The palatoglossus is
supplied by the
pharyngeal plexus
 Blood Supply
• Arteries:
 Lingual artery Lingual
artery & vein
Dorsal lingual
artery & vein

 Tonsillar branch of
facial artery
 Ascending pharyngeal
artery
• Veins:
 Lingual vein,
Deep lingual
ultimately drains into Hypoglossal
nerve
vein

the internal jugular

vein
 Lymphatic Drainage
• Tip:
– Submental nodes
bilaterally & then deep
cervical nodes

• Anterior two third:

– Submandibular
unilaterally & then deep
cervical nodes

• Posterior third:
– Deep cervical nodes
(jugulodigastric mainly)
 Functions
• The tonge is the most important
articulator for speech production.
During speech, the tongue can make
amazing range of movements
• The primary function of the
tongue is to provide
a mechanism for taste. Taste buds are
located on different areas of the
tongue, but are generally found
around the edges. They are sensitive
to four main
tastes: Bitter, Sour,
Salty & Sweet
The tongue is needed for sucking,
chewing, swallowing, eating,
drinking, kissing, sweeping the
mouth for food debris and other
particles and for making funny faces
(poking the tongue out, waggling it)
Trumpeters and horn & flute players
have very well developed tongue
muscles, and are able to perform
rapid, controlled movements or
articulations
 Clinical Notes
 Lacerations of the tongue
 Tongue-Tie
(ankyloglossia) (due to
large frenulum)
 Lesion of the hypoglossal
nerve
– The protruded tongue
deviates toward the side
of the lesion
– Tongue is atrophied &
wrinkled
 Palate
 Lies in the roof of the
oral cavity
 Has two parts: hard

– Hard (bony) palate

anteriorly soft
palate
– Soft (muscular)
palate posteriorly
 Hard Palate
 Lies in the roof of the oral
cavity
 Forms the floor of the
nasal cavity
 Formed by:
– Palatine processes of
maxillae in front
– Horizontal plates of
palatine bones behind
• Bounded by alveolar
arches
 Hard Palate
 Posteriorly, continuous
with soft palate
 Its undersurface
covered by
mucoperiosteum
 Shows transverse ridges
in the anterior parts
 Soft Palate
 Attached to the posterior
border of the hard palate
 Covered on its upper and lower
surfaces by mucous membrane
 Composed of:
– Muscle fibers
– An aponeurosis
– Lymphoid tissue
– Glands
– Blood vessels
– Nerves
 Palatine Aponeurosis
 Fibrous sheath
 Attached to posterior
border of hard palate
 Is expanded tendon of
tensor velli palatini
 Splits to enclose
musculus uvulae
 Gives origin & insertion
to palatine muscles
 Muscles
 Tensor veli palatini
– Origin: spine of sphenoid; auditory tube
– Insertion: forms palatine aponeurosis
– Action: Tenses soft palate
• Levator veli palatini
– Origin:petrous temporal bone, auditory
tube, palatine aponeurosis
– Insertion: palatine aponeurosis
– Action: Raises soft palate
• Musculus uvulae
– Origin: posterior border of hard palate
– Insertion: mucosa of uvula
– Action: Elevates uvula
 Muscles
• Palatoglossus
– Origin: palatine aponeurosis
– Insertion: side of tongue
– Action: pulls root of tongue
upward, narrowing oropharyngeal
isthmus

• Palatopharyngeus
– Origin: palatine aponeurosis
– Insertion: posterior border of
thyroid cartilage
– Action: Elevates wall of the
pharynx
 Sensory Nerve Supply
• Mostly by the maxillary
nerve through its
branches:
– Greater palatine nerve
– Lesser palatine nerve
– Nasopalatine nerve
• Glossopharyngeal nerve
supplies the region of the
soft palate
 Motor Nerve Supply

• All the muscles, except tensor veli palatini, are

supplied by the:
– Pharyngeal plexus

• Tensor veli palatini supplied by the:

– Nerve to medial pterygoid, a branch of the
mandibular division of the trigeminal nerve
 Blood Supply
• Branches of the maxillary
artery
– Greater palatine
– Lesser palatine
– Sphenopalatine

• Ascending palatine, branch of

the facial artery

• Ascending pharyngeal, branch

of the external carotid artery
 Applied Anatomy
• Cleft palate:
– Unilateral
– Bilateral
– Median
• Paralysis of the soft
palate Pharyngeal
isthmus

– The pharyngeal
isthmus can not be
closed during
swallowing and speech
Thank you