The axial skeleton begins to form during early embryonic development. However, growth, remodeling, and ossification (bone formation) continue for several decades after birth before the adult skeleton is fully formed. Knowledge of the developmental processes that give rise to the skeleton is important for understanding the abnormalities that may arise in skeletal structures.
Development of the Skull:
During the third week of embryonic development, a rod-like structure called the notochord develops dorsally along the length of the embryo. The tissue overlying the notochord enlarges and forms the neural tube, which will give rise to the brain and spinal cord. By the fourth week, mesoderm tissue located on either side of the notochord thickens and separates into a repeating series of block-like tissue structures, each of which is called a somite. As the somites enlarge, each one will split into several parts. The most medial of these parts is called a sclerotome. The sclerotomes consist of an embryonic tissue called mesenchyme, which will give rise to the fibrous connective tissues, cartilages, and bones of the body.
The bones of the skull arise from mesenchyme during embryonic development in two different ways. The first mechanism produces the bones that form the top and sides of the brain case. This involves the local accumulation of mesenchymal cells at the site of the future bone. These cells then differentiate directly into bone producing cells, which form the skull bones through the process of intramembranous ossification. As the brain case bones grow in the fetal skull, they remain separated from each other by large areas of dense connective tissue, each of which is called a fontanelle (Figure 7.33). The fontanelles are the soft spots on an infant’s head. They are important during birth because these areas allow the skull to change shape as it squeezes through the birth canal. After birth, the fontanelles allow for continued growth and expansion of the skull as the brain enlarges. The largest fontanelle is located on the anterior head, at the junction of the frontal and parietal bones. The fontanelles decrease in size and disappear by age 2. However, the skull bones remained separated from each other at the sutures, which contain dense fibrous connective tissue that unites the adjacent bones. The connective tissue of the sutures allows for continued growth of the skull bones as the brain enlarges during childhood growth.
The second mechanism for bone development in the skull produces the facial bones and floor of the brain case. This also begins with the localized accumulation of mesenchymal cells. However, these cells differentiate into cartilage cells, which produce a hyaline cartilage model of the future bone. As this cartilage model grows, it is gradually converted into bone through the process of endochondral ossification. This is a slow process and the cartilage is not completely converted to bone until the skull achieves its full adult size.
At birth, the brain case and orbits of the skull are disproportionally large compared to the bones of the jaws and lower face. This reflects the relative underdevelopment of the maxilla and mandible, which lack teeth, and the small sizes of the paranasal sinuses and nasal cavity. During early childhood, the mastoid process enlarges, the two halves of the mandible and frontal bone fuse together to form single bones, and the paranasal sinuses enlarge. The jaws also expand as the teeth begin to appear. These changes all contribute to the rapid growth and enlargement of the face during childhood.
Figure 7.33 Newborn Skull The bones of the newborn skull are not fully ossified and are separated by large areas called fontanelles, which are filled with fibrous connective tissue. The fontanelles allow for continued growth of the skull after birth. At the time of birth, the facial bones are small and underdeveloped, and the mastoid process has not yet formed.
Development of the Vertebral Column and Thoracic cage:
Development of the vertebrae begins with the accumulation of mesenchyme cells from each sclerotome around the notochord. These cells differentiate into a hyaline cartilage model for each vertebra, which then grow and eventually ossify into bone through the process of endochondral ossification. As the developing vertebrae grow, the notochord largely disappears. However, small areas of notochord tissue persist between the adjacent vertebrae and this contributes to the formation of each intervertebral disc.
The ribs and sternum also develop from mesenchyme. The ribs initially develop as part of the cartilage model for each vertebra, but in the thorax region, the rib portion separates from the vertebra by the eighth week. The cartilage model of the rib then ossifies, except for the anterior portion, which remains as the costal cartilage. The sternum initially forms as paired hyaline cartilage models on either side of the anterior midline, beginning during the fifth week of development. The cartilage models of the ribs become attached to the lateral sides of the developing sternum. Eventually, the two halves of the cartilaginous sternum fuse together along the midline and then ossify into bone. The manubrium and body of the sternum are converted into bone first, with the xiphoid process remaining as cartilage until late in life.
The thoracic cage (rib cage) forms the thorax (chest) portion of the body. It consists of the 12 pairs of ribs with their costal cartilages and the sternum (Figure 7.32). The ribs are anchored posteriorly to the 12 thoracic vertebrae (T1–T12). The thoracic cage protects the heart and lungs.
Figure 7.32 Thoracic Cage The thoracic cage is formed by the (a) sternum and (b) 12 pairs of ribs with their costal cartilages. The ribs are anchored posteriorly to the 12 thoracic vertebrae. The sternum consists of the manubrium, body, and xiphoid process. The ribs are classified as true ribs (1–7) and false ribs (8–12). The last two pairs of false ribs are also known as floating ribs (11–12).
Sternum:
The sternum is the elongated bony structure that anchors the anterior thoracic cage. It consists of three parts: the manubrium, body, and xiphoid process. The manubrium is the wider, superior portion of the sternum. The top of the manubrium has a shallow, U-shaped border called the jugular (suprasternal) notch. This can be easily felt at the anterior base of the neck, between the medial ends of the clavicles. The clavicular notch is the shallow depression located on either side at the superior-lateral margins of the manubrium. This is the site of the sternoclavicular joint, between the sternum and clavicle. The first ribs also attach to the manubrium.
The elongated, central portion of the sternum is the body. The manubrium and body join together at the sternal angle, so called because the junction between these two components is not flat, but forms a slight bend. The second rib attaches to the sternum at the sternal angle. Since the first rib is hidden behind the clavicle, the second rib is the highest rib that can be identified by palpation. Thus, the sternal angle and second rib are important landmarks for the identification and counting of the lower ribs. Ribs 3–7 attach to the sternal body.
The inferior tip of the sternum is the xiphoid process. This small structure is cartilaginous early in life, but gradually becomes ossified starting during middle age.
Ribs:
Each rib is a curved, flattened bone that contributes to the wall of the thorax. The ribs articulate posteriorly with the T1–T12 thoracic vertebrae, and most attach anteriorly via their costal cartilages to the sternum. There are 12 pairs of ribs. The ribs are numbered 1–12 in accordance with the thoracic vertebrae.
Parts of a Typical Rib:
The posterior end of a typical rib is called the head of the rib (see Figure 7.27). This region articulates primarily with the costal facet located on the body of the same numbered thoracic vertebra and to a lesser degree, with the costal facet located on the body of the next higher vertebra. Lateral to the head is the narrowed neck of the rib. A small bump on the posterior rib surface is the tubercle of the rib, which articulates with the facet located on the transverse process of the same numbered vertebra. The remainder of the rib is the body of the rib (shaft). Just lateral to the tubercle is the angle of the rib, the point at which the rib has its greatest degree of curvature. The angles of the ribs form the most posterior extent of the thoracic cage. In the anatomical position, the angles align with the medial border of the scapula. A shallow costal groove for the passage of blood vessels and a nerve is found along the inferior margin of each rib.
Rib Classifications:
The bony ribs do not extend anteriorly completely around to the sternum. Instead, each rib ends in a costal cartilage. These cartilages are made of hyaline cartilage and can extend for several inches. Most ribs are then attached, either directly or indirectly, to the sternum via their costal cartilage (see Figure 7.32). The ribs are classified into three groups based on their relationship to the sternum.
Ribs 1–7 are classified as true ribs (vertebrosternal ribs). The costal cartilage from each of these ribs attaches directly to the sternum. Ribs 8–12 are called false ribs (vertebrochondral ribs). The costal cartilages from these ribs do not attach directly to the sternum. For ribs 8–10, the costal cartilages are attached to the cartilage of the next higher rib. Thus, the cartilage of rib 10 attaches to the cartilage of rib 9, rib 9 then attaches to rib 8, and rib 8 is attached to rib 7. The last two false ribs (11–12) are also called floating ribs (vertebral ribs). These are short ribs that do not attach to the sternum at all. Instead, their small costal cartilages terminate within the musculature of the lateral abdominal wall.
The vertebral column is also known as the spinal column or spine (Figure 7.20). It consists of a sequence of vertebrae (singular = vertebra), each of which is separated and united by an intervertebral disc. Together, the vertebrae and intervertebral discs form the vertebral column. It is a flexible column that supports the head, neck, and body and allows for their movements. It also protects the spinal cord, which passes down the back through openings in the vertebrae.
Figure 7.20 Vertebral Column The adult vertebral column consists of 24 vertebrae, plus the sacrum and coccyx. The vertebrae are divided into three regions: cervical C1–C7 vertebrae, thoracic T1–T12 vertebrae, and lumbar L1–L5 vertebrae. The vertebral column is curved, with two primary curvatures (thoracic and sacrococcygeal curves) and two secondary curvatures (cervical and lumbar curves).
Regions of the Vertebral Column:
The vertebral column originally develops as a series of 33 vertebrae, but this number is eventually reduced to 24 vertebrae, plus the sacrum and coccyx. The vertebral column is subdivided into five regions, with the vertebrae in each area named for that region and numbered in descending order. In the neck, there are seven cervical vertebrae, each designated with the letter “C” followed by its number. Superiorly, the C1 vertebra articulates (forms a joint) with the occipital condyles of the skull. Inferiorly, C1 articulates with the C2 vertebra, and so on. Below these are the 12 thoracic vertebrae, designated T1–T12. The lower back contains the L1–L5 lumbar vertebrae. The single sacrum, which is also part of the pelvis, is formed by the fusion of five sacral vertebrae. Similarly, the coccyx, or tailbone, results from the fusion of four small coccygeal vertebrae. However, the sacral and coccygeal fusions do not start until age 20 and are not completed until middle age.
An interesting anatomical fact is that almost all mammals have seven cervical vertebrae, regardless of body size. This means that there are large variations in the size of cervical vertebrae, ranging from the very small cervical vertebrae of a shrew to the greatly elongated vertebrae in the neck of a giraffe. In a full-grown giraffe, each cervical vertebra is 11 inches tall.
Curvatures of the Vertebral Column:
The adult vertebral column does not form a straight line, but instead has four curvatures along its length (see Figure 7.20). These curves increase the vertebral column’s strength, flexibility, and ability to absorb shock. When the load on the spine is increased, by carrying a heavy backpack for example, the curvatures increase in depth (become more curved) to accommodate the extra weight. They then spring back when the weight is removed. The four adult curvatures are classified as either primary or secondary curvatures. Primary curves are retained from the original fetal curvature, while secondary curvatures develop after birth.
During fetal development, the body is flexed anteriorly into the fetal position, giving the entire vertebral column a single curvature that is concave anteriorly. In the adult, this fetal curvature is retained in two regions of the vertebral column as the thoracic curve, which involves the thoracic vertebrae, and the sacrococcygeal curve, formed by the sacrum and coccyx. Each of these is thus called a primary curve because they are retained from the original fetal curvature of the vertebral column.
A secondary curve develops gradually after birth as the child learns to sit upright, stand, and walk. Secondary curves are concave posteriorly, opposite in direction to the original fetal curvature. The cervical curve of the neck region develops as the infant begins to hold their head upright when sitting. Later, as the child begins to stand and then to walk, the lumbar curve of the lower back develops. In adults, the lumbar curve is generally deeper in females.
Disorders associated with the curvature of the spine include kyphosis (an excessive posterior curvature of the thoracic region), lordosis (an excessive anterior curvature of the lumbar region), and scoliosis (an abnormal, lateral curvature, accompanied by twisting of the vertebral column).
General Structure of a Vertebra:
Within the different regions of the vertebral column, vertebrae vary in size and shape, but they all follow a similar structural pattern. A typical vertebra will consist of a body, a vertebral arch, and seven processes (Figure 7.23).
The body is the anterior portion of each vertebra and is the part that supports the body weight. Because of this, the vertebral bodies progressively increase in size and thickness going down the vertebral column. The bodies of adjacent vertebrae are separated and strongly united by an intervertebral disc.
The vertebral arch forms the posterior portion of each vertebra. It consists of four parts, the right and left pedicles and the right and left laminae. Each pedicle forms one of the lateral sides of the vertebral arch. The pedicles are anchored to the posterior side of the vertebral body. Each lamina forms part of the posterior roof of the vertebral arch. The large opening between the vertebral arch and body is the vertebral foramen, which contains the spinal cord. In the intact vertebral column, the vertebral foramina of all of the vertebrae align to form the vertebral (spinal) canal, which serves as the bony protection and passageway for the spinal cord down the back. When the vertebrae are aligned together in the vertebral column, notches in the margins of the pedicles of adjacent vertebrae together form an intervertebral foramen, the opening through which a spinal nerve exits from the vertebral column (Figure 7.24).
Seven processes arise from the vertebral arch. Each paired transverse process projects laterally and arises from the junction point between the pedicle and lamina. The single spinous process (vertebral spine) projects posteriorly at the midline of the back. The vertebral spines can easily be felt as a series of bumps just under the skin down the middle of the back. The transverse and spinous processes serve as important muscle attachment sites. A superior articular process extends or faces upward, and an inferior articular process faces or projects downward on each side of a vertebrae. The paired superior articular processes of one vertebra join with the corresponding paired inferior articular processes from the next higher vertebra. These junctions form slightly moveable joints between the adjacent vertebrae. The shape and orientation of the articular processes vary in different regions of the vertebral column and play a major role in determining the type and range of motion available in each region.
Figure 7.23 Parts of a Typical Vertebra A typical vertebra consists of a body and a vertebral arch. The arch is formed by the paired pedicles and paired laminae. Arising from the vertebral arch are the transverse, spinous, superior articular, and inferior articular processes. The vertebral foramen provides for passage of the spinal cord. Each spinal nerve exits through an intervertebral foramen, located between adjacent vertebrae. Intervertebral discs unite the bodies of adjacent vertebrae.
Figure 7.24 Intervertebral Disc The bodies of adjacent vertebrae are separated and united by an intervertebral disc, which provides padding and allows for movements between adjacent vertebrae. The disc consists of a fibrous outer layer called the anulus fibrosus and a gel-like center called the nucleus pulposus. The intervertebral foramen is the opening formed between adjacent vertebrae for the exit of a spinal nerve.
Regional Modifications of Vertebrae:
In addition to the general characteristics of a typical vertebra described above, vertebrae also display characteristic size and structural features that vary between the different vertebral column regions. Thus, cervical vertebrae are smaller than lumbar vertebrae due to differences in the proportion of body weight that each supports. Thoracic vertebrae have sites for rib attachment, and the vertebrae that give rise to the sacrum and coccyx have fused together into single bones.
Cervical Vertebrae:
Typical cervical vertebrae, such as C4 or C5, have several characteristic features that differentiate them from thoracic or lumbar vertebrae (Figure 7.25). Cervical vertebrae have a small body, reflecting the fact that they carry the least amount of body weight. Cervical vertebrae usually have a bifid (Y-shaped) spinous process. The spinous processes of the C3–C6 vertebrae are short, but the spine of C7 is much longer. You can find these vertebrae by running your finger down the midline of the posterior neck until you encounter the prominent C7 spine located at the base of the neck. The transverse processes of the cervical vertebrae are sharply curved (U-shaped) to allow for passage of the cervical spinal nerves. Each transverse process also has an opening called the transverse foramen. An important artery that supplies the brain ascends up the neck by passing through these openings. The superior and inferior articular processes of the cervical vertebrae are flattened and largely face upward or downward, respectively.
The first and second cervical vertebrae are further modified, giving each a distinctive appearance. The first cervical (C1) vertebra is also called the atlas, because this is the vertebra that supports the skull on top of the vertebral column (in Greek mythology, Atlas was the god who supported the heavens on his shoulders). The C1 vertebra does not have a body or spinous process. Instead, it is ring-shaped, consisting of an anterior arch and a posterior arch. The transverse processes of the atlas are longer and extend more laterally than do the transverse processes of any other cervical vertebrae. The superior articular processes face upward and are deeply curved for articulation with the occipital condyles on the base of the skull. The inferior articular processes are flat and face downward to join with the superior articular processes of the C2 vertebra.
The second cervical (C2) vertebra is called the axis, because it serves as the axis for rotation when turning the head toward the right or left. The axis resembles typical cervical vertebrae in most respects, but is easily distinguished by the dens (odontoid process), a bony projection that extends upward from the vertebral body. The dens joins with the inner aspect of the anterior arch of the atlas, where it is held in place by the transverse ligament.
Figure 7.25 Cervical Vertebrae A typical cervical vertebra has a small body, a bifid spinous process, transverse processes that have a transverse foramen and are curved for spinal nerve passage. The atlas (C1 vertebra) does not have a body or spinous process. It consists of an anterior and a posterior arch and elongated transverse processes. The axis (C2 vertebra) has the upward projecting dens, which articulates with the anterior arch of the atlas.
Thoracic Vertebrae:
The bodies of the thoracic vertebrae are larger than those of cervical vertebrae (Figure 7.26). The characteristic feature for a typical midthoracic vertebra is the spinous process, which is long and has a pronounced downward angle that causes it to overlap the next inferior vertebra. The superior articular processes of thoracic vertebrae face anteriorly and the inferior processes face posteriorly. These orientations are important determinants for the type and range of movements available to the thoracic region of the vertebral column.
Thoracic vertebrae have several additional articulation sites, each of which is called a facet, where a rib is attached. Most thoracic vertebrae have two facets located on the lateral sides of the body, each of which is called a costal facet (costal = “rib”). These are for articulation with the head (end) of a rib. An additional facet is located on the transverse process for articulation with the tubercle of a rib.
Figure 7.26 Thoracic Vertebrae A typical thoracic vertebra is distinguished by the spinous process, which is long and projects downward to overlap the next inferior vertebra. It also has articulation sites (facets) on the vertebral body and a transverse process for rib attachment.
Figure 7.27 Rib Articulation in Thoracic Vertebrae Thoracic vertebrae have superior and inferior articular facets on the vertebral body for articulation with the head of a rib, and a transverse process facet for articulation with the rib tubercle.
Lumbar Vertebrae:
Lumbar vertebrae carry the greatest amount of body weight and are thus characterized by the large size and thickness of the vertebral body (Figure 7.28). They have short transverse processes and a short, blunt spinous process that projects posteriorly. The articular processes are large, with the superior process facing backward and the inferior facing forward.
Figure 7.28 Lumbar Vertebrae Lumbar vertebrae are characterized by having a large, thick body and a short, rounded spinous process.
Sacrum and Coccyx:
The sacrum is a triangular-shaped bone that is thick and wide across its superior base where it is weight bearing and then tapers down to an inferior, non-weight bearing apex (Figure 7.29). It is formed by the fusion of five sacral vertebrae, a process that does not begin until after the age of 20. On the anterior surface of the older adult sacrum, the lines of vertebral fusion can be seen as four transverse ridges. On the posterior surface, running down the midline, is the median sacral crest, a bumpy ridge that is the remnant of the fused spinous processes (median = “midline”; while medial = “toward, but not necessarily at, the midline”). Similarly, the fused transverse processes of the sacral vertebrae form the lateral sacral crest.
The sacral promontory is the anterior lip of the superior base of the sacrum. Lateral to this is the roughened auricular surface, which joins with the ilium portion of the hipbone to form the immobile sacroiliac joints of the pelvis. Passing inferiorly through the sacrum is a bony tunnel called the sacral canal, which terminates at the sacral hiatus near the inferior tip of the sacrum. The anterior and posterior surfaces of the sacrum have a series of paired openings called sacral foramina (singular = foramen) that connect to the sacral canal. Each of these openings is called a posterior (dorsal) sacral foramen or anterior (ventral) sacral foramen. These openings allow for the anterior and posterior branches of the sacral spinal nerves to exit the sacrum. The superior articular process of the sacrum, one of which is found on either side of the superior opening of the sacral canal, articulates with the inferior articular processes from the L5 vertebra.
The coccyx, or tailbone, is derived from the fusion of four very small coccygeal vertebrae (see Figure 7.29). It articulates with the inferior tip of the sacrum. It is not weight bearing in the standing position, but may receive some body weight when sitting.
Figure 7.29 Sacrum and Coccyx The sacrum is formed from the fusion of five sacral vertebrae, whose lines of fusion are indicated by the transverse ridges. The fused spinous processes form the median sacral crest, while the lateral sacral crest arises from the fused transverse processes. The coccyx is formed by the fusion of four small coccygeal vertebrae.
Intervertebral Discs and Ligaments of the Vertebral Column:
The bodies of adjacent vertebrae are strongly anchored to each other by an intervertebral disc. This structure provides padding between the bones during weight bearing, and because it can change shape, also allows for movement between the vertebrae. Although the total amount of movement available between any two adjacent vertebrae is small, when these movements are summed together along the entire length of the vertebral column, large body movements can be produced. Ligaments that extend along the length of the vertebral column also contribute to its overall support and stability.
Intervertebral Disc:
An intervertebral disc is a fibrocartilaginous pad that fills the gap between adjacent vertebral bodies (see Figure 7.24). Each disc is anchored to the bodies of its adjacent vertebrae, thus strongly uniting these. The discs also provide padding between vertebrae during weight bearing. Because of this, intervertebral discs are thin in the cervical region and thickest in the lumbar region, which carries the most body weight. In total, the intervertebral discs account for approximately 25 percent of your body height between the top of the pelvis and the base of the skull. Intervertebral discs are also flexible and can change shape to allow for movements of the vertebral column.
Each intervertebral disc consists of two parts. The anulus fibrosus is the tough, fibrous outer layer of the disc. It forms a circle (anulus = “ring” or “circle”) and is firmly anchored to the outer margins of the adjacent vertebral bodies. Inside is the nucleus pulposus, consisting of a softer, more gel-like material. It has a high water content that serves to resist compression and thus is important for weight bearing. With increasing age, the water content of the nucleus pulposus gradually declines. This causes the disc to become thinner, decreasing total body height somewhat, and reduces the flexibility and range of motion of the disc, making bending more difficult.
The gel-like nature of the nucleus pulposus also allows the intervertebral disc to change shape as one vertebra rocks side to side or forward and back in relation to its neighbors during movements of the vertebral column. Thus, bending forward causes compression of the anterior portion of the disc but expansion of the posterior disc. If the posterior anulus fibrosus is weakened due to injury or increasing age, the pressure exerted on the disc when bending forward and lifting a heavy object can cause the nucleus pulposus to protrude posteriorly through the anulus fibrosus, resulting in a herniated disc (“ruptured” or “slipped” disc) (Figure 7.30). The posterior bulging of the nucleus pulposus can cause compression of a spinal nerve at the point where it exits through the intervertebral foramen, with resulting pain and/or muscle weakness in those body regions supplied by that nerve. The most common sites for disc herniation are the L4/L5 or L5/S1 intervertebral discs, which can cause sciatica, a widespread pain that radiates from the lower back down the thigh and into the leg. Similar injuries of the C5/C6 or C6/C7 intervertebral discs, following forcible hyperflexion of the neck from a collision accident or football injury, can produce pain in the neck, shoulder, and upper limb.
Figure 7.30 Herniated Intervertebral Disc Weakening of the anulus fibrosus can result in herniation (protrusion) of the nucleus pulposus and compression of a spinal nerve, resulting in pain and/or muscle weakness in the body regions supplied by that nerve.
Ligaments of the Vertebral Column:
Adjacent vertebrae are united by ligaments that run the length of the vertebral column along both its posterior and anterior aspects (Figure 7.31). These serve to resist excess forward or backward bending movements of the vertebral column, respectively.
The anterior longitudinal ligament runs down the anterior side of the entire vertebral column, uniting the vertebral bodies. It serves to resist excess backward bending of the vertebral column. Protection against this movement is particularly important in the neck, where extreme posterior bending of the head and neck can stretch or tear this ligament, resulting in a painful whiplash injury. Prior to the mandatory installation of seat headrests, whiplash injuries were common for passengers involved in a rear-end automobile collision.
The supraspinous ligament is located on the posterior side of the vertebral column, where it interconnects the spinous processes of the thoracic and lumbar vertebrae. This strong ligament supports the vertebral column during forward bending motions. In the posterior neck, where the cervical spinous processes are short, the supraspinous ligament expands to become the nuchal ligament (nuchae = “nape” or “back of the neck”). The nuchal ligament is attached to the cervical spinous processes and extends upward and posteriorly to attach to the midline base of the skull, out to the external occipital protuberance. It supports the skull and prevents it from falling forward. This ligament is much larger and stronger in four-legged animals such as cows, where the large skull hangs off the front end of the vertebral column. You can easily feel this ligament by first extending your head backward and pressing down on the posterior midline of your neck. Then tilt your head forward and you will fill the nuchal ligament popping out as it tightens to limit anterior bending of the head and neck.
Additional ligaments are located inside the vertebral canal, next to the spinal cord, along the length of the vertebral column. The posterior longitudinal ligament is found anterior to the spinal cord, where it is attached to the posterior sides of the vertebral bodies. Posterior to the spinal cord is the ligamentum flavum (“yellow ligament”). This consists of a series of short, paired ligaments, each of which interconnects the lamina regions of adjacent vertebrae. The ligamentum flavum has large numbers of elastic fibers, which have a yellowish color, allowing it to stretch and then pull back. Both of these ligaments provide important support for the vertebral column when bending forward.
Figure 7.31 Ligaments of Vertebral Column The anterior longitudinal ligament runs the length of the vertebral column, uniting the anterior sides of the vertebral bodies. The supraspinous ligament connects the spinous processes of the thoracic and lumbar vertebrae. In the posterior neck, the supraspinous ligament enlarges to form the nuchal ligament, which attaches to the cervical spinous processes and to the base of the skull.
The cranium (skull) is the skeletal structure of the head that supports the face and protects the brain. It is subdivided into the facial bones and the brain case, or cranial vault (Figure 7.3). The facial bones underlie the facial structures, form the nasal cavity, enclose the eyeballs, and support the teeth of the upper and lower jaws. The rounded brain case surrounds and protects the brain and houses the middle and inner ear structures.
In the adult, the skull consists of 22 individual bones, 21 of which are immobile and united into a single unit. The 22nd bone is the mandible (lower jaw), which is the only moveable bone of the skull.
Figure 7.3Parts of the Skull The skull consists of the rounded brain case that houses the brain and the facial bones that form the upper and lower jaws, nose, orbits, and other facial structures.
Anterior View of Skull
The anterior skull consists of the facial bones and provides the bony support for the eyes and structures of the face. This view of the skull is dominated by the openings of the orbits and the nasal cavity. Also seen are the upper and lower jaws, with their respective teeth (Figure 7.4).
The orbit is the bony socket that houses the eyeball and muscles that move the eyeball or open the upper eyelid. The upper margin of the anterior orbit is the supraorbital margin. Located near the midpoint of the supraorbital margin is a small opening called the supraorbital foramen. This provides for passage of a sensory nerve to the skin of the forehead. Below the orbit is the infraorbital foramen, which is the point of emergence for a sensory nerve that supplies the anterior face below the orbit.
Figure 7.4Anterior View of Skull An anterior view of the skull shows the bones that form the forehead, orbits (eye sockets), nasal cavity, nasal septum, and upper and lower jaws.
Inside the nasal area of the skull, the nasal cavity is divided into halves by the nasal septum. The upper portion of the nasal septum is formed by the perpendicular plate of the ethmoid bone and the lower portion is the vomer bone. Each side of the nasal cavity is triangular in shape, with a broad inferior space that narrows superiorly. When looking into the nasal cavity from the front of the skull, two bony plates are seen projecting from each lateral wall. The larger of these is the inferior nasal concha, an independent bone of the skull. Located just above the inferior concha is the middle nasal concha, which is part of the ethmoid bone. A third bony plate, also part of the ethmoid bone, is the superior nasal concha. It is much smaller and out of sight, above the middle concha. The superior nasal concha is located just lateral to the perpendicular plate, in the upper nasal cavity.
Lateral View of Skull
A view of the lateral skull is dominated by the large, rounded brain case above and the upper and lower jaws with their teeth below (Figure 7.5). Separating these areas is the bridge of bone called the zygomatic arch. The zygomatic arch is the bony arch on the side of skull that spans from the area of the cheek to just above the ear canal. It is formed by the junction of two bony processes: a short anterior component, the temporal process of the zygomatic bone (the cheekbone) and a longer posterior portion, the zygomatic process of the temporal bone, extending forward from the temporal bone. Thus the temporal process (anteriorly) and the zygomatic process (posteriorly) join together, like the two ends of a drawbridge, to form the zygomatic arch. One of the major muscles that pulls the mandible upward during biting and chewing arises from the zygomatic arch.
On the lateral side of the brain case, above the level of the zygomatic arch, is a shallow space called the temporal fossa. Below the level of the zygomatic arch and deep to the vertical portion of the mandible is another space called the infratemporal fossa. Both the temporal fossa and infratemporal fossa contain muscles that act on the mandible during chewing.
Figure 7.5Lateral View of Skull The lateral skull shows the large rounded brain case, zygomatic arch, and the upper and lower jaws. The zygomatic arch is formed jointly by the zygomatic process of the temporal bone and the temporal process of the zygomatic bone. The shallow space above the zygomatic arch is the temporal fossa. The space inferior to the zygomatic arch and deep to the posterior mandible is the infratemporal fossa.
Bones of the Brain Case:
The brain case contains and protects the brain. The interior space that is almost completely occupied by the brain is called the cranial cavity. This cavity is bounded superiorly by the rounded top of the skull, which is called the calvaria (skullcap), and the lateral and posterior sides of the skull. The bones that form the top and sides of the brain case are usually referred to as the “flat” bones of the skull.
The floor of the brain case is referred to as the base of the skull. This is a complex area that varies in depth and has numerous openings for the passage of cranial nerves, blood vessels, and the spinal cord. Inside the skull, the base is subdivided into three large spaces, called the anterior cranial fossa, middle cranial fossa, and posterior cranial fossa (fossa = “trench or ditch”) (Figure 7.6). From anterior to posterior, the fossae increase in depth. The shape and depth of each fossa corresponds to the shape and size of the brain region that each houses. The boundaries and openings of the cranial fossae (singular = fossa) will be described in a later section.
Figure 7.6 Cranial Fossae The bones of the brain case surround and protect the brain, which occupies the cranial cavity. The base of the brain case, which forms the floor of cranial cavity, is subdivided into the shallow anterior cranial fossa, the middle cranial fossa, and the deep posterior cranial fossa.
The brain case consists of eight bones. These include the paired parietal and temporal bones, plus the unpaired frontal, occipital, sphenoid, and ethmoid bones.
Parietal Bone
The parietal bone forms most of the upper lateral side of the skull (see Figure 7.5). These are paired bones, with the right and left parietal bones joining together at the top of the skull. Each parietal bone is also bounded anteriorly by the frontal bone, inferiorly by the temporal bone, and posteriorly by the occipital bone.
Temporal Bone
The temporal bone forms the lower lateral side of the skull (see Figure 7.5). Common wisdom has it that the temporal bone (temporal = “time”) is so named because this area of the head (the temple) is where hair typically first turns gray, indicating the passage of time.
The temporal bone is subdivided into several regions (Figure 7.7). The flattened, upper portion is the squamous portion of the temporal bone. Below this area and projecting anteriorly is the zygomatic process of the temporal bone, which forms the posterior portion of the zygomatic arch. Posteriorly is the mastoid portion of the temporal bone. Projecting inferiorly from this region is a large prominence, the mastoid process, which serves as a muscle attachment site. The mastoid process can easily be felt on the side of the head just behind your earlobe. On the interior of the skull, the petrous portion of each temporal bone forms the prominent, diagonally oriented petrous ridge in the floor of the cranial cavity. Located inside each petrous ridge are small cavities that house the structures of the middle and inner ears.
Figure 7.7Temporal Bone A lateral view of the isolated temporal bone shows the squamous, mastoid, and zygomatic portions of the temporal bone.
Important landmarks of the temporal bone, as shown in Figure 7.8, include the following:
External acoustic meatus (ear canal)—This is the large opening on the lateral side of the skull that is associated with the ear.
Internal acoustic meatus—This opening is located inside the cranial cavity, on the medial side of the petrous ridge. It connects to the middle and inner ear cavities of the temporal bone.
Mandibular fossa—This is the deep, oval-shaped depression located on the external base of the skull, just in front of the external acoustic meatus. The mandible (lower jaw) joins with the skull at this site as part of the temporomandibular joint, which allows for movements of the mandible during opening and closing of the mouth.
Articular tubercle—The smooth ridge located immediately anterior to the mandibular fossa. Both the articular tubercle and mandibular fossa contribute to the temporomandibular joint, the joint that provides for movements between the temporal bone of the skull and the mandible.
Styloid process—Posterior to the mandibular fossa on the external base of the skull is an elongated, downward bony projection called the styloid process, so named because of its resemblance to a stylus (a pen or writing tool). This structure serves as an attachment site for several small muscles and for a ligament that supports the hyoid bone of the neck. (See also Figure 7.7.)
Stylomastoid foramen—This small opening is located between the styloid process and mastoid process. This is the point of exit for the cranial nerve that supplies the facial muscles.
Carotid canal—The carotid canal is a zig-zag shaped tunnel that provides passage through the base of the skull for one of the major arteries that supplies the brain. Its entrance is located on the outside base of the skull, anteromedial to the styloid process. The canal then runs anteromedially within the bony base of the skull, and then turns upward to its exit in the floor of the middle cranial cavity, above the foramen lacerum.
Figure 7.8External and Internal Views of Base of Skull (a) The hard palate is formed anteriorly by the palatine processes of the maxilla bones and posteriorly by the horizontal plate of the palatine bones. (b) The complex floor of the cranial cavity is formed by the frontal, ethmoid, sphenoid, temporal, and occipital bones. The lesser wing of the sphenoid bone separates the anterior and middle cranial fossae. The petrous ridge (petrous portion of temporal bone) separates the middle and posterior cranial fossae.
Frontal Bone
The frontal bone is the single bone that forms the forehead. At its anterior midline, between the eyebrows, there is a slight depression called the glabella (see Figure 7.5). The frontal bone also forms the supraorbital margin of the orbit. Near the middle of this margin, is the supraorbital foramen, the opening that provides passage for a sensory nerve to the forehead. The frontal bone is thickened just above each supraorbital margin, forming rounded brow ridges. These are located just behind your eyebrows and vary in size among individuals, although they are generally larger in males. Inside the cranial cavity, the frontal bone extends posteriorly. This flattened region forms both the roof of the orbit below and the floor of the anterior cranial cavity above (see Figure 7.8b).
Occipital Bone
The occipital bone is the single bone that forms the posterior skull and posterior base of the cranial cavity (Figure 7.9; see also Figure 7.8). On its outside surface, at the posterior midline, is a small protrusion called the external occipital protuberance, which serves as an attachment site for a ligament of the posterior neck. Lateral to either side of this bump is a superior nuchal line (nuchal = “nape” or “posterior neck”). The nuchal lines represent the most superior point at which muscles of the neck attach to the skull, with only the scalp covering the skull above these lines. On the base of the skull, the occipital bone contains the large opening of the foramen magnum, which allows for passage of the spinal cord as it exits the skull. On either side of the foramen magnum is an oval-shaped occipital condyle. These condyles form joints with the first cervical vertebra and thus support the skull on top of the vertebral column.
Figure 7.9Posterior View of Skull This view of the posterior skull shows attachment sites for muscles and joints that support the skull.
Sphenoid Bone
The sphenoid bone is a single, complex bone of the central skull (Figure 7.10). It serves as a “keystone” bone, because it joins with almost every other bone of the skull. The sphenoid forms much of the base of the central skull (see Figure 7.8) and also extends laterally to contribute to the sides of the skull (see Figure 7.5). Inside the cranial cavity, the right and left lesser wings of the sphenoid bone, which resemble the wings of a flying bird, form the lip of a prominent ridge that marks the boundary between the anterior and middle cranial fossae. The sella turcica (“Turkish saddle”) is located at the midline of the middle cranial fossa. This bony region of the sphenoid bone is named for its resemblance to the horse saddles used by the Ottoman Turks, with a high back and a tall front. The rounded depression in the floor of the sella turcica is the hypophyseal (pituitary) fossa, which houses the pea-sized pituitary (hypophyseal) gland. The greater wings of the sphenoid bone extend laterally to either side away from the sella turcica, where they form the anterior floor of the middle cranial fossa. The greater wing is best seen on the outside of the lateral skull, where it forms a rectangular area immediately anterior to the squamous portion of the temporal bone.
On the inferior aspect of the skull, each half of the sphenoid bone forms two thin, vertically oriented bony plates. These are the medial pterygoid plate and lateral pterygoid plate (pterygoid = “wing-shaped”). The right and left medial pterygoid plates form the posterior, lateral walls of the nasal cavity. The somewhat larger lateral pterygoid plates serve as attachment sites for chewing muscles that fill the infratemporal space and act on the mandible.
Figure 7.10Sphenoid Bone Shown in isolation in (a) superior and (b) posterior views, the sphenoid bone is a single midline bone that forms the anterior walls and floor of the middle cranial fossa. It has a pair of lesser wings and a pair of greater wings. The sella turcica surrounds the hypophyseal fossa. Projecting downward are the medial and lateral pterygoid plates. The sphenoid has multiple openings for the passage of nerves and blood vessels, including the optic canal, superior orbital fissure, foramen rotundum, foramen ovale, and foramen spinosum.
Ethmoid Bone:
The ethmoid bone is a single, midline bone that forms the roof and lateral walls of the upper nasal cavity, the upper portion of the nasal septum, and contributes to the medial wall of the orbit (Figure 7.11 and Figure 7.12). On the interior of the skull, the ethmoid also forms a portion of the floor of the anterior cranial cavity (see Figure 7.8b).
Within the nasal cavity, the perpendicular plate of the ethmoid bone forms the upper portion of the nasal septum. The ethmoid bone also forms the lateral walls of the upper nasal cavity. Extending from each lateral wall are the superior nasal concha and middle nasal concha, which are thin, curved projections that extend into the nasal cavity (Figure 7.13).
In the cranial cavity, the ethmoid bone forms a small area at the midline in the floor of the anterior cranial fossa. This region also forms the narrow roof of the underlying nasal cavity. This portion of the ethmoid bone consists of two parts, the crista galli and cribriform plates. The crista galli (“rooster’s comb or crest”) is a small upward bony projection located at the midline. It functions as an anterior attachment point for one of the covering layers of the brain. To either side of the crista galli is the cribriform plate (cribrum = “sieve”), a small, flattened area with numerous small openings termed olfactory foramina. Small nerve branches from the olfactory areas of the nasal cavity pass through these openings to enter the brain.
The lateral portions of the ethmoid bone are located between the orbit and upper nasal cavity, and thus form the lateral nasal cavity wall and a portion of the medial orbit wall. Located inside this portion of the ethmoid bone are several small, air-filled spaces that are part of the paranasal sinus system of the skull.
Figure 7.11Sagittal Section of Skull This midline view of the sagittally sectioned skull shows the nasal septum.
Figure 7.12Ethmoid Bone The unpaired ethmoid bone is located at the midline within the central skull. It has an upward projection, the crista galli, and a downward projection, the perpendicular plate, which forms the upper nasal septum. The cribriform plates form both the roof of the nasal cavity and a portion of the anterior cranial fossa floor. The lateral sides of the ethmoid bone form the lateral walls of the upper nasal cavity, part of the medial orbit wall, and give rise to the superior and middle nasal conchae. The ethmoid bone also contains the ethmoid air cells.
Figure 7.13Lateral Wall of Nasal Cavity The three nasal conchae are curved bones that project from the lateral walls of the nasal cavity. The superior nasal concha and middle nasal concha are parts of the ethmoid bone. The inferior nasal concha is an independent bone of the skull.
Sutures of the Skull:
A suture is an immobile joint between adjacent bones of the skull. The narrow gap between the bones is filled with dense, fibrous connective tissue that unites the bones. The long sutures located between the bones of the brain case are not straight, but instead follow irregular, tightly twisting paths. These twisting lines serve to tightly interlock the adjacent bones, thus adding strength to the skull for brain protection.
The two suture lines seen on the top of the skull are the coronal and sagittal sutures. The coronal suture runs from side to side across the skull, within the coronal plane of section (see Figure 7.5). It joins the frontal bone to the right and left parietal bones. The sagittal suture extends posteriorly from the coronal suture, running along the midline at the top of the skull in the sagittal plane of section (see Figure 7.9). It unites the right and left parietal bones. On the posterior skull, the sagittal suture terminates by joining the lambdoid suture. The lambdoid suture extends downward and laterally to either side away from its junction with the sagittal suture. The lambdoid suture joins the occipital bone to the right and left parietal and temporal bones. This suture is named for its upside-down “V” shape, which resembles the capital letter version of the Greek letter lambda (Λ). The squamous suture is located on the lateral skull. It unites the squamous portion of the temporal bone with the parietal bone (see Figure 7.5). At the intersection of four bones is the pterion, a small, capital-H-shaped suture line region that unites the frontal bone, parietal bone, squamous portion of the temporal bone, and greater wing of the sphenoid bone. It is the weakest part of the skull. The pterion is located approximately two finger widths above the zygomatic arch and a thumb’s width posterior to the upward portion of the zygomatic bone.
Facial Bones of the Skull
The facial bones of the skull form the upper and lower jaws, the nose, nasal cavity and nasal septum, and the orbit. The facial bones include 14 bones, with six paired bones and two unpaired bones. The paired bones are the maxilla, palatine, zygomatic, nasal, lacrimal, and inferior nasal conchae bones. The unpaired bones are the vomer and mandible bones. Although classified with the brain-case bones, the ethmoid bone also contributes to the nasal septum and the walls of the nasal cavity and orbit.
Maxillary Bone
The maxillary bone, often referred to simply as the maxilla (plural = maxillae), is one of a pair that together form the upper jaw, much of the hard palate, the medial floor of the orbit, and the lateral base of the nose (see Figure 7.4). The curved, inferior margin of the maxillary bone that forms the upper jaw and contains the upper teeth is the alveolar process of the maxilla (Figure 7.14). Each tooth is anchored into a deep socket called an alveolus. On the anterior maxilla, just below the orbit, is the infraorbital foramen. This is the point of exit for a sensory nerve that supplies the nose, upper lip, and anterior cheek. On the inferior skull, the palatine process from each maxillary bone can be seen joining together at the midline to form the anterior three-quarters of the hard palate (see Figure 7.8a). The hard palate is the bony plate that forms the roof of the mouth and floor of the nasal cavity, separating the oral and nasal cavities.
Figure 7.14Maxillary Bone The maxillary bone forms the upper jaw and supports the upper teeth. Each maxilla also forms the lateral floor of each orbit and the majority of the hard palate.
Palatine Bone:
The palatine bone is one of a pair of irregularly shaped bones that contribute small areas to the lateral walls of the nasal cavity and the medial wall of each orbit. The largest region of each of the palatine bone is the horizontal plate. The plates from the right and left palatine bones join together at the midline to form the posterior quarter of the hard palate (see Figure 7.8a). Thus, the palatine bones are best seen in an inferior view of the skull and hard palate.
Zygomatic Bone:
The zygomatic bone is also known as the cheekbone. Each of the paired zygomatic bones forms much of the lateral wall of the orbit and the lateral-inferior margins of the anterior orbital opening (see Figure 7.4). The short temporal process of the zygomatic bone projects posteriorly, where it forms the anterior portion of the zygomatic arch (see Figure 7.5).
Nasal Bone:
The nasal bone is one of two small bones that articulate (join) with each other to form the bony base (bridge) of the nose. They also support the cartilages that form the lateral walls of the nose (see Figure 7.11). These are the bones that are damaged when the nose is broken.
Lacrimal Bone:
Each lacrimal bone is a small, rectangular bone that forms the anterior, medial wall of the orbit (see Figure 7.4 and Figure 7.5). The anterior portion of the lacrimal bone forms a shallow depression called the lacrimal fossa, and extending inferiorly from this is the nasolacrimal canal. The lacrimal fluid (tears of the eye), which serves to maintain the moist surface of the eye, drains at the medial corner of the eye into the nasolacrimal canal. This duct then extends downward to open into the nasal cavity, behind the inferior nasal concha. In the nasal cavity, the lacrimal fluid normally drains posteriorly, but with an increased flow of tears due to crying or eye irritation, some fluid will also drain anteriorly, thus causing a runny nose.
Inferior Nasal Conchae:
The right and left inferior nasal conchae form a curved bony plate that projects into the nasal cavity space from the lower lateral wall (see Figure 7.13). The inferior concha is the largest of the nasal conchae and can easily be seen when looking into the anterior opening of the nasal cavity.
Vomer Bone:
The unpaired vomer bone, often referred to simply as the vomer, is triangular-shaped and forms the posterior-inferior part of the nasal septum (see Figure 7.11). The vomer is best seen when looking from behind into the posterior openings of the nasal cavity (see Figure 7.8a). In this view, the vomer is seen to form the entire height of the nasal septum. A much smaller portion of the vomer can also be seen when looking into the anterior opening of the nasal cavity.
Mandible:
The mandible forms the lower jaw and is the only moveable bone of the skull. At the time of birth, the mandible consists of paired right and left bones, but these fuse together during the first year to form the single U-shaped mandible of the adult skull. Each side of the mandible consists of a horizontal body and posteriorly, a vertically oriented ramus of the mandible (ramus = “branch”). The outside margin of the mandible, where the body and ramus come together is called the angle of the mandible (Figure 7.15).
The ramus on each side of the mandible has two upward-going bony projections. The more anterior projection is the flattened coronoid process of the mandible, which provides attachment for one of the biting muscles. The posterior projection is the condylar process of the mandible, which is topped by the oval-shaped condyle. The condyle of the mandible articulates (joins) with the mandibular fossa and articular tubercle of the temporal bone. Together these articulations form the temporomandibular joint, which allows for opening and closing of the mouth (see Figure 7.5). The broad U-shaped curve located between the coronoid and condylar processes is the mandibular notch.
Important landmarks for the mandible include the following:
Alveolar process of the mandible—This is the upper border of the mandibular body and serves to anchor the lower teeth.
Mental protuberance—The forward projection from the inferior margin of the anterior mandible that forms the chin (mental = “chin”).
Mental foramen—The opening located on each side of the anterior-lateral mandible, which is the exit site for a sensory nerve that supplies the chin.
Mylohyoid line—This bony ridge extends along the inner aspect of the mandibular body (see Figure 7.11). The muscle that forms the floor of the oral cavity attaches to the mylohyoid lines on both sides of the mandible.
Mandibular foramen—This opening is located on the medial side of the ramus of the mandible. The opening leads into a tunnel that runs down the length of the mandibular body. The sensory nerve and blood vessels that supply the lower teeth enter the mandibular foramen and then follow this tunnel. Thus, to numb the lower teeth prior to dental work, the dentist must inject anesthesia into the lateral wall of the oral cavity at a point prior to where this sensory nerve enters the mandibular foramen.
Lingula—This small flap of bone is named for its shape (lingula = “little tongue”). It is located immediately next to the mandibular foramen, on the medial side of the ramus. A ligament that anchors the mandible during opening and closing of the mouth extends down from the base of the skull and attaches to the lingula.
Figure 7.15 Isolated Mandible The mandible is the only moveable bone of the skull.
The Orbit:
The orbit is the bony socket that houses the eyeball and contains the muscles that move the eyeball or open the upper eyelid. Each orbit is cone-shaped, with a narrow posterior region that widens toward the large anterior opening. To help protect the eye, the bony margins of the anterior opening are thickened and somewhat constricted. The medial walls of the two orbits are parallel to each other but each lateral wall diverges away from the midline at a 45° angle. This divergence provides greater lateral peripheral vision.
The walls of each orbit include contributions from seven skull bones (Figure 7.16). The frontal bone forms the roof and the zygomatic bone forms the lateral wall and lateral floor. The medial floor is primarily formed by the maxilla, with a small contribution from the palatine bone. The ethmoid bone and lacrimal bone make up much of the medial wall and the sphenoid bone forms the posterior orbit.
At the posterior apex of the orbit is the opening of the optic canal, which allows for passage of the optic nerve from the retina to the brain. Lateral to this is the elongated and irregularly shaped superior orbital fissure, which provides passage for the artery that supplies the eyeball, sensory nerves, and the nerves that supply the muscles involved in eye movements.
Figure 7.16 Bones of the Orbit Seven skull bones contribute to the walls of the orbit. Opening into the posterior orbit from the cranial cavity are the optic canal and superior orbital fissure.
The Nasal Septum and Nasal Conchae:
The nasal septum consists of both bone and cartilage components (Figure 7.17; see also Figure 7.11). The upper portion of the septum is formed by the perpendicular plate of the ethmoid bone. The lower and posterior parts of the septum are formed by the triangular-shaped vomer bone. In an anterior view of the skull, the perpendicular plate of the ethmoid bone is easily seen inside the nasal opening as the upper nasal septum, but only a small portion of the vomer is seen as the inferior septum. A better view of the vomer bone is seen when looking into the posterior nasal cavity with an inferior view of the skull, where the vomer forms the full height of the nasal septum. The anterior nasal septum is formed by the septal cartilage, a flexible plate that fills in the gap between the perpendicular plate of the ethmoid and vomer bones. This cartilage also extends outward into the nose where it separates the right and left nostrils. The septal cartilage is not found in the dry skull.
Attached to the lateral wall on each side of the nasal cavity are the superior, middle, and inferior nasal conchae (singular = concha), which are named for their positions (see Figure 7.13). These are bony plates that curve downward as they project into the space of the nasal cavity. They serve to swirl the incoming air, which helps to warm and moisturize it before the air moves into the delicate air sacs of the lungs. This also allows mucus, secreted by the tissue lining the nasal cavity, to trap incoming dust, pollen, bacteria, and viruses. The largest of the conchae is the inferior nasal concha, which is an independent bone of the skull. The middle concha and the superior conchae, which is the smallest, are both formed by the ethmoid bone. When looking into the anterior nasal opening of the skull, only the inferior and middle conchae can be seen. The small superior nasal concha is well hidden above and behind the middle concha.
Figure 7.17Nasal Septum The nasal septum is formed by the perpendicular plate of the ethmoid bone and the vomer bone. The septal cartilage fills the gap between these bones and extends into the nose.
Cranial Fossae
Inside the skull, the floor of the cranial cavity is subdivided into three cranial fossae (spaces), which increase in depth from anterior to posterior (see Figure 7.6, Figure 7.8b, and Figure 7.11). Since the brain occupies these areas, the shape of each conforms to the shape of the brain regions that it contains. Each cranial fossa has anterior and posterior boundaries and is divided at the midline into right and left areas by a significant bony structure or opening.
Anterior Cranial Fossa:
The anterior cranial fossa is the most anterior and the shallowest of the three cranial fossae. It overlies the orbits and contains the frontal lobes of the brain. Anteriorly, the anterior fossa is bounded by the frontal bone, which also forms the majority of the floor for this space. The lesser wings of the sphenoid bone form the prominent ledge that marks the boundary between the anterior and middle cranial fossae. Located in the floor of the anterior cranial fossa at the midline is a portion of the ethmoid bone, consisting of the upward projecting crista galli and to either side of this, the cribriform plates.
Middle Cranial Fossa:
The middle cranial fossa is deeper and situated posterior to the anterior fossa. It extends from the lesser wings of the sphenoid bone anteriorly, to the petrous ridges (petrous portion of the temporal bones) posteriorly. The large, diagonally positioned petrous ridges give the middle cranial fossa a butterfly shape, making it narrow at the midline and broad laterally. The temporal lobes of the brain occupy this fossa. The middle cranial fossa is divided at the midline by the upward bony prominence of the sella turcica, a part of the sphenoid bone. The middle cranial fossa has several openings for the passage of blood vessels and cranial nerves (see Figure 7.8).
Openings in the middle cranial fossa are as follows:
Optic canal—This opening is located at the anterior lateral corner of the sella turcica. It provides for passage of the optic nerve into the orbit.
Superior orbital fissure—This large, irregular opening into the posterior orbit is located on the anterior wall of the middle cranial fossa, lateral to the optic canal and under the projecting margin of the lesser wing of the sphenoid bone. Nerves to the eyeball and associated muscles, and sensory nerves to the forehead pass through this opening.
Foramen rotundum—This rounded opening (rotundum = “round”) is located in the floor of the middle cranial fossa, just inferior to the superior orbital fissure. It is the exit point for a major sensory nerve that supplies the cheek, nose, and upper teeth.
Foramen ovale of the middle cranial fossa—This large, oval-shaped opening in the floor of the middle cranial fossa provides passage for a major sensory nerve to the lateral head, cheek, chin, and lower teeth.
Foramen spinosum—This small opening, located posterior-lateral to the foramen ovale, is the entry point for an important artery that supplies the covering layers surrounding the brain. The branching pattern of this artery forms readily visible grooves on the internal surface of the skull and these grooves can be traced back to their origin at the foramen spinosum.
Carotid canal—This is the zig-zag passageway through which a major artery to the brain enters the skull. The entrance to the carotid canal is located on the inferior aspect of the skull, anteromedial to the styloid process (see Figure 7.8a). From here, the canal runs anteromedially within the bony base of the skull. Just above the foramen lacerum, the carotid canal opens into the middle cranial cavity, near the posterior-lateral base of the sella turcica.
Foramen lacerum—This irregular opening is located in the base of the skull, immediately inferior to the exit of the carotid canal. This opening is an artifact of the dry skull, because in life it is completely filled with cartilage. All the openings of the skull that provide for passage of nerves or blood vessels have smooth margins; the word lacerum (“ragged” or “torn”) tells us that this opening has ragged edges and thus nothing passes through it.
Posterior Cranial Fossa:
The posterior cranial fossa is the most posterior and deepest portion of the cranial cavity. It contains the cerebellum of the brain. The posterior fossa is bounded anteriorly by the petrous ridges, while the occipital bone forms the floor and posterior wall. It is divided at the midline by the large foramen magnum (“great aperture”), the opening that provides for passage of the spinal cord.
Located on the medial wall of the petrous ridge in the posterior cranial fossa is the internal acoustic meatus (see Figure 7.11). This opening provides for passage of the nerve from the hearing and equilibrium organs of the inner ear, and the nerve that supplies the muscles of the face. Located at the anterior-lateral margin of the foramen magnum is the hypoglossal canal. These emerge on the inferior aspect of the skull at the base of the occipital condyle and provide passage for an important nerve to the tongue.
Immediately inferior to the internal acoustic meatus is the large, irregularly shaped jugular foramen (see Figure 7.8a). Several cranial nerves from the brain exit the skull via this opening. It is also the exit point through the base of the skull for all the venous return blood leaving the brain. The venous structures that carry blood inside the skull form large, curved grooves on the inner walls of the posterior cranial fossa, which terminate at each jugular foramen.
Paranasal Sinuses:
The paranasal sinuses are hollow, air-filled spaces located within certain bones of the skull (Figure 7.18). All of the sinuses communicate with the nasal cavity (paranasal = “next to nasal cavity”) and are lined with nasal mucosa. They serve to reduce bone mass and thus lighten the skull, and they also add resonance to the voice. This second feature is most obvious when you have a cold or sinus congestion. These produce swelling of the mucosa and excess mucus production, which can obstruct the narrow passageways between the sinuses and the nasal cavity, causing your voice to sound different to yourself and others. This blockage can also allow the sinuses to fill with fluid, with the resulting pressure producing pain and discomfort.
The paranasal sinuses are named for the skull bone that each occupies. The frontal sinus is located just above the eyebrows, within the frontal bone (see Figure 7.17). This irregular space may be divided at the midline into bilateral spaces, or these may be fused into a single sinus space. The frontal sinus is the most anterior of the paranasal sinuses. The largest sinus is the maxillary sinus. These are paired and located within the right and left maxillary bones, where they occupy the area just below the orbits. The maxillary sinuses are most commonly involved during sinus infections. Because their connection to the nasal cavity is located high on their medial wall, they are difficult to drain. The sphenoid sinus is a single, midline sinus. It is located within the body of the sphenoid bone, just anterior and inferior to the sella turcica, thus making it the most posterior of the paranasal sinuses. The lateral aspects of the ethmoid bone contain multiple small spaces separated by very thin bony walls. Each of these spaces is called an ethmoid air cell. These are located on both sides of the ethmoid bone, between the upper nasal cavity and medial orbit, just behind the superior nasal conchae.
Figure 7.18Paranasal Sinuses The paranasal sinuses are hollow, air-filled spaces named for the skull bone that each occupies. The most anterior is the frontal sinus, located in the frontal bone above the eyebrows. The largest are the maxillary sinuses, located in the right and left maxillary bones below the orbits. The most posterior is the sphenoid sinus, located in the body of the sphenoid bone, under the sella turcica. The ethmoid air cells are multiple small spaces located in the right and left sides of the ethmoid bone, between the medial wall of the orbit and lateral wall of the upper nasal cavity.
Hyoid Bone:
The hyoid bone is an independent bone that does not contact any other bone and thus is not part of the skull (Figure 7.19). It is a small U-shaped bone located in the upper neck near the level of the inferior mandible, with the tips of the “U” pointing posteriorly. The hyoid serves as the base for the tongue above, and is attached to the larynx below and the pharynx posteriorly. The hyoid is held in position by a series of small muscles that attach to it either from above or below. These muscles act to move the hyoid up/down or forward/back. Movements of the hyoid are coordinated with movements of the tongue, larynx, and pharynx during swallowing and speaking.
Figure 7.19Hyoid Bone The hyoid bone is located in the upper neck and does not join with any other bone. It provides attachments for muscles that act on the tongue, larynx, and pharynx.
The skeletal system includes all of the bones, cartilages, and ligaments of the body that support and give shape to the body and body structures. The skeleton consists of the bones of the body. For adults, there are 206 bones in the skeleton. Younger individuals have higher numbers of bones because some bones fuse together during childhood and adolescence to form an adult bone. The primary functions of the skeleton are to provide a rigid, internal structure that can support the weight of the body against the force of gravity, and to provide a structure upon which muscles can act to produce movements of the body. The lower portion of the skeleton is specialized for stability during walking or running. In contrast, the upper skeleton has greater mobility and ranges of motion, features that allow you to lift and carry objects or turn your head and trunk.
In addition to providing for support and movements of the body, the skeleton has protective and storage functions. It protects the internal organs, including the brain, spinal cord, heart, lungs, and pelvic organs. The bones of the skeleton serve as the primary storage site for important minerals such as calcium and phosphate. The bone marrow found within bones stores fat and houses the blood-cell producing tissue of the body.
The skeleton is subdivided into two major divisions—the axial and appendicular.
The Axial Skeleton:
The skeleton is subdivided into two major divisions—the axial and appendicular. The axial skeleton forms the vertical, central axis of the body and includes all bones of the head, neck, chest, and back (Figure 7.2). It serves to protect the brain, spinal cord, heart, and lungs. It also serves as the attachment site for muscles that move the head, neck, and back, and for muscles that act across the shoulder and hip joints to move their corresponding limbs.
The axial skeleton of the adult consists of 80 bones, including the skull, the vertebral column, and the thoracic cage. The skull is formed by 22 bones. Also associated with the head are an additional seven bones, including the hyoid bone and the ear ossicles (three small bones found in each middle ear). The vertebral column consists of 24 bones, each called a vertebra, plus the sacrum and coccyx. The thoracic cage includes the 12 pairs of ribs, and the sternum, the flattened bone of the anterior chest.
Figure 7.2 Axial and Appendicular Skeleton The axial skeleton supports the head, neck, back, and chest and thus forms the vertical axis of the body. It consists of the skull, vertebral column (including the sacrum and coccyx), and the thoracic cage, formed by the ribs and sternum. The appendicular skeleton is made up of all bones of the upper and lower limbs.
The Appendicular Skeleton:
The appendicular skeleton includes all bones of the upper and lower limbs, plus the bones that attach each limb to the axial skeleton. There are 126 bones in the appendicular skeleton of an adult. The bones of the appendicular skeleton are covered in a separate chapter.
The skeletal system forms the rigid internal framework of the body. It consists of the bones, cartilages, and ligaments. Bones support the weight of the body, allow for body movements, and protect internal organs. Cartilage provides flexible strength and support for body structures such as the thoracic cage, the external ear, and the trachea and larynx. At joints of the body, cartilage can also unite adjacent bones or provide cushioning between them. Ligaments are the strong connective tissue bands that hold the bones at a moveable joint together and serve to prevent excessive movements of the joint that would result in injury. Providing movement of the skeleton are the muscles of the body, which are firmly attached to the skeleton via connective tissue structures called tendons. As muscles contract, they pull on the bones to produce movements of the body. Thus, without a skeleton, you would not be able to stand, run, or even feed yourself!
Each bone of the body serves a particular function, and therefore bones vary in size, shape, and strength based on these functions. For example, the bones of the lower back and lower limb are thick and strong to support your body weight. Similarly, the size of a bony landmark that serves as a muscle attachment site on an individual bone is related to the strength of this muscle. Muscles can apply very strong pulling forces to the bones of the skeleton. To resist these forces, bones have enlarged bony landmarks at sites where powerful muscles attach. This means that not only the size of a bone, but also its shape, is related to its function. For this reason, the identification of bony landmarks is important during your study of the skeletal system.
Bones are also dynamic organs that can modify their strength and thickness in response to changes in muscle strength or body weight. Thus, muscle attachment sites on bones will thicken if you begin a workout program that increases muscle strength. Similarly, the walls of weight-bearing bones will thicken if you gain body weight or begin pounding the pavement as part of a new running regimen. In contrast, a reduction in muscle strength or body weight will cause bones to become thinner. This may happen during a prolonged hospital stay, following limb immobilization in a cast, or going into the weightlessness of outer space. Even a change in diet, such as eating only soft food due to the loss of teeth, will result in a noticeable decrease in the size and thickness of the jaw bones.
