- List and identify the bones of the brain case and face
- Locate the major suture lines of the skull and name the bones associated with each
- Define the paranasal sinuses and identify the location of each
- Identify the bones and structures that form the nasal septum and nasal conchae, and locate the hyoid bone
- Identify the bony openings of the skull
- Anterior View of Skull
- Lateral View of Skull
- Bones of the Brain Case
- Sutures of the Skull
- Facial Bones of the Skull
- Paranasal Sinuses
- Hyoid Bone
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 6.16). 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.
Watch this video to view a rotating and exploded skull, with color-coded bones. Which bone (yellow) is centrally located and joins with most of the other bones of the skull?
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 6.17).
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 6.18).
Bones of the Brain Case
The interior space that is almost completely occupied by the brain is called the cranial cavity. The bones that form the top and sides of the brain case are usually referred to as the “flat” bones of the skull. The brain case consists of eight bones. These include the paired parietal and temporal bones, plus the unpaired frontal, occipital, sphenoid, and ethmoid bones.
The parietal bone forms most of the upper lateral side of the skull (see Figure 6.18). 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.
The temporal bone forms the lower lateral side of the skull (see Figure 6.18). 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 6.19). 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. 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 6.19.)
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 6.17). 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 6.20b).
The occipital bone is the single bone that forms the posterior skull and posterior base of the cranial cavity (Figure 6.21; see also Figure 6.20). 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.
The sphenoid bone is a single, complex bone of the central skull (Figure 6.22). 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 and also extends laterally to contribute to the sides of the skull (see Figure 6.18). 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.
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 6.23). On the interior of the skull, the ethmoid also forms a portion of the floor of the anterior cranial cavity.
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 6.24).
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.
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 6.18). 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 6.21). 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 6.18).
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.
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 6.18). 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 6.25). 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 6.20a). 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.
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 6.20a). Thus, the palatine bones are best seen in an inferior view of the skull and hard palate.
Homeostatic Imbalances: Cleft Lip and Cleft Palate
During embryonic development, the right and left maxilla bones come together at the midline to form the upper jaw. At the same time, the muscle and skin overlying these bones join together to form the upper lip. Inside the mouth, the palatine processes of the maxilla bones, along with the horizontal plates of the right and left palatine bones, join together to form the hard palate. If an error occurs in these developmental processes, a birth defect of cleft lip or cleft palate may result.
Cleft lip is a common development defect that affects approximately 1:1000 births, most of which are male. This defect involves a partial or complete failure of the right and left portions of the upper lip to fuse together, leaving a cleft (gap).
A more severe developmental defect is cleft palate, which affects the hard palate. The hard palate is the bony structure that separates the nasal cavity from the oral cavity. It is formed during embryonic development by the midline fusion of the horizontal plates from the right and left palatine bones and the palatine processes of the maxilla bones. Cleft palate affects approximately 1:2500 births and is more common in females. It results from a failure of the two halves of the hard palate to completely come together and fuse at the midline, thus leaving a gap between them. This gap allows for communication between the nasal and oral cavities. In severe cases, the bony gap continues into the anterior upper jaw where the alveolar processes of the maxilla bones also do not properly join together above the front teeth. If this occurs, a cleft lip will also be seen. Because of the communication between the oral and nasal cavities, a cleft palate makes it very difficult for an infant to generate the suckling needed for nursing, thus leaving the infant at risk for malnutrition. Surgical repair is required to correct cleft palate defects.
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 6.17). The short temporal process of the zygomatic bone projects posteriorly, where it forms the anterior portion of the zygomatic arch (see Figure 6.18).
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 6.17). These are the bones that are damaged when the nose is broken.
Each lacrimal bone is a small, rectangular bone that forms the anterior, medial wall of the orbit (see Figure 6.17 and Figure 6.18). 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 6.17). 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.
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 6.17). The vomer is best seen when looking from behind into the posterior openings of the nasal cavity (see Figure 6.20a). 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.
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 6.27).
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 6.18). 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.
- 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.
The paranasal sinuses are hollow, air-filled spaces located within certain bones of the skull (Figure 6.27). 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 6.27). 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.
The hyoid bone is an independent bone that does not contact any other bone and thus is not part of the skull (Figure 6.28). 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.