Antipyretics for children are prescribed by a pediatrician. But there are emergency situations for fever when the child needs to be given medicine immediately. Then the parents take responsibility and use antipyretic drugs. What is allowed to give to infants? How can you bring down the temperature in older children? What medicines are the safest?
SKELETON SYSTEM
SKULL BONES
Bones of the brain skull
The frontal bone (os frontale) in an adult is unpaired, participates in the formation of the anterior part of the cranial vault and the anterior cranial fossa. In the frontal bone, an anterior, vertically (frontally) located part is distinguished - the frontal scales, as well as the orbital and nasal parts (Fig. 44, 45).
The frontal scales (squama frontalis) have a convex outer surface (facies externa) and a concave inner surface (facies interna). Below, the scales are separated from the right and left orbital parts by a paired supraorbital margin (margo supraorbitalis), in which there is an infraorbital notch (incisura supraorbitalis) closer to the nasal part of the frontal bone. In this place, the supraorbital artery and nerve are adjacent to the bone. Often this notch turns into a supraorbital foramen (foramen supraorbitale). In the medial part of the supraorbital region there is a recess - frontal notch, through which the nerve of the same name and blood vessels. Laterally, the supraorbital margin passes into the zygomatic process (processus zygomaticus), which connects to the zygomatic bone. From the zygomatic process upward and backward along the surface of the scales, the temporal line (linea temporalis) departs - the place of attachment of the temporal fascia covering the temporal muscle. Slightly above each supraorbital edge, a convex ridge is visible - the superciliary arch (arcus superciliaris), passing medially into a smooth area - the glabella, or glabella (glabella). Above the superciliary arch is the frontal tubercle (tuber frontale) - the place where the primary ossification point of the frontal bone appears.
Rice. 45. Frontal bone, bottom view:
1 — Fossa for Iacrimal gland; Lacrimal fossa; 2 - Troehlearspine; 3- Supra-orbital margin; 4 - Nasa l margin; 5 - Nasal spine; 6 - Trochlear fovea; 7 - Supra-orbital notch/foramen; 8 - Orbital surface; 9— Ethmoidal notch; 10 - Orbital part
The inner (brain) surface (facies interna) of the frontal bone below passes into the horizontally located orbital parts. On the inner surface of the scales along the midline there is a groove of the superior sagittal sinus (siilcus sinus sagittalis superioris), which below passes into the frontal crest (crista frontalis). At the base of the crest is a blind hole (foramen caecum), where the process of the hard shell of the brain is fixed.
The orbital part (pars orbitalis) of the frontal bone is steam room, it is a thin plate lying horizontally. The right orbital part is separated from the left by a deep ethmoid notch (incisura ethmoidalis), in which the ethmoid plate of the ethmoid bone is placed. On the upper (brain) surface of the orbital parts, finger-like impressions and cerebral protrusions (elevations) are visible (impressiones digitatae et juga cerebralia - BNA).The lower (orbital) surface is smooth, concave, forming the upper wall of the orbits. Near the lateral angle of the orbital part is the fossa of the lacrimal gland(fossa glandulae lacrimalis), and near the supraorbital notch, a small depression - trochlear fossa(fovea trochlearis). Next to the fossa is a small trochlear spine (spina trochlearis), with which the cartilaginous block (trochlea) fuses for the tendon of the superior oblique muscle of the eye.
The nasal part (pars nasalis) of the frontal bone has the shape of a horseshoe. Located between the orbital parts, it limits the front and sides of the lattice notch. The anterior part of the nasal part is serrated, connected to the nasal bones and the frontal processes of the upper jaws. In the midline, a scallop departs downward from the nasal part, which ends with a sharp nasal spine (spina nasalis), which participates in the formation of the nasal septum. To the right and left of the scallop are the apertures of the frontal sinus (aperturae sinus frontalis). The frontal sinus (sinus frontalis) of an adult, which has a different size, contains air and is separated by a septum. In the posterior sections of the nasal part of the frontal bone there are pits that cover the cells of the ethmoid bone that are open upwards.
The occipital bone (os occipitale) forms the posterior part of the brain region of the skull. It distinguishes between the basilar (main), lateral parts and the occipital scales. All of them surround a large (occipital) foramen (foramen occipitale magnum), through which the cranial cavity communicates with the spinal canal (Fig. 46). The large (occipital) foramen of man, unlike other primates, is located not at the back, but at the bottom of the skull.
The basilar part (pars basilaris) is located in front of the large (occipital) foramen. By the age of 18-20, it fuses with the body of the sphenoid bone into a single structure. The cerebral surface (facies cerebralis) of the basilar part, together with the body of the sphenoid bone, forms a platform inclined towards the large occipital foramen - the clivus. A groove of the inferior stony sinus runs along the lateral edge of the basilar part. On its lower surface there is a well-defined pharyngeal tubercle (tuberculum pharyngeum) - the place of attachment of the posterior pharyngeal wall.
The lateral part (pars lateralis) is a steam room, located on the side of the large (occipital) foramen. Gradually expanding, it passes posteriorly into unpaired occipital scales. On the lower surface of each lateral part is a well-defined occipital condyle (condylus occipitalis) of an ellipsoid shape. The condyles, with their convex surface, articulate with the superior articular fossae of the atlas. Each lateral part above the condyle is pierced by the hypoglossal canal (canalis nervi hypoglossalis), in which the hypoglossal nerve (XII cranial nerve) passes. Immediately behind the occipital condyle is the condylar fossa (fossa condylaris), at the bottom of which there is an opening for the venous outlet - the condylar canal (canalis condylaris), in which the condylar emissary vein passes. The condylar canal opens at the posterior surface of the occipital condyle, and the hypoglossal canal opens at the top of the condyle. Laterally from the occipital condyle there is a jugular notch (incisura jugularis), behind this notch is limited by the jugular process directed upwards (processus jugularis). On the cerebral surface of the lateral part there is a well-defined groove of the sigmoid sinus (sulcus sinus sigmoidei).
The occipital scales (squama occipitalis) is a wide plate with a concave inner surface and a convex outer surface. In the center of the outer surface there is an external occipital protrusion (protuberantia occipitalis externa), from which the external occipital crest (crista occipitalis externa) descends down the midline to the posterior edge of the large (occipital) foramen. From the occipital protrusion to the right and to the left there is an upper nuchal line (linea nuchae superior) curved downwards. Parallel to the latter, approximately at the level of the middle of the external occipital crest, the lower nuchal line (linea nuchae inferior) departs from it in both directions. Above the external occipital protrusion there is a less noticeable highest nuchal line (linea nuchae suprema). Lines and tubercles are places of attachment of the occipital muscles and fascia. The external occipital protrusion, located in the center of the outer surface of the scales, is an important bony landmark on the back of the head.
On the inner, or cerebral, surface of the occipital scales there is a cruciform elevation (eminentia cruciformis), formed by furrows that divide the cerebral surface of the scales into four pits. The center of the cruciform eminence forms the internal occipital protuberance (protuberantia occipitalis interna). At the level of the ledge to the right and to the left there is a groove of the transverse sinus (sulcus sinus transversi), passing into the groove of the sigmoid sinus. The groove of the superior sagittal sinus extends upward from the internal occipital protrusion. The internal occipital protrusion narrows downward and continues as the internal occipital crest (crista occipitalis interna), which reaches the foramen magnum. The edges of the upper and lateral parts of the scales are strongly serrated. In these places, the occipital bone is connected to the parietal and temporal bones.
The parietal bone (os parietale) is paired, forms the upper lateral part of the cranial vault. The parietal bone is a quadrangular plate, convex outward and concave from the inside (Fig. 47). Three of its edges are serrated. The frontal (anterior) edge (margo frontalis) is connected to the frontal bone with a serrated suture; occipital (posterior) edge (margo occipitalis) - with the occipital bone; upper sagittal edge (margo sagittalis) - with the same bone of the other side; the fourth scaly (lower) edge (margo squamosus), obliquely cut, connects to the scales of the temporal bone.
Rice. 46. Occipital bone (A - position of the occipital bone on the outer base of the skull, B - view from below,
C - side view, right, D - inside view, front):
1 - Highest nuchal line; 2 - External occipital crest; 3 - Foramen magnum; 4- Condylar canat; 5 - Hypoglossal canal; 6 - Basilar part; 7 - Pharyngeal tubercle; 8 - Occipital condyle; 9 - Inferior nuchal line; 10— Superior nuchal line; eleven - External occipital protuberance; 12 - Jugular process; 13— internal occipital crest; 14 - Cruciform cminence; 15Groove for superior sagittal sinus; 16 - Squamous pari of occipital bone; 17 Groove for transverse sinus; 18- Groove for inferior petrosol sinus; 19—Jugular notch
Rice. 46-B. Side view. It is possible to estimate the size of the occipital scale located above the large occipital foramen. The internal openings of the condylar canal and the canal of the hypoglossal nerve are located next to the jugular process, which limits the jugular foramen from behind.
Rice. 46-G. View from the inside (front). The grooves of the venous sinuses of the dura mater are visible: the lower petrosal, sigmoid, transverse, superior sagittal sinuses. The cruciate eminence is located above the confluence of the superior sagittal and transverse sinuses. The shape of the elevation suggests that in some cases the sagittal sinus may flow into the left transverse sinus.
Four corners correspond to four edges: anterior superior frontal angle (angulus frontalis), anterior inferior wedge-shaped angle (angulus sphenoidalis), posterior superior occipital angle (angulus occipitalis), posterior inferior mastoid angle (angulus mastoideus).
In the center of the outer convex surface of the parietal bone protrudes parietal tubercle (tuber parietale). Somewhat below it there are two curved upper and lower temporal lines. (lineae temporales superior et inferior), from which the fascia and muscle of the same name begin.
The relief of the concave inner surface of the parietal bone is due to the adjacent hard shell of the brain and its vessels. The sulcus of the superior sagittal sinus runs along the upper edge of the parietal bone. (sulcus sinus sagittalis superioris). The superior sagittal sinus is adjacent to this sulcus, connected to the sulcus of the same name on the opposite side. In the region of the mastoid angle is the groove of the sigmoid sinus (sulcus sinus sigmoidei). On the inner surface of the bone there are tree-branched arterial grooves (sulci arteriosi) - traces of the fit of the meningeal arteries. Along the groove of the superior sagittal sinus, there are granulation pits of various sizes (foveolae granulares) - imprints of pachyon granulations of the arachnoid membrane of the brain.
Rice. 47. Parietal bone, right (A - external view):
1 - Mastoid angle; 2 - Occipital border; 3 - Occipital angie; 4 - Parictal tuber; parietal eminence; 5 - Parietal foramen; 6— Externa l surface; 7 - Sagitta l border; 8 - front angle; 9—Superior temporal line; 10— Inferior tempora line; eleven — Frontal border; 12 - Sphcnoidal angle; 13 - Squamosa l border
Rice. 47. Parietal bone, right (B - inside view):
1 - Frontal border; 2 - Frontal angle; 3 - Granular foveolae; 4 - Sagittal border; 5 - Groove for superior sagittal sinus; 6—Occipital angle; 7 - Internal surface; 8 - Occipital border: 9 - Grooves for arteries; 10 Groove for sigmoid sinus; 11 —mastoid angle; 12 - Squamosalborder; 13 - Sphenoidal angle
The ethmoid bone (os ethmoidale) is part of the anterior part of the base of the skull, as well as the facial skull, participating in the formation of the walls of the orbits and the nasal cavity (Fig. 48). In the ethmoid bone, a horizontally located ethmoid plate is distinguished. From it down the middle line goes a perpendicular plate. On the sides, ethmoid labyrinths are attached to the cribriform plate, which are closed from the outside by vertically (sagittally) located right and left orbital plates (Fig. 49, 50).
The cribriform plate (lamina cribrosa), located in the cribriform notch of the frontal bone, is involved in the formation of the bottom of the anterior cranial fossa and the upper wall of the nasal cavity. The plate, like a sieve, has numerous holes through which the olfactory filaments (I pair of cranial nerves) pass into the cranial cavity. A cockscomb (crista galli) rises above the cribriform plate along the midline, which continues anteriorly into a paired process - the wing of the cockscomb (ala cristae galli). These processes, together with the frontal bone lying in front, limit the blind opening (foramen caecum), in which the process of the hard shell of the brain is fixed.
The perpendicular plate (lamina perpendicularis), of an irregular pentagonal shape, is, as it were, a continuation of the cockscomb downwards. In the nasal cavity, the perpendicular plate, located sagittally, participates in the formation of the upper part of the septum of the nasal cavity.
Rice. 48. Location of the ethmoid bone on the internal base of the skull (A - internal base of the skull, top view, B - position of the ethmoid bone in the facial skull, front view. Frontal section through the orbits and nasal cavity)
Rice. 48. The upper surface of the ethmoid plate of the ethmoid bone forms part of the anterior cranial fossa, bundles of olfactory nerve fibers pass through the openings of the plate. The lower surface of the cribriform plate is involved in the formation of the upper wall, and the cribriform labyrinth is involved in the formation lateral wall nasal cavity. The lattice cells communicate with each other and with the nasal cavity. The ethmoid bone is limited by the frontal and sphenoid bones, occupies central position in the nasal cavity and participates in the formation of the medial wall of the orbit (orbital plate).
Labyrinth labyrinth (labyrinthus ethmoidalis) - paired, includes bone air-bearing lattice cells (cellulae ethmoidales), communicating with each other and with the nasal cavity. The lattice labyrinth is, as it were, suspended at the ends of the lattice plate to the right and left of the perpendicular plate. The medial surface of the ethmoid labyrinths, facing the nasal cavity, is covered by two thin curved bone plates - nasal conchas. The upper part of each turbinate is attached to the medial wall of the labyrinth cells, and the lower edge hangs freely into the gap between the labyrinth and the perpendicular plate. The superior nasal concha (concha nasalis superior) is attached at the top, below it and somewhat anteriorly is the middle nasal concha (concha nasalis media). Sometimes there is a weakly expressed third - the highest nasal concha (concha nasalis suprema). Between the upper and middle nasal conchas there is a narrow gap - the upper nasal passage (meatus nasi superior). Under the lower edge of the middle turbinate is the middle nasal passage (meatus nasi medius).
Rice. 49. Ethmoid bone (A - top view, B - front view):
1 - Perpendicular piate; 2 - Crista galli; 3 - Ethmoidal cells; 4 - Cribriform piate; 5 - Middle nasal concha; 6 - Orbital piate; 7—Superior nasal meatus
Rice. 49: A. A cribriform plate and a cockscomb are visible, to which the crescent of the brain is partially attached. Through the numerous openings of the cribriform plate, the fibers of the olfactory nerve pass from the nasal cavity to the anterior cranial fossa. Due to the thinness of the plate and the large number of holes in it, the cribriform plate is prone to injury. Most often, damage is clinically manifested by leakage of cerebrospinal fluid through the nose.
B. A perpendicular plate is visible, participating in the formation of the bony septum of the nose, dividing the nasal cavity into the right and left halves. The middle turbinate, which is part of the ethmoid bone, and the ethmoid cells grouped on either side of the middle turbinate are visible.
The posterior end of the middle nasal concha has a hook-shaped process (processus uncinatus) curved downwards, which, on the whole skull, is connected to the ethmoid process of the inferior concha. Behind the uncinate process, one of the large cells of the labyrinth protrudes into the middle nasal passage - the ethmoid vesicle (bulla ethmoidalis). Between this vesicle behind and above and the uncinate process below is a funnel-shaped gap - the ethmoid funnel (infundibulum ethmoidale), through which the frontal sinus communicates with the middle nasal passage.
On the lateral side, the ethmoidal labyrinths are covered by a smooth thin orbital plate (lamina orbitalis), which is part of the medial wall of the orbit. On the other sides, the ethmoid cells on an isolated ethmoid bone gape, and on the whole skull they are covered by neighboring bones: the frontal, lacrimal, sphenoid, palatine, and upper jaw.
Rice. 50. Ethmoid bone (A - topography of the ethmoid bone, B - side view, left, C - rear view):
1 - Orbital piate; 2 - Middle nasal concha; 3 - Posterior ethmoidal foramen; 4— - Anterior ethmoidal foramen; 5 - Ethmoidal cells; 6 - Crista galli; 7 - Perpendicular piate; uncinate process; 9 - Ethmoidal bulla; 10 - Superior nasal concha; 11 - Ethmoidal infundibulum
Rice. 50: B. Perpendicular plate and open anterior cribriform cells are visible. The orbits are separated from the ethmoid cells by a thin orbital plate.
B. Only in this position is the uncinate process visible. In other positions, it is almost completely covered by the middle turbinate. The uncinate process partially closes the entrance to the maxillary sinus. The lunar cleft is an important landmark during endoscopic operations on the maxillary sinus. The narrow depression between the middle nasal concha and the uncinate process is called the ethmoidal infundibulum. The frontal, maxillary sinuses, anterior and middle cells of the ethmoid bone open into the middle nasal passage. The superior turbinate is located at the posterior end of the ethmoid bone.
The temporal bone (os temporale) is a steam room, part of the base and lateral wall of the brain skull, located between the sphenoid bone (front), parietal (above) and occipital (behind). Inside the temporal bone is a receptacle for the organs of hearing and balance. Blood vessels and nerves pass through the canals of the temporal bone. The temporal bone forms a joint with the lower jaw and connects to the zygomatic bone, forming the zygomatic arch (arcus zygomaticus). The temporal bone consists of a pyramid (stony part) with a mastoid process, tympanic and squamous parts (Fig. 51.52).
The pyramid (stony part, pars petrosa) has the shape of a trihedral pyramid, it is called stony due to the hardness of the bone substance. The pyramid is located in the skull in an almost horizontal plane, its base, facing backwards and laterally, passes into the mastoid process. The top of the pyramid (apex partis petrosae) is directed forward and medially. There are three surfaces in the pyramid: anterior, posterior, and inferior. The anterior and posterior surfaces face the cranial cavity, the lower one is clearly visible from the side of the outer base of the skull. According to these surfaces, the pyramid has three edges: upper, front and rear.
Front surface of the pyramid (facies anterior partis petrosae), facing forward and upward, laterally passes into the cerebral surface of the squamous part. In the middle part of the anterior surface of the pyramid, a small arcuate elevation (eminentia arcuata) is visible, corresponding to the anterior (upper) semicircular canal of the bony labyrinth of the inner ear lying in the thickness of the pyramid. Between the arched elevation and the stony-scaly fissure is the roof of the tympanic cavity (tegmen tympani). Near the top of the pyramid on its front surface is the trigeminal impression (impressio trigemini) - the place where the trigeminal ganglion of the same name nerve fits. Lateral to the trigeminal depression there are two small openings: a cleft canal of the greater petrosal nerve (hiatus canalis nervi petrosi majoris), from which the groove of the greater stony nerve originates (sulcus nervi petrosi majoris).Somewhat anteriorly and laterally there is a cleft canal of the small stony nerve(hiatus canalis nervi petrosi minoris),continuing into the furrow of the lesser stony nerve(sulcus nervi petrosi minoris).
The top edge of the pyramid(margo superior partis petrosae)separates the front surface from the back. The groove of the superior petrosal sinus runs along this edge. (sulcus sinus petrosi superioris).
The back surface of the pyramid (facies posterior partis petrosae) facing back and medially. Approximately in the middle of the back surface of the pyramid is the internal auditory opening (porus acusticus internus), passing into a short wide canal - the internal auditory meatus (meatus acusticus internus), at the bottom of which there are several openings for the facial (VII nerve) and vestibulocochlear (VIII nerve). ) nerves, as well as for the artery and veins of the vestibulocochlear organ. Laterally and above the internal auditory opening is the subarc fossa (fossa subarcuata), into which the process of the dura mater of the brain enters. Below and lateral to this fossa is a small gap - the aperture of the tubule of the vestibule (apertura canaliculi vestibuli).
Rear edge of the pyramid (margo posterior partis petrosae) separates its back surface from the bottom. The groove of the inferior stony sinus passes through it. (sulcus sinus petrosi inferioris). Approximately in the middle of the posterior edge, next to the jugular notch, a dimple is visible, at the bottom of which the aperture of the cochlear tubule is located (apertura canaliculi cochleae).
Bottom surface of the pyramid (facies inferior partis petrosae) on the side of the outer base of the skull has a complex relief. Closer to the base of the pyramid is a rather deep jugular fossa (fossa jugularis), on the front wall of which there is a groove ending in the opening of the mastoid canaliculus (canaliculus mastoideus), in which the ear branch of the vagus nerve passes. The jugular fossa does not have a wall on the back side, it is limited by the jugular notch (incisura jugularis), which, together with the notch of the same name of the occipital bone, forms a jugular foramen (foramen jugulare) on the whole skull. Through it pass the internal jugular vein and three cranial nerves: glossopharyngeal (IX cranial nerve), vagus (X nerve) and accessory (XI nerve). Anterior to the jugular fossa is the external aperture of the carotid canal ( apertura externa canalis carotici) - the beginning of the sleep canal. Its internal aperture (apertura interna canalis carotici) opens at the top of the pyramid. In the wall of the carotid canal, near its external opening, there are two small dimples that continue into thin carotid tympanic tubules. (canaliculi caroticotympanici), in which the carotid-tympanic nerves, originating from the autonomic plexus of the internal carotid artery, pass into the tympanic cavity. In the comb separating the external opening of the carotid canal from the jugular fossa, a stony dimple (fossula petrosa) is barely visible. At its bottom, the lower opening of the tympanic tubule opens (apertura inferior canaliculi tympanici - BNA), in which the inferior tympanic artery (a branch of the ascending pharyngeal) and the tympanic branch of the glossopharyngeal nerve (IX nerve) pass. Lateral to the jugular fossa, near the mastoid process, a thin long styloid process protrudes (processus styloideus), from which the stylopharyngeal and stylohyoid muscles begin.
Rice. 51. Temporal bone, right (A - the temporal bone as part of the skull and its parts are highlighted in color, B - ventral view, parts of the temporal bone are highlighted in different colors, C - ventral view):
1 - Occipital bone; 2 - Temporal bone; 3 - parietal bone; 4 - Sphenoid; Sphenoid bone; 5 - Zygomatic bone; 6 - Petrous part; 7 - Squa-mouspart; 8 - Tympanic part; 9— Mandibularfossa; 10 - Styloid process; 11 —Mastoidforamen; 12 - Mastoid notch; 13— Mastoid process; 14 - External acoustic opcning; 15— Zygomatic process; 16 - Articular tubercle; 17 - Carotid canal; 18 - Jugular lossa; 19 - Stylomastoid foramen
Rice. 51. Position of the temporal bone in the skull
The temporal bone is one of the main structures at the base of the skull. It forms the bone capsule of the organ of hearing and balance, participates in the formation of the temporomandibular joint.
Centers of ossification (ossification) of the left temporal bone
The temporal bone develops from three ossification centers that form a single bone.
The squamous part develops from the connective tissue, bypassing the cartilaginous stage (blue).
Stony part, or pyramid ( purple), goes through all three stages of osteogenesis (connective tissue, cartilage, bone). The stony part contains auditory and vestibular analyzers, develops after the appearance of ossification points in the cartilaginous auditory capsule.
The tympanic part (green color) develops on the basis of the connective tissue, forms the main part of the external auditory canal. The styloid process develops on the basis of cartilage.
Rice. 52. Temporal bone, right (A - side view: parts of the temporal bone are highlighted in different colors, B - side view, C - inside view):
1 - Petreus part; 2 - Squamous part; 3 - Tympanic part; 4 - Mastoid process; 5— Mastoid foramen; 6 - Styloid process; 7 - Tympanomastoid fissure; 8— Extemal acoustic meatus; 9 - External acoustic opening; 10 - Mandibular fossa; eleven- Arliculartubercle; 1 2 - Temporal surface; 13 - Zygomatic process; 14 - Petrotvmpanic fissure; 15 - Styloid process; 16 - Posterior bordcrof pctrous part; 17 - Superior borderof petrouspart; 18- Apex of petrous part; 19 - Internal acoustic meatus; 20— arterial grooves; 21 - Subarcuate fossa; 22 Groove for sigmoid sinus
Between the styloid and mastoid processes is the stylomastoid foramen (foramen stylomastoideum), through which the facial nerve (VII nerve) and the stylomastoid vein emerge from the facial canal of the temporal bone. The stylomastoid artery, a branch of the posterior auricular artery, enters the canal through this opening.
The lower surface of the pyramid is separated from its anterior surface by the front edge, which is delimited from the scale by a stony-scaly fissure (fissOra petrosquamosa). Next to it, on the front short edge of the pyramid, there is an opening of the musculo-tubal canal (canalis musculotubarius), leading to the tympanic cavity. This canal is divided by a septum into a semi-canal of the muscle that strains eardrum and semi-canal of the auditory tube (semicanalis tubae auditivae).
The mastoid process (processus mastoideus) is located behind the external auditory canal. At the top, it is separated from the scales by a parietal notch (incisura parietalis). The outer surface of the process is convex, rough. The sternocleidomastoid and other muscles are attached to it. Below, the mastoid process is rounded (palpable through the skin). On the medial side, the process is limited by a deep mastoid notch (incisura mastoidea). Medial to this notch is the sulcus of the occipital artery. (sulcus arteriae occipitalis). At the base of the mastoid process, closer to the posterior edge of the temporal bone, there is a non-permanent mastoid opening (foramen mastoideum) for the mastoid emissary vein and the mastoid branch of the occipital artery. On the inner surface of the mastoid process facing the cranial cavity, a wide groove of the sigmoid sinus is visible. Inside the process are mastoid cells separated from each other by bone bridges (cellulae mastoideae). The largest of them - the mastoid cave (antrum mastoideum) - communicates with the tympanic cavity.
The tympanic part (pars tympanica) of the temporal bone is a small plate, curved in the form of a gutter and open at the top. Merging with its edges with the squamous part and with the mastoid process of the temporal bone, it limits the external auditory opening (porus acusticus externus) in front, below and behind. The continuation of this opening is the external auditory canal (meatus acusticus externus), which reaches the tympanic membrane, which separates the auditory canal from the tympanic cavity. On the border of the tympanic part and the mastoid process, behind the external auditory canal, there is a tympanomastoid fissure (fissura tympanomastoidea), through which the ear branch of the vagus nerve emerges from the mastoid canal to the surface of the bone.
In front of the external auditory opening (under the mandibular fossa) is a tympanic fissure (fissura tympanosquamosa), into which a bone plate (lamina tympani) enters from the inside, adjacent to the stony part. As a result, the tympanic-squamous fissure is divided into two: closer to the mandibular fossa, a stony-squamous fissure (fissOra petrosquamosa) is visible; Johann (Glaser Johann Heinrich, 1629-1675) - Swiss physician and anatomist; Huguier Pierre Charles (1804–1874) French physician and anatomist Civinini Philippo (1805-1854), Italian anatomist. Through the stony-tympanic fissure, a branch emerges from the tympanic cavity facial nerve(VII nerve) - drum string.
The scaly part (pars squamosa) is a convex outward plate with a beveled free upper edge (Fig. 53). It is superimposed like scales (squama - scales) on the corresponding edge of the parietal bone and the large wing of the sphenoid bone, at the bottom the scales are connected to the pyramid, mastoid process and tympanic part of the temporal bone. On the outer smooth temporal surface (facies temporalis) of the vertical part of the scale involved in the formation of the temporal fossa, the groove of the middle temporal artery runs vertically (sulcus arteriae temporalis mediae).
From the scales somewhat higher and anterior to the external auditory opening, the zygomatic process (processus zygomaticus) begins, which goes forward and connects with the temporal process of the zygomatic bone with its serrated end, forming the zygomatic arch. At the base of the zygomatic process is the mandibular fossa (fossa mandibularis) for articulation with the condylar (articular) process of the lower jaw. In front, the mandibular fossa is limited by the articular tubercle (tuberculum articulare), which separates it from the infratemporal fossa. On the cerebral surface (facies cerebralis) of the squamous part, finger-like impressions and arterial grooves are visible - traces of the adjacent convolutions of the brain, the middle meningeal artery and its branches.
Canals of the temporal bone (Table 11). The carotid canal (canalis caroticus), through which the internal carotid artery and the internal carotid (vegetative) plexus pass into the cranial cavity, begins on the lower surface of the temporal bone pyramid with the external opening of the carotid canal. Further, the carotid canal rises, bends at a right angle, goes forward and medially. The canal opens in the cranial cavity with an internal carotid foramen.
Rice. 53. Temporal bone, right, view from inside and from above:
1 - Carotica canal; 2 - Petrotis part; 3 - Anterior surface of petrous pari; 4 - Groove for greater petrosal nerve; 5 - Sphenoidal margin; 6Groove for lesser petrosal nerve; 7- Hiatus for lesser petrosal nerve; 8 - Hiatus for greater petrosal nerve; 9- parietal margin; 10 - C e rebral surface; eleven — Petrosquamous fissure; 12 - Tegmen tympani; 13 - arcuate eminence; 14Groove for superior petrosal sinus; 15 - Parietal notch; 1 6— Groove for sigmoid sinus; 17 - Mastoid ceils; 18 - Occipital margin; 19- Superior border of petrous part; 20- Trigemina l Impression
The musculoskeletal canal (canalis musculotubarius) has a common wall with the carotid canal. It starts at the anterior edge of the pyramid near its border with the scales of the temporal bone, goes posteriorly and laterally, parallel to the anterior edge of the pyramid. The musculo-tubal canal is divided by a septum into two semi-canals: the upper one is the semi-canal of the muscle that strains the eardrum (semicanalis musculi tensoris tympani), is occupied by the muscle of the same name, and the lower one - the semicanal of the auditory tube (semicanalis tubae auditivae) - is the bone part of this tube. Both semi-channels open into the tympanic cavity on its anterior wall.
The facial canal (canalis facialis), in which the facial nerve and blood vessels pass, begins at the bottom of the internal auditory canal. Then, in the thickness of the pyramid of the temporal bone, the facial canal goes horizontally forward, perpendicular to the longitudinal axis of the pyramid. Having reached the level of the cleft of the canal of the large stony nerve, the canal leaves laterally and posteriorly at a right angle, forming a bend, or knee of the facial canal (geniculum canalis facialis). Further, the canal follows horizontally back along the axis of the pyramid to its base, where it turns vertically down, bending around the tympanic cavity. On the lower surface of the pyramid, the canal ends with a stylomastoid opening.
The tubule of the tympanic string (canaliculus chordae tympani) starts from the canal of the facial nerve slightly above the stylomastoid foramen, goes forward and opens into the tympanic cavity. In this tubule passes a branch of the facial nerve - a tympanic string (chorda tympani), which then exits the tympanic cavity through the stony-tympanic fissure.
Table 11. Canals of the temporal bone
|
Name |
Channel start |
Messages (branches) along the channel and its end |
What's going on in the channel |
|
sleepy channel (Canalis caroticus; Carotid canal) |
External carotid foramen on the lower surface of the pyramid |
Sleepy-tympanic tubules (see below). Internal carotid foramen at the top of the pyramid in the cranial cavity |
Internal carotid artery, accompanied by the venous plexus of the same name and the internal carotid (vegetative) nerve plexus |
|
Carotid tubules (Canaliculi caroticotympanici; Caroticotympanic canaliculi) |
Holes on the wall of the carotid canal (at its beginning) |
Holes on the anterior (carotid) wall of the tympanic cavity |
Carotid-tympanic nerves (branches of the internal carotid plexus); carotid-tympanic arteries (from the internal carotid artery) |
|
facial nerve canal (Canalis nervi facialis; Facial canal) |
internal auditory canal |
Along the channel on the front surface of the pyramid - a cleft of the large stony nerve; in the lower section - the opening of the tubule of the drum string (see below). End - stylomastoid foramen |
Facial nerve (VII pair); superficial petrosal branch (from the middle meningeal artery) - above, stylomastoid artery and vein - below |
|
Drum string tubule (Canaliculus chordae tympani; Canaliculus for chorda tympani) |
Hole in the lower part of the facial canal |
An opening in the posterior (mastoid) wall of the tympanic cavity |
The drum string is a branch of the facial nerve. Leaves the tympanic cavity through the stony-tympanic (Glazerov) fissure |
|
drum tubule (Canaliculus tympanicus; Tympanic canaliculus) |
In a rocky dimple on the bottom surface of the pyramid |
An opening in the lower (jugular) wall of the tympanic cavity where the canal terminates. The nerve passes along its medial (labyrinthine) wall and ends on the anterior surface of the pyramid with a cleft canal of the small stony nerve |
The tympanic nerve, which at the exit from the tympanic cavity is called the small stony nerve (branch of the IX pair); superior tympanic artery (branch of middle meningeal artery) |
|
Musculo-tubal canal (Canalis musculotubarius; Musculotubal canal)(divided into 2 half-channels: the upper one is the half-channel of the muscle straining the eardrum (Semicanalis musculi tensoris tympani; Canal for tensor tympani), lower - semi-canal of the auditory tube (Semicanalis tubae auditivae, Semicanalis tubae auditoriae; Canal for pharyngotympanic tube; Canal for auditory tube)) |
Begins at the junction of the anterior edge of the pyramid with the scales of the temporal bone at the apex of the pyramid |
Ends with holes on the anterior (carotid) wall of the tympanic cavity |
Tensor tympanic membrane muscle and auditory tube |
The tympanic tubule (canaliculus tympanicus) begins with a lower opening in the depths of the stony pit on the lower surface of the temporal bone pyramid, then rises upward into the tympanic cavity through its lower wall. Further, the tubule continues in the form of a furrow (sulcus promontorii) on the labyrinth wall of this cavity on the surface of the cape (promontorium). Then the tubule perforates the upper wall of the tympanic cavity and ends with a cleft of the canal of the small stony nerve on the anterior surface of the pyramid. The tympanic nerve, a branch of the glossopharyngeal nerve, passes through the tympanic tubule.
The mastoid tubule (canaliculus mastoideus) originates in the jugular fossa, crosses the facial canal in its lower part and opens into the tympanic-mastoid fissure. The auricular branch of the vagus nerve passes through this tubule.
Carotid-tympanic tubules (canaliculi caroticotympanici) begin on the wall of the carotid canal near its outer opening and penetrate into the tympanic cavity. Nerves and arteries of the same name pass through both tubules into the tympanic cavity.
The sphenoid bone (os sphenoidale) is located in the center of the base of the skull, it is involved in the formation of the lateral walls of the vault, as well as the cavities and pits of the brain and facial sections of the skull (Fig. 54). The sphenoid bone consists of a body from which three pairs of processes extend: large wings, small wings and pterygoid processes (Fig. 55).
Inside the body (cdrpus) of the sphenoid bone of an irregular cuboid shape is a cavity - the sphenoid sinus (sinus sphenoidalis). Six surfaces are distinguished on the body: the upper, or cerebral; back, fused in adults with the basilar (main) part of the occipital bone; anterior, passing without sharp boundaries into the lower; two side.
Rice. 54. Sphenoid bone in the skull
Location of the sphenoid bone in the skull
The sphenoid bone is one of the most complex among all the bones of the skull.
A. Side view. Part of the greater wing of the sphenoid bone can be seen above the zygomatic arch, and parts of the pterygoid processes below the zygomatic arch.
B. Base of the skull, internal view. The sphenoid bone is the link between the anterior and middle cranial fossae. The holes through which the nerves and blood vessels pass are clearly visible.
B. Base of the skull, external view. The body of the sphenoid bone connects to the basilar part of the occipital bone, forming a clivus.
Rice. 55. Sphenoid bone (A - front view, B - bottom view):
1 - Spine ofsphenoid bone; 2— lesser wing; 3 - Sphenoidal crest; 4 - Opening ofsphenoidal sinus; 5—Superior orbital fissure; 6 - Orbital surface; 7— Temporal surface; 8 - Foramen rotundum; 9 - Pterygoid canal; 10— Pterygoid fossa; 11 - Pterygoid hamulus; 1 2— Sphenoidal concha; 13 - Pterygoid process, medial piate; 14 - Pterygoid process, lateral piate; 15 - Foramen spinosum; 16 - Foramen ovale; 17 - Greaterwing; 18 - Body of sphenoid
On the upper surface (facies superior) a recess is noticeable - the Turkish saddle (sella turcica). In the center of the Turkish saddle there is a pituitary fossa (fossa hypophysialis), in which the endocrine gland, the pituitary gland, is located. Anterior to the recess is a transverse tubercle of the saddle (tuberculum sellae), behind is the high back of the saddle (dorsum sellae). The lateral parts of the back of the saddle are inclined anteriorly - these are the posterior inclined processes (processus clinoidei posteriores). At the base of the back of the saddle on the right and left there is a groove in which the internal carotid artery passes - the carotid sulcus (sulcus caroticus).
Outside and somewhat posterior to the carotid groove is a wedge-shaped tongue (lingula sphenoidalis), which turns the carotid groove into a deep groove. This groove, together with the top of the pyramid of the temporal bone, limits the internal carotid foramen, through which the internal carotid artery enters the cranial cavity from the carotid canal.
The anterior surface of the body of the sphenoid bone is extended into a small wedge-shaped ridge (crista sphenoidalis). The latter continues on the lower surface of the body of the sphenoid bone in the form of a sharp wedge-shaped beak (rostrum sphenoidale). The sphenoid ridge connects with its anterior edge to the perpendicular plate of the ethmoid bone.
Rice. 55. Sphenoid bone (B - rear view, D - top view):
1 — Spongy bone; Trabcular bone; 2, Ptcrygoid fossa; 3 - Pterygoid canal; 4 - Spinc of sphenoid bone; 5 - Anterior clinoid procss; 6 - Lesserwing; 7 - optical channel; 8 - Dorsum sellae; 9 - Posterior clinoid process; 10— Greaterwing. cerebra! surface; 11 - Superior orbital fissure; 12 - Foramen rotundum; 13 - Seaphoid fossa; 14 - Pterygoid process, lateral piate; 15 - Pterygoid process. medial piate; 16 - Sella turcica; 17 - Foramen spinosum; 18 - Foramen ovale; 19 - Carotid sulcus; 20 - Jugum sphenoidale; Sphenoidal yokc; 21 - Carotid sulcus;22 - Greater swing; 23 - Hypophysial fossa
On the sides of the ridge there are irregularly shaped bone plates - wedge-shaped shells (conchae sphenoidales), limiting the apertures of the sphenoid sinus ( aperturae sinus sphenoidalis), leading to the airy sphenoid sinus (sinus sphenoidalis), most often divided by a septum into two parts. The lateral surfaces of the body of the sphenoid bone continue anteriorly and downwards into the small and large wings.
The small wing (ala minor) is a paired horizontal plate extending from each side of the body of the sphenoid bone with two roots. Between the latter is the optic canal (canalis opticus), through which passes from the orbit optic nerve. The lesser wing has an upper surface facing the cranial cavity, and a lower one participating in the formation of the upper wall of the orbit. The anterior edges of the small wings are serrated; the orbital part of the frontal bone and the ethmoid plate of the ethmoid bone are connected to them on the right and left. The smooth posterior edges of the lesser wings face the cranial cavity. On the medial side, each small wing has an anterior inclined process. (processus clinoideus anterior). The dura mater fuses with the anterior and posterior inclined processes.
The large wing (ala major) of the sphenoid bone is paired, begins with a wide base from the lateral surface of the body. At the very base, each wing has three holes. Above the others and in front is a round hole (foramen rotundum), through which the second branch of the trigeminal nerve passes. In the middle of the large wing, an oval hole (foramen ovale) is visible, through which the third branch of the trigeminal nerve passes. The spinous opening (foramen spinosum) of a smaller size, intended for the middle meningeal (sheath) artery, is located in the region of the posterior angle of the large wing.
The large wing has four surfaces: cerebral, orbital, maxillary and temporal. On the concave cerebral surface (facies cerebralis), digital depressions, cerebral protrusions and arterial grooves (sulci arteriosi) are well expressed. The quadrangular smooth orbital surface (facies orbitalis) is part of the lateral wall of the orbit. The maxillary surface (facies maxillaris) occupies a triangular area between the orbital surface at the top and the base of the pterygoid process at the bottom. On this surface, facing the pterygopalatine fossa, a round hole opens. The temporal surface (facies temporalis) is the most extensive, the infratemporal crest (crista infratemporalis) divides it into two parts. The upper part of the large wing, located almost vertically, is part of the wall of the temporal fossa. The lower part of the wing, located almost horizontally, forms the upper wall of the infratemporal fossa.
Between the small and large wings is the upper orbital fissure (fissura orbitalis superior). The oculomotor, trochlear, and abducens nerves (III, IV, VI cranial nerves) and the ophthalmic nerve, the first branch of the trigeminal nerve (V nerve), pass through it from the cranial cavity to the orbit.
The pterygoid process (processus pterygoideus) is paired, departs downward from the body of the sphenoid bone at the site of the beginning of the large wing. It consists of two plates - medial (lamina medialis) and lateral (lamina lateralis), fused at the front edges. Below, both plates are separated by a pterygoid notch (incisura pterygoidea). The medial plate below passes into the pterygoid hook (hamulus pterygoideus). The medial surface of the pterygoid process, facing the nasal cavity, forms the posterior part of its lateral wall. The lateral plate serves as the medial wall of the infratemporal fossa. The base of the process pierces from front to back a narrow pterygoid canal (canalis pterygoideus), which serves to pass into the pterygo-palatine fossa of the deep stony nerve (a branch of the facial nerve) and the sympathetic nerve (from the internal carotid plexus). From the fossa through this canal to the upper part of the pharynx passes the artery of the pterygoid canal. The anterior opening of the pterygoid canal opens into the pterygopalatine fossa, the posterior opening on the outer base of the skull near the spine of the sphenoid bone (in the region of the torn opening). Along the anterior edge of the pterygoid process, the pterygopalatine sulcus (sulcus pterygopalatinus - BNA), open in front, passes from top to bottom. Posteriorly, the plates of the pterygoid process diverge, here a pterygoid fossa (fossa pterygoidea) is formed, in which the medial pterygoid muscle (chewing) begins.
Osparietale - a steam room, quadrangular in shape, has the form of a bowl, forms the upper and side parts of the cranial vault. Develops on the ground. It distinguishes two surfaces - external, fades externa, and internal, fades interna, and four edges: upper (sagittal, margo sagittalis), lower (scaly, margo squamosus), anterior (frontal, margo frontalis) and rear (occipital, margo occipitalis).
According to the four edges, the parietal bone has four corners: frontal, angulus frontalis; occipital, angulus occipitalis; wedge-shaped, angulus sphenoidalis; mastoid, angulus mastoideus.
The outer surface of the parietal bone is smooth and convex. The place of greatest convexity is called the parietal tubercles, tuber perietale. Below the hill are horizontal upper and lower temporal lines, linea temporales superior et inferior. The upper temporal line is the site of attachment of the temporal fascia, and the lower line is the site of attachment of the temporalis muscle.
The inner surface is concave. It shows the imprints of the relief of the brain - finger-shaped squeezes, impressiones digitatae, as well as arterial grooves, sulci arterioles, middle meningeal artery, sul. a. meningea mediae.
An incomplete furrow of the superior sagittal sinus, sul, runs along the upper edge of the cerebral surface. sinus sagittalis superior. In the back of the same upper edge of the bone there is a small parietal opening, foramen parietale, which is a venous graduate, emissario, in which the parietal emissary vein passes, connecting the superficial temporal vein with the superior sagittal sinus. In the depth of the sagittal groove and next to it, a large number of dimples of granulations of the arachnoid membrane, foveolae granulares, are observed. On the cerebral surface, at the mastoid angle, lies a small deep groove of the sigmoid sinus, sul. sinus sigmoidei, one end of which passes into the temporal bone groove of the same name, and the second into the groove of the occipital sinus of the occipital bone.
The upper (sagittal) edge is longer than all the others, participates in the formation of the sagittal suture, sutura sagittalis.
The lower (scaly) edge is arcuate, participates in the formation of scaly, parieto-mastoid and wedge-parietal sutures.
The anterior (frontal) edge connects with the parietal edge of the scales of the frontal bone, forming the coronal suture, sutura coronalis.
The posterior (occipital) edge is connected to the lambda-shaped edge of the occipital bone, forming a lambda-shaped suture, sutura lambdoidea.
ossification. Ossification points occur at 2 months of intrauterine development in the region of the parietal tubercle. The ossification of the parietal bone is completed at the 2nd year of life.
Parietal bone, os parietale, a pair of quadrangular-shaped flat bone, concave in the form of a bowl. Forms most of the roof of the skull. It distinguishes between a convex outer surface, facies externa, and a concave inner, facies interna, 4 edges, passing one into another through four corners. The anterior, frontal, margo frontalis, is connected to the scales of the frontal bone, the posterior, occipital, margo occipitalis - to the scales of the occipital bone. The upper edge is sagittal, margo sagittalis, located in the sagittal direction and connected to the corresponding edge of the bone of the opposite side. The lower edge is scaly, margo squamosus, adjacent to the scales of the temporal bone. Upper rake angle- frontal, angulus frontalis, and upper rear - occipital, angulus occipitalis, almost straight. The anterior lower angle is wedge-shaped, angulus sphenoidalis, connects to the greater wing of the sphenoid bone, sharp, and the posterior lower angle is mastoid, angulus mastoideus, obtuse, adjacent to the mastoid part of the temporal bone.
On the outer surface of the parietal bone is the parietal tubercle, tuber parietale; below it pass the upper and lower temporal lines, lineae temporales superior et inferior, facing the convexity of the top. The upper temporal line is the site of attachment of the temporal fascia, the lower - the temporal muscle. At the sagittal edge there is a parietal opening, foramen parietalae, through which a graduate passes, connecting the superior sagittal sinus and the veins of the soft tissues of the cranial vault.
On the inner surface of the parietal bone along the sagittal edge, a sagittally extending groove of the superior sagittal sinus, sulcus sinus sagittalis superioris, is noticeable, which, connecting with the groove of the same name of another parietal bone, serves as the location of the superior sagittal sinus. Near this furrow there are pits, foveolae granulares, - traces of granulations of the arachnoid membrane, which are differently expressed and sometimes presented in the form of holes (especially in the elderly). On the inner surface of the parietal bone there are digital impressions, cerebral eminences and arterial grooves. The arterial sulcus comes from the main angle and is a trace of the location in this area of the middle artery of the dura mater. On the inner surface of the mastoid angle is a wide groove of the sigmoid sinus, sulcus sinus sigmoidei.
Ossification. The parietal bone is formed from two ossification points located one above the other in the region of the parietal tubercle and appearing at the end of the 2nd month of intrauterine development. The end of the process of ossification of the parietal bone ends in the 2nd year of life.
Occipital bone
Occipital bone, os occipitalae, unpaired, makes up the back of the base and roof of the skull. It distinguishes four parts: the main, pars basilaris, two lateral, partes laterales, and scales, squama. In a child, these parts are separate bones connected by cartilage. On the 3-6th year of life, the cartilage ossifies and they fuse together into one bone. All these parts join together to form a large opening, the foramen magnum. In this case, the scales lie behind this hole, the main part is in front, and the lateral ones are on the sides. The scales are mainly involved in the formation of the back of the skull roof, and the main and lateral parts are the base of the skull.
The main part of the occipital bone is wedge-shaped, the base of which faces forward to the sphenoid bone, and the apex is posterior, limiting the large opening in front. In the main part, five surfaces are distinguished, of which the upper and lower are connected behind at the anterior edge of the occipital foramen. The anterior surface is connected to the sphenoid bone until the age of 18-20 with the help of cartilage, which subsequently ossifies. The upper surface - the slope, clivus, is concave in the form of a gutter, which is located in the sagittal direction. The medulla oblongata, pons, blood vessels and nerves are adjacent to the slope. In the middle of the lower surface is the pharyngeal tubercle, tuberculum pharyngeum, to which the initial part of the pharynx is attached. On the sides of the pharyngeal tubercle, two transverse ridges extend from each side, of which m is attached to the anterior one. longus capitis, and to the back - m. rectus capitis anterior. Lateral rough surfaces of the main part are connected by means of cartilage to the petrous part of the temporal bone. On their upper surface, near the lateral edge, there is a small groove of the lower petrosal sinus, sulcus sinus petrosi inferioris. It is in contact with a similar groove in the petrous part of the temporal bone and serves as a place to which the inferior petrosal venous sinus of the dura is adjacent.
The lateral part is located on both sides of the foramen magnum and connects the main part to the scales. Its medial edge faces the foramen magnum, the lateral edge faces the temporal bone. The lateral edge carries the jugular notch, incisura jugularis, which, with the corresponding notch of the temporal bone, limits the jugular foramen. The intra-jugular process, processus intra] ugularis, located along the edge of the notch of the occipital bone, divides the opening into anterior and posterior. In the anterior passes the internal jugular vein, in the posterior - IX, X, XI pairs of cranial nerves. The back of the jugular notch is limited by the base of the jugular process, processus jugularis, which faces the cranial cavity. Behind and inside of the jugular process on the inner surface of the lateral part is a deep groove of the transverse sinus, sulcus sinus transversi. In the anterior part of the lateral part, on the border with the main part, there is a jugular tubercle, tuberculum jugulare, and on the lower surface there is an occipital condyle, condylus occipitalis, with which the skull articulates with the 1st cervical vertebra. The condyles, according to the shape of the upper articular surface of the atlas, form oblong ridges with convex oval articular surfaces. Behind each condyle there is a condylar fossa, fossa condylaris, at the bottom of which there is a visible opening of the outlet canal connecting the veins of the meninges with the external veins of the head. This hole is absent in half of the cases on both sides or on one side. Its width is highly variable. The base of the occipital condyle is pierced by the hypoglossal nerve canal, canalis hypoglossi.
The occipital scales, squama occipitalis, are triangular in shape, curved, its base facing the occipital foramen, the apex facing the parietal bones. The upper edge of the scales is connected to the parietal bones by means of a lambdoid suture, and the lower edge is connected to the mastoid parts of the temporal bones. In this regard, the upper edge of the scales is called lambdoid, margo lambdoideus, and the lower edge is mastoid, margo mastoideus. The outer surface of the scales is convex, in its middle there is an external occipital protrusion, protuberantia occipitalis externa, from which the external occipital crest, crista occipitalis externa, descends vertically down towards the occipital foramen, intersecting in pairs with two nuchal lines, lineae nuchae superior et inferior. In some cases, the highest nuchal line, lineae nuchae suprema, is also noted. Muscles and ligaments are attached to these lines. The inner surface of the occipital scale is concave, forming in the center an internal occipital protrusion, protuberantia occipitalis interna, which is the center of the cruciform eminence, eminentia cruciformis. This elevation divides the inner surface of the scale into four separate depressions. The occipital lobes of the brain adjoin the two upper ones, and the cerebellar hemispheres adjoin the two lower ones.
Ossification. It begins at the beginning of the 3rd month of intrauterine development, when islands of ossification appear both in the cartilaginous and connective tissue parts of the occipital bone. In the cartilaginous part, five ossification points arise, of which one is in the main part, two in the lateral parts, and two in the cartilaginous part of the scale. Two ossification points appear in the connective tissue upper part of the scale. By the end of the 3rd month, the fusion of the upper and lower sections of the scales occurs; in the 3rd-6th year, the main part, lateral parts and scales grow together.
frontal bone
frontal bone, os frontale, has the shape of a shell and is involved in the formation of the base, the roof of the skull, as well as the walls of the orbits and the nasal cavity. The following parts are distinguished in the frontal bone: unpaired - frontal scales, squama frontalis, and nasal, pars nasalis, and paired - orbital parts, partes orbitales. The scales have two surfaces: outer, fades externa, and inner, fades interna. The outer surface is convex, smooth, composed of two halves connected by a frontal suture. By the age of 5, this suture is usually overgrown. However, often the suture does not heal, and the frontal bone remains divided into two halves. Two frontal tubercles, tuber frontale, corresponding to the initial ossification points, are defined on the sides of the suture. Under the tubercles are on each side of the crescent-shaped ridges - superciliary arches, arcus superciliaris, individually different in shape and size. Between the frontal tubercles and the superciliary arches, a platform is formed - the glabella, glabella. Laterally, the lower sections of the frontal bone are elongated and the zygomatic processes, processus zygomaticus, which are connected by a serrated edge to one of the processes of the zygomatic bone. From each zygomatic process, a temporal line, linea temporalis, goes up, delimiting a small lateral temporal surface, fades temporalis, from the anterior part of the frontal scales. The upper edge of the scales - the parietal, margo parietalis, is arcuately curved and connects at the top with the parietal bone and the large wing of the sphenoid bone. Below, the scales are delimited from the orbital parts by a paired supraorbital margin, margo supraorbitalis, and from the nasal part by a small uneven notch that makes up the nasal margin, margo nasalis. On the supraorbital margin, in its medial part, an infraorbital notch, incisura supraorbitalis, is formed, and medially from it, a frontal notch, incisura frontalis, sometimes turning into openings through which the vessels and nerves of the same name pass.
The inner surface of the scales is concave, has imprints of the cerebral convolutions, arterial grooves and in the middle a sharp vertical frontal crest, crista frontalis, diverging outward into two legs, delimiting the sagittally located groove of the superior sagittal sinus, sulcus sinus sagittalis superior. Below, at the beginning of the ridge, a small blind hole, foramen caecum, is visible. On the sides of the sagittal groove are pits of arachnoid granulations.
The nasal part is located between the orbital parts and is represented by an uneven horseshoe-shaped piece of bone that limits the front and sides of the ethmoid notch, incisura ethmoidalis. The anterior part of this part is connected in front with the nasal bones and the frontal process of the upper jaw, and with the posterior edge - with the anterior edge of the perforated plate of the ethmoid bone. Below, it passes into a sharp spike - the nasal spine, spina nasalis, which is part of the nasal septum. The posterior sections of the nasal part contain cells that are in contact with the ethmoid bone and form the roof of the cells of the ethmoid bone, cellulae ethmoidales. Between the frontal spine and the edge of the ethmoid notch on each side there is an opening of the frontal sinus, apertura sinus frontalis.
The orbital part is a steam room, it is an irregular quadrilateral bone plate, in which the upper and lower surfaces and 4 edges are distinguished. The anterior margin is formed by the supraorbital margin, the lateral margin is connected in front with the zygomatic bone, posteriorly with the greater wings of the sphenoid bone, the posterior margin is adjacent to the lesser wings of the sphenoid bone, the medial margin is attached to the lacrimal bone and the orbital plate of the ethmoid bone. The upper surface faces the cranial cavity, has finger impressions and cerebral elevations. The lower surface is directed to the orbit, it is smooth. In its anterior-lateral part there is a small block fossa, fovea trochlearis. The fossa of the lacrimal gland, fossa glandulae lacrimalis, is located in front and laterally.
The frontal bone belongs to the pneumatic bones, as it contains a cavity - the frontal sinus, sinus frontalis, filled with air. The frontal sinus is located between the scale plates in the region corresponding to the glabella and superciliary arches and communicates with the nasal cavity. It is divided by a vertical partition into the right and left sinuses. Value frontal sinuses subject to large individual fluctuations: the sinuses may be absent or may be of considerable size, extending laterally to the zygomatic process. The right and left sinuses are different in size. The partition between the sinuses may be absent or, conversely, instead of one there may be several partitions. In such cases, there are 3-4 frontal sinuses.
Ossification. The frontal bone develops from two islands of ossification located near the supraorbital margin and arising at the end of the 2nd month of intrauterine development. By the time of birth, the frontal bone of a newborn consists of two separate bones, which join in the 2nd year of life. The seam between both halves of the bone is observed up to 5 years.
Ethmoid bone
Ethmoid bone, os ethmoidale, unpaired, consists of a middle part and two lateral parts (Fig. 22). The middle part is composed of a small horizontal lattice plate, lamina cribrosa, and a large perpendicular one, lamina perpendicularis.
The lateral parts are a complex of a large number of air cells, limited by thin bone plates and forming a lattice labyrinth, labyrintus ethmoidalis.
The ethmoid bone is located in the ethmoid notch of the frontal bone. Its cribriform plate is part of the brain skull. The remaining parts take part in the formation of the skeleton of the nasal cavity and the inner walls of the orbit. The shape of the ethmoid bone resembles an irregular cube, but its shape as a whole and its individual parts is individually different and ranges from cuboid to parallelepiped. The ethmoid plate is connected in front and on the sides with the frontal bone, behind - with the anterior edge of the sphenoid bone. The plate is permeated with many small holes for the branches of the olfactory nerves. A cockscomb, crista galli, extends upward from the lamina cribrosa in the midline. Anterior to it lies a paired process - the wing of the cockscomb, ala cristae galli, which, together with the base of the spina frontalis, forms the blind hole already mentioned above. Attached to the crista galli is the anterior end of the greater falciform process of the dura mater. A perpendicular plate of irregular hexagonal shape descends freely downward, forming the anterior part of the bony septum of the nose and connecting its edges with the spina frontalis, nasal bones, vomer, sphenoid crest and cartilaginous part of the nasal septum.
The lattice labyrinth is located on both sides of the perpendicular plate, connecting at the top with the outer edge of the lattice plate. The cells of the labyrinth are divided into three troupes, not sharply delimited from each other: front, middle and back. On the lateral side, they are covered by a very thin bony orbital plate, lamina orbitalis, facing the free surface into the cavity of the orbit. From the inside, only a small part of the cells is covered with bone plates. Most of them remain open and are covered by neighboring bones - the frontal, lacrimal, sphenoid, palatine and upper jaw. The orbital plate is part of the medial wall of the orbit. The medial surface of the labyrinth limits the upper part of the nasal cavity and is equipped with two thin bone plates facing the nasal cavity - the upper and middle nasal conchas, conch-chae nasalis superior et media. Between the shells there is a gap - the upper course of the nose, meatus nasi superior. Above and behind the upper shell, the highest nasal shell, concha nasalis suprema, is sometimes found. Under the middle shell is a large ethmoid vesicle, bulla ethmoidalis, which, together with the hook-shaped process, processus uncinatus, extending at the point of transition of the lower edge of the labyrinth into the anterior part of the middle turbinate, limits the semilunar cleft, hiatus semilunaris, which passes into the ethmoid funnel, infundibulum ethmoidale, where the entrance to the maxillary sinus is located. The shells of the ethmoid bone have a different shape and size; consequently, the depth and length of the corresponding cavity passages are different.
Ossification. Ossification of the ethmoid bone begins from the lateral sections at the 5-6th month of intrauterine development. At the end of the 1st year of life, ossification points appear at the base of the cock's comb and in the perpendicular plate. The merger of the lateral sections with the middle one occurs in the 5-6th year. The cartilaginous base of the ethmoid bone of the newborn does not have a cockscomb.
Temporal bone
The temporal bone, os temporale, is a paired bone, complex in shape and structure, which participates in the formation of the base of the skull, being placed between the occipital and sphenoid bones, and also complements the side walls of the cranial roof. It distinguishes three parts located around the external auditory opening: scaly, tympanic and stony.
The squamous part, pars squamosa, is a vertically located bone plate. With a free, uneven, oblique edge, it is connected by means of a scaly suture to the lower edge of the parietal bone and to the greater wing of the sphenoid bone. Below, the scaly part is adjacent to the stony and tympanic parts and is separated from it by a stony-scaly fissure, fissura petrosquamosa (visible only on the bones of young subjects), and from the tympanic part by a tympanic-squamous fissure, fissura tympanosquamosa.
The outer temporal surface, facies temporalis, of the squamous part is smooth, participates in the formation of the temporal fossa (Fig. 23). Near the lower edge, the zygomatic process departs from it, processus zygomaticus, directed anteriorly, where it connects with the temporal process of the zygomatic bone and forms the zygomatic arch, arcus zygomaticus. The zygomatic process departs with two roots, between which the mandibular fossa, jossa mandibularis, is formed. It is covered with cartilage and articulates with the articular process of the lower jaw. The anterior root of the zygomatic process, thickening anteriorly from the mandibular fossa, forms the articular tubercle, tuberculum articulare. On the posterior root of the zygomatic process there is a similar articular tubercle, tuberculum retroarticulare, less pronounced. Posteriorly, it passes into the temporal line, linea temporalis.
The inner cerebral surface, facies cerebralis, of the squamous part is equipped with cerebral elevations, digital impressions, and also furrows of the vessels of the meninges.
The tympanic part, pars tympanica, is centered around the external auditory canal, meatus acusticus externus. In newborns, it is expressed in the form of a ring, anulus tympanicus, open upward and surrounding the external auditory meatus. In the future, it grows and merges with neighboring parts. In adults, the tympanic part limits the external auditory opening, porus acusticus externus, and the tympanic cavity, cavum tympani, from below and behind, merging with the free edge with the scales and the mastoid part. It is separated from the scales by a tympanic-squamous fissure, into which a process of the tympanic roof enters from the front surface of the pyramid, due to which the said fissure is divided into two parallel cavity passes a branch of the facial nerve - a drum string, chorda tympani. The cartilaginous part of the ear canal is attached to the free rough and curved edge of the tympanic part, which limits the external auditory opening.
Above the external auditory opening rises the supra-anal spine, spina supra meatum.
The stony part, pars petrosa, or pyramid, is shaped like a three-sided pyramid, the base of which is turned backwards and laterally, the top is anteriorly and medially. Three surfaces are distinguished on the pyramid, of which the anterior, facies anterior, and the posterior, facies posterior, face the cranial cavity, and the lower, facies inferior, is part of the outer surface of the base of the skull (Fig. 24 and 25). The surfaces are separated by three edges: top, back and front. The base of the pyramid is fused with the scaly part. A small section of the base of the pyramid, facing outward, remains uncovered and contains an external auditory opening. The pyramid of the temporal bone contains most of the elements of the hearing organs: the bone part of the external auditory canal, middle and inner ear.
On the anterior surface of the pyramid is an arcuate elevation, eminentia arcuata, corresponding to the anterior semicircular canal of the labyrinth of the inner ear. In front of this elevation are two thin grooves: the large and small stony nerves, sulci n. retrosi majoris et n. petrosi minoris, ending in front with the same clefts, hiatus canalis n. petrosi majoris et hiatus canalis n. petrosi minoris. Nerves exit through these openings. The lateral part of this bone surface, lying between the arcuate elevation and the scaly-stony fissure, constitutes the upper wall of the tympanic cavity and is therefore called the tympanic roof, tegmen tympani. Near the top of the pyramid is the trigeminal impression, impressio trigemini. Along the upper edge of the pyramid runs a furrow of the superior petrosal sinus, sulcus sinus petrosi superioris. On the back surface of the pyramid there is an internal auditory opening, porus acusticus internus, leading to the internal auditory meatus, meatus acusticus internus. Behind the internal auditory opening, the external opening of the vestibule aqueduct, apertura externa aqueductus vestibuli, through which the ductus endolymphaticus passes (see Fig. 23), is determined. At the upper edge of the pyramid, between the internal auditory opening and the external opening of the vestibule aqueduct, there is a subarc fossa, fossa subarcuata, which in children reaches a large size, and in adults it is significantly reduced. At the lower edge at the level of porus acusticus internus is the opening of the cochlear tubule, apertura externa canaliculi cochleae. Along the posterior edge of the pyramid there is a furrow of the lower petrosal sinus, sulcus sinus petrosi inferioris. The bottom surface of the pyramid is uneven. From it descends down and forward the styloid process, processus styloideus - the place of attachment of the muscles. The process reaches its full development in the elderly. It is composed of several segments, ossifying separately and merging with each other rather late. Between the styloid and mastoid processes under the external auditory opening is the awl-mastoid opening, foramen stylomastoideum, which serves as the exit point of the facial nerve. Anterior and medial to the styloid process is the jugular fossa, fossa jugularis. At the bottom of this fossa, the opening of the mastoid tubule, canaliculus mastoideus, is visible. Anterior to the jugular fossa is the external opening of the carotid canal, foramen caroticum externum, leading to the carotid canal, canalis caroticus, which opens at the top of the pyramid with an exit internal opening, foramen caroticum internum. On the back wall of the carotid canal, near the external opening, there are several small openings of the carotid tympanic tubules, canaliculi caroticotympanici, which open into the tympanic cavity and conduct vessels and nerves. In the crest between the external opening of the carotid canal and the jugular fossa, a stony dimple, fossula petrosa, is isolated, at the bottom of which the tympanic canaliculus for the nerve of the same name begins. Laterally from the foramen caroticum internum, in the depth of the angle formed by the scales and the anterior edge of the pyramid, the inlet of the musculo-tubal canal, canalis musculotubarius, is determined, divided by an incomplete bone septum into two half-channels: for the muscle that strains the eardrum, semicanalis m. tensoris iympani, auditory tube, semicanalis tubae auditivae.
The base of the pyramid is extended downwards into the mastoid process, processus mastoideus, the outer surface of which is rough due to the attachment of the sternocleidomastoid muscle to it. Inside the mastoid process there are cells, cellulae mastoidei, of various shapes and sizes, lined with a mucous membrane. The largest cell is the mastoid cave, antrum mastoideum, which communicates with the middle ear cavity. Inside from the top of the mastoid process are two parallel furrows. Medially passes the groove of the occipital artery, sulcus a. occipitalis, and laterally - the mastoid notch, incisura mastoidea, which is the site of the beginning of the digastric muscle. The mastoid process is separated from the tympanic part by the tympanic mastoid fissure, fissura tympanomastoidea, through which the ear branch of the vagus nerve passes. In the seam between the mastoid part and the occipital bone is the mastoid opening, foramen mastoideum. On the outer surface of the mastoid process, a practically important area is isolated - the mastoid triangle, which is limited in front by a line drawn from the spina supra meatum (see the Temporal bone section of this publication) to the top of the mastoid process, behind - by the line of attachment of the sternocleidomastoid muscle and from above - a line that is a continuation of the lower edge of the zygomatic process. The triangle serves as a place for trepanation in inflammatory processes of the middle ear.
On the inner surface of the mastoid process there is an S-shaped curved groove of the sigmoid sinus, sulcus sinus sigmoidei. Approximately in the middle of its length, the mastoid opening opens.
Canals of the temporal bone. 1. The canal of the facial nerve, canalis facialis, begins at the bottom of the internal auditory canal and goes forward and laterally to the level of the clefts of the petrous nerve canals. From here, at a right angle, it goes laterally and backward, forming a bend - the knee, geniculum canalis facialis, changes direction from horizontal to vertical and ends with an awl-mastoid opening.
2. Canal of the carotid artery, canalis caroticus (described in the text).
3. Musculo-tubal canal, canalis musculotubarius.
4. The tubule of the drum string, canaliculus chordae tympani, starts from the facial canal slightly above the awl-mastoid foramen and ends in the area of fissura petrotympanica. It contains a branch of the facial nerve - the drum string.
5. Mastoid tubule, canaliculus mastoideus, originates at the bottom of the jugular fossa and ends in the tympanic-mastoid fissure. A branch of the vagus nerve passes through this tubule.
6. The tympanic canal canaliculus tympanicus arises in the fossula petrosa with an opening apertura inferior canaliculi tympanici, through which a branch of the glossopharyngeal nerve, p. tympanicus, enters. After passing through the tympanic cavity, this nerve, called n. petrosus superficialis minor, exits through the upper opening of the canal, located on the anterior surface of the pyramid.
7. Carotid-tympanic tubules, canaliculi caroticotympanici, pass through the wall of the carotid canal near its external opening and open into the tympanic cavity. They serve for the passage of blood vessels and nerves.
Ossification. The temporal bone has 6 ossification points. At the end of the 2nd month of intrauterine development, ossification points appear in the scales, at the 3rd month - in the tympanic part. On the 5th month, several ossification points appear in the cartilaginous anlage of the pyramid. By the time of birth, the temporal bone consists of three parts: squamous with the rudiment of the zygomatic process, stony with the rudiment of the mastoid part and the tympanic, which are mostly already connected, but the newborn still has gaps between them filled with connective tissue. The styloid process develops from two centers. The upper center appears before birth and merges with the petrous part during the 1st year of life. The lower center appears after birth and merges with the upper one only after the onset of puberty. During the first year of life, the three parts of the bone fuse together.
Sphenoid bone
Sphenoid bone, os sphenoidale, unpaired, located in the middle of the base of the skull. It connects with many bones of the skull and takes part in the formation of a number of bone cavities, cavities, and to a small extent in the formation of the roof of the skull. The shape of the sphenoid bone is peculiar and complex. 4 parts are distinguished in it: the body, corpus, and three pairs of processes, of which two pairs are directed to the sides and are called small wings, alae minora, and large wings, alae majora.
The third pair of processes, pterygoid, processus pterygoidei, is turned downward (Fig. 26 and 27).
The body makes up the middle part of the bone and has an irregular shape, close to a cube, in which 6 surfaces are distinguished. In the body there is a sphenoid sinus, sinus sphenoidalis, filled with air. Therefore, the sphenoid bone belongs to the pneumatic bones. The posterior surface of an approximately quadrangular shape fuses with the main part of the occipital bone in children through cartilage, in adults through bone tissue. The anterior surface of the body faces the posterior upper part of the nasal cavity, adjoining the posterior bone cells of the ethmoid bone. A wedge-shaped ridge, crista sphenoidalis, passes along the midline of this surface, to which the perpendicular plate of the ethmoid bone is adjacent. The wedge-shaped crest passes below into the wedge-shaped beak, rostrum sphenoidale. On both sides of the crista sphenoidalis are the openings of the sphenoid sinus, aperturae sinus sphenoidalis, individually different in shape and size. The front surface at an angle passes into the lower, bearing in the middle the already mentioned wedge-shaped beak. The anterior part of the lower surface and the lower part of the anterior are formed by thin triangular bone plates, shells of the sphenoid bone, conchae sphenoidales, which limit the lower and partly outer edges of the apertura sinus sphenoidalis. In young, the wedge-shaped shells are connected to the rest of the body by a suture and are somewhat mobile. The lateral surfaces of the body in the middle and lower parts are occupied by the base of large and small wings. The upper part of the lateral surfaces is free and on each side there is a groove of the carotid artery, sulcus caroticus, along which the internal carotid artery passes. Behind and laterally, the edge of the furrow forms a protrusion - a wedge-shaped tongue, lingula sphenoidalis. The upper surface, facing the cranial cavity, has a depression in the middle, called the Turkish saddle, sella turcica (see Fig. 26). At the bottom of it is the pituitary fossa, fossa hypophysialis, in which the pituitary gland is placed. The saddle is bounded in front and behind by protrusions, the anterior of which is represented by a tubercle of the saddle, tuberculum sellae, and the posterior by a high ridge called the back of the saddle, dorsum sellae. The back surface of the back of the saddle continues into the upper surface of the main part of the occipital bone, forming a slope, clivus. The corners of the back of the Turkish saddle are extended downward and backward in the form of posterior deviated processes, processus clinoidei posteriores. Behind the tuberculum sellae on each side is the median deviated process, proceccus clinoideus medius. In front of the tubercle of the saddle there is a transversely running shallow furrow of the chiasm, sulcus chiasmatis, where the optic chiasm is located.
The small wings of the sphenoid bone, alae minora, depart from the body on each side with two roots. Between them is the optic canal, canalis opticus, through which the optic nerve and ophthalmic artery pass. Small wings of a flat shape are directed horizontally outward and either connected with large wings or terminate separately from them. The upper surface of the wings faces the cranial cavity, the lower surface faces the orbit. The anterior serrated edge of the wings is connected to the frontal bone, while the posterior smooth edge protrudes into the cranial cavity: an anterior deviated process, processus clinoideus anterior, is formed on it on each side. The lower surface of the small wings, together with the large wings, limits the upper orbital fissure, fissura orbitalis superior, through which the oculomotor, trochlear, ophthalmic and abducens nerves and the superior ophthalmic vein pass.
Large wings, alae majora, depart from each side of the lower-lateral sections of the body of the sphenoid bone, spreading outwards and upwards. They have 4 surfaces and 4 edges. The cerebral surface, facies cerebralis, faces the cranial cavity, is concave, has cerebral elevations and digital impressions. Medially, 3 holes are defined on it: round, foramen rotundum, oval, foramen ovale, and spinous, foramen spinosum, penetrating the wing through. Posteriorly, the large wings end in a sharp protrusion, an angular spine, spina angularis. The temporal surface, facies temporalis, is external, divided transversely by the infratemporal crest, crista infratemporalis. on two surfaces, of which the upper one participates in the formation of the temporal fossa, the lower one passes to the base of the skull and takes part in the formation of the infratemporal fossa. The orbital surface, facies orbitalis, faces forward, forms the posterior part of the outer wall of the eye socket. The maxillary surface, facies maxillaris, faces the upper jaw. The edges of the large wings are connected to the squamous part of the temporal bone, with the zygomatic bone, parietal and frontal. The marginal names correspond to the adjacent bones, margo squamosus, margo zygomaticus, margo parietalis, and margo frontalis.
Pterygoid processes, processus pterygoidei, depart from the sphenoid bone at the junction of the body with large wings and consists of medial and lateral plates, laminae medialis et laminae lateralis. In front, both plates are connected, and behind they are separated from each other by a deep pterygoid fossa, fossa pterygoidea. Below, between both plates, there is a pterygoid notch, incisura pterygoidea, which includes the processus pyramidalis of the palatine bone. On the anterior surface of the pterygoid processes there is a large palatine groove, sulcus palatinus major, which, when connected to the corresponding grooves of neighboring bones (palatine and maxillary), turns into a large palatine canal, canalis palatinus major. At the base of the pterygoid process in the anterior-posterior direction is the pterygoid canal, canalis pterygoideus. The lateral plate is shorter, but wider than the medial one, and is part of the infratemporal fossa. The medial plate ends below with a curved pterygoid hook, hamulus pterygoideus. In the upper part of the posterior edge of the medial plate there is a navicular fossa, fossa scaphoidea, which serves to attach m. tensoris veli palatini, and the cartilaginous part of the auditory tube is adjacent to its upper section.
The sphenoid sinus is divided by a septum, septum sinuum sphenoidalium, into two unequal parts. The sinus opens into the nasal cavity through openings on the anterior surface of the body of the sphenoid bone.
Ossification. The development of the sphenoid bone comes from 4 ossification points that arise in the anterior and posterior parts of the body, in each of the processes; in addition, there are separate ossification points in the medial plate of the pterygoid processes and in the conchae sphenoidales. The first on the 2nd month of embryonic development are the ossification points in the large wings, and on the 3rd month - all the rest, except for the conchae sphenoidales, where they appear after birth. At the 6-7th month of intrauterine development, small wings are connected to the anterior half of the body of the sphenoid bone. By the end of the intrauterine period, the anterior and posterior parts of the body merge. Large wings and sphenoid processes are connected to the body of the bone at the end of the 1st year after birth. The sphenoid sinus in newborns is small and reaches full development in the 6th year of life. The connection of the body of the sphenoid bone with the main part of the occipital bone occurs between 16 and 20 years, more often at 16-18 years.
The parietal bone, os parietale, is a pair of quadrangular-shaped flat bone, concave in the form of a bowl. Forms most of the roof of the skull. It distinguishes between a convex outer surface, facies externa, and a concave inner, facies interna, 4 edges, passing one into another through four corners. The anterior, frontal, margo frontalis, is connected to the scales of the frontal bone, the posterior, occipital, margo occipitalis, to the scales of the occipital bone. The upper edge is sagittal, margo sagittalis, located in the sagittal direction and connected to the corresponding edge of the bone of the opposite side. The lower edge is scaly, margo squamosus, adjacent to the scales of the temporal bone. The upper anterior angle is frontal, angulus frontalis, and the upper posterior is occipital, angulus occipitalis, almost straight. The anterior lower angle is wedge-shaped, angulus sphenoidalis, connects to the greater wing of the sphenoid bone, sharp, and the posterior lower angle is mastoid, angulus mastoideus, obtuse, adjacent to the mastoid part of the temporal bone.
On the outer surface of the parietal bone is the parietal tubercle, tuber parietale; below it are the upper and lower temporal lines, lineae temporales superior et inferior, convex upwards. The upper temporal line is the site of attachment of the temporal fascia, the lower - the temporal muscle. At the sagittal edge there is a parietal opening, foramen parietalae, through which a graduate passes, connecting the superior sagittal sinus and the veins of the soft tissues of the cranial vault.
On the inner surface of the parietal bone along the sagittal edge, a sagittally extending groove of the superior sagittal sinus, sulcus sinus sagittalis superioris, is noticeable, which, connecting with the groove of the same name of another parietal bone, serves as the location of the superior sagittal sinus. Near this furrow there are pits of foveolae granulares - traces of granulations of the arachnoid membrane, which are variously expressed and sometimes presented in the form of holes (especially in the elderly). On the inner surface of the parietal bone there are digital impressions, cerebral eminences and arterial grooves. The arterial sulcus comes from the main angle and is a trace of the location in this area of the middle artery of the dura mater. On the inner surface of the mastoid angle is a wide groove of the sigmoid sinus, sulcus sinus sigmoidei.
Ossification. The parietal bone is formed from two ossification points located one above the other in the region of the parietal tubercle and appearing at the end of the 2nd month of intrauterine development. The end of the process of ossification of the parietal bone ends in the 2nd year of life.
Rice. 15.1. Parietal bone, external and internal view
5 Linea temporalis sup., 6 For. Parietale, 7 Tuber parietale, 8 Margo sagittalis, 9 Margo occipitalis, 10 Margo frontalis, 11 Margo squamosus, 12 Angulus sphenoidalis, 13 Sulci arteriosi, 14 Sutura lambdoidea
A. Osteology.
1. Localization. Lateral and cranial surface of the skull between the frontal and occipital bones.
2. Parts. Quadrangular plates.
3. Description.
A. Surfaces. The convex outer surface extends in the form of an arch ventro-dorsally with temporal lines running lateral to the parietal tubercles. The concave inner surface has a recess for the sagittal sinus along the site of attachment of the falciform process and an imprint of the relief of the cerebral gyri, arachnoid granulations of the meningeal vessels.
b. The edges. The interparietal or sagittal margin is deeply serrated, especially posteriorly. The frontal or coronal and occipital or lambdoid edges are also deeply serrated and have areas of change in the bevel of the articular surfaces approximately in the central part. The temporal or scaly margin has a thick, bumpy surface dorsal to the parietal notch of the temporal bone and a thin, broadly sloping margin ventral to it.
V. Angles. Converge in the area bregma. The ventro-cranial or frontal angles limit the large fontanel in newborns. Dorso-cranial or occipital angles converging in the region of lambda - small fontanel. In the pterion area, the ventro-caudal angle forms the main fontanel, and the dorso-caudal angle in the asterion area forms the mastoid fontanel. It is important to note that on the inner surface of the dorso-caudal angle of both sides there is a recess for the lateral sinus - the place of attachment; cerebellum.
4. Ossification. On each parietal tubercle is the center of the endesmal
ossification.
5. Joints. The parietal bone articulates with five other bones.
A. Parietal. The interparietal or sagittal suture is notched and has a small section of very wide teeth behind - an adaptive mechanism for significant expansion
b. Frontal
1). The coronal suture with an external bevel medially on the parietal bone and an internal bevel laterally allows for greater mobility. When the parietal bone moves laterally in the pterion region, the frontal - moves forward.
V. Occipital.
1). The lambdoid suture is scaly-toothed with an external bevel medially and an internal bevel laterally, a highly mobile articulation. In both the coronal and lambdoid sutures, a change in the bevel prevents displacement of one bone onto another, but does not exclude compression.
g. Main.
1). The anterior, lower corner of the parietal bone has an external bevel in the pterion area, scaly-type, lies at the base of the apex of the large wing of the sphenoid bone.
d. Vysochnaya.
1). The posterior-inferior or parieto-mastoid edge has rough folds, an adaptation to the rotational and oscillatory movements of the stony part, which rests on the upper edge of the mastoid part of the temporal bone, which includes the parietal notch.
2). The scaly edge is beveled posteriorly, provides sliding movement with the upper edge of the temporal, bone, ventral parietal notch.
B. Physiological movement.
These are external and internal rotations around an arbitrary axis passing for each bone through a point on the coronal margin, slightly lateral to the bregma, further dorso-lateral to the parietal tubercle. During external rotation, simultaneously with flexion of the SBS, the parietal bone rotates around this axis, extending the main angle vento-laterally, and the mastoid - more laterally than ventrally. At the same time, the swept edges are slightly lowered and separated from each other, especially at the back. With internal rotation, the opposite happens. The coordination of the cranial articulation mechanism is amazing. The articulation pattern of the parietal bone is the subject of detailed research on how and why such articulations develop. The marked change from the dentate cartilages and membrane plates characteristic of children to the complex articulations of adults is no doubt an extraordinary and not accidental phenomenon. To say that this is the result of a more differentiated fusion than osteoplastic resorption is to say nothing. Let us emphasize that the development of this and other sutures on the skull is proportional to the amount and nature of the movements existing in each joint. The sagittal suture between the parietal bones in an adult resembles interlocked fingers. What movement of the vault bones during development can lead to such a pattern?
The reciprocal transmission of these fingerlike formations can only be compared with two possible types of movements: 1) hinge-like movement 2) removal and convergence along the suture line. Since the teeth are wider and longer at the back of the suture, we can assume a greater degree of traction in this area. It really is. The mechanism can be compared to an interconnected connection, like a bridge, which allows violent changes.
The suture between the lower edge of the parietal bone and the upper edge of the temporal bone presents a completely different picture. The anterior 3/4 of the parietosquamous suture has a long, furrowed bevel of the overlapping articular surfaces for sliding movement, which allows the parietal bone and its paired temporal bone to exit laterally or move away medially with a sliding movement along the ridges and grooves of the bone, something similar to a metal groove, connecting the floating dock to the shore.
The parietal notch on the upper edge of the temporal bone is the mechanism for coordinating the movement of the parietal bone with the reciprocal membrane and the rest of the cranio-sacral mechanism. Its development has a definite purpose.
The anterior and posterior borders of the parietal bones have a compensatory mechanism for both physiological movement and excessive tension. As an adaptation of the mobility of the calvaria to the mobility of the base, three types of movement are allowed: rotation around the point of change of the bevel, lateroflexion at the point of change of the bevel, and traction or compression along the suture line. Since all these movements are minimal, they reflect the types of movements that appear during the period of development and which subsequently build a compensatory mechanism with great potential for readiness for various kinds of difficult situations that may arise throughout life.
Any discrepancy between the movements between the parietal bones and the soft structures adjacent to them is amortized, so to speak, by this mechanism, leading to end result to a high degree of consistency with the functioning of the entire cranio-sacral mechanism. All seams are developed according to a "plan" with a specific purpose in accordance with the whole mechanism, which is wonderfully integrated and coordinated for affective functioning,
B. Impact on others soft tissues and rational treatment.
I. Bones. The parietal bones are often traumatized and adjust to damage to the base. Parietal "horns" are a manifestation of peripheral fixation, which impedes the normal development of patterns. Fixation of the coronal floor limits the movement of the SBS. The sagittal crest indicates an overflow of the sagittal sinus and the possible development of dysfunction of some parts of the central nervous system.
2. arteries. The middle meningeal artery lies under the scales of the parietal bone. Bone pressure can be to some extent the cause of hypertension and "congestive" headaches.
Z. Vienna. Parietal bone causing dural tension: can seriously affect venous drainage. The large falciform process forms the sagittal sinus, which is normally egg-shaped, and can narrow significantly when stressed. The same can be said about the lateral sinuses: when one or both mastoid angles are involved in the pathological process.
4. Cerebrospinal fluid. The parasagittal region is the main location of the arachnoid granulations, through which part of the cerebrospinal fluid leaves its cerebral receptacles. It is very important that there is no tension of the dura mater in this area.
5. The contents of the skull. In newborn babies, part of each lobe of the brain lies under the parietal bones. In adults, the coverage is not as extensive, but includes important motor and sensory centers that coordinate peripheral stimulation and shape the muscle response. Disorders in the parietal lobe of the brain are characterized by disturbances in consciousness, such as visual and tactile perception, as well as impaired limb function on the affected side. In children with a damaged brain, the half of the body opposite to the affected side develops more slowly. Such children often have behavioral problems (impulsivity, aggressiveness, etc.).
II. PATOBIOMEXAHIKA.
A. Primary (embryonic) deformation. Because The parietal bones develop against a membrane background and are particularly susceptible to development of distortions such as parietal "horns" or other unusual shapes.
B. Secondary (in relation to the main and occipital bones) deformation.
1. External and internal rotation. During occipital bone flexion and external rotation of the temporal bones, the parietal bones are displaced ventrolaterally, in the parietal notch, with a descent of the arch and an expansion of the transverse size of the head. With internal rotation - reverse changes.
2. Torsion. The parietal bone on the side of the raised greater wing and the lowered edge of the occipital bone is in relative external rotation, and on the opposite side - in the internal one. This results in a slight deflection of the swept seam. From the side of the raised large wing - laterally in the region of bregma and medially in the region of lambda.
Z. Lateroflexion type. The sagittal suture is displaced slightly to the side of the convexity (the side of the lowered edge of the occipital bone). On this side, the tarsus will be in relative external rotation, and on the opposite side, it will be in internal rotation.
B. Traumatic deformity.
Traumatic impact can be directed directly to one of the areas of the parietal bone or indirectly be the result of a fall on the feet or buttocks. The injury may be unilateral or bilateral and involve one or more sutures. In any case, the membranes, and hence the venous drainage with the fluctuation of the cerebrospinal fluid, can be seriously affected.
1. Injury in the region of bregma or parieto-frontal. One or both parietal bones may be compressed caudally at the bregma, causing lateral displacement of one or both angles, while the occipital condyles are forced to move posteriorly within the articular surfaces on one or both sides.
2. Injury in the area of the arch or parietal-squamous. The impact force can be directed caudally from one or both sides and falls on the medial region of the temporal scales, thus causing. external rotation of one or both temporal bones and SBS flexion.
If the injury is sufficiently lateral to displace one occipital condyle anteriorly and the other posteriorly, then there will be external and internal rotation of the temporal bones, respectively.
3. Injury in the lambda or parieto-occipital area.
One or both parietal bones may move caudally in the lambda area with strong compression of C0-1. In this case, the SBS is brought into flexion with excessive rotation of the temporal bones. If the injury is angular, and one condyle is forced to be ventral to the other, a corresponding rotation of the temporal bones will be observed.
III. DIAGNOSTICS OF PATHOBIOMECHANICAL CHANGES
A. History: idiopathic epilepsy, local headache, circulatory disorders, birth trauma, closed craniocerebral trauma, including minor injuries.
B. Inspection and palpation of the position.
Irregular shapes, rise or fall of sutures, abnormal position, specific traumatic syndromes.
1. Parietal scaly sagittal suture. The parietal bones are externally rotated, the temporal bones tend to overlap along the parietosquamous suture. One temporal bone may be in external rotation and the other in internal rotation. SVS flexion is usually observed with occipital condyle drooping.
2. Parieto-frontal. The bregma region and the sagittal suture are omitted. The main angles are in the ventrolateral position. Large wings and SBS are limited. The dorsal part of the occipital bone on one or both sides has a limitation of extension.
Z. Parieto-occipital. The region bregma is lowered and the occiput is in a dorsal position. The occipital bones may be in external rotation if the lateral injury does not involve the occiput in such a way as to bring one temporal bone into internal rotation.
B. Palpation of mobility.
From the master grip, begin external rotation by directing the mastoid angle laterally and slightly ventrally. Then from the neutral position - internal rotation. Compare movements in both directions on one side and the other. Individually, each suture whose movement may be restricted by injury can be checked with a `Y-spread`; the fluid impulse should be directed from the midline to the sagittal suture and from the opposite pole to the coronal, squamous, and lambdoid sutures. Check the movement of the SBS, especially the flexion, which may be excessive. Correct the rotation of the temporal bones and eliminate the compression of C0-1
IV. CORRECTION OF PATHOBIOMECHANICAL CHANGES.
A. Formation. Parietal "horns" in newborns can be smoothed with light pressure on their top and release from all fixations in the peripheral joints. Plastic changes require a certain amount of time. Smoothed places can be made more convex by collecting the membrane with all fingers to the center of ossification.
Even in adults, there is some compliance, so mobility and firmness can be improved, normal, contours can be maintained, venous drainage through the diploetic veins and venous sinuses can be improved, to reduce the possibility of development pathological process in the CNS from congestion. Using the II and III fingers of both hands, make a light pressure until the resistance of the bone decreases. Start at the inion and continue along the sagittal suture to the glabella. In the lambda area, it will be more convenient to cross the 1st fingers. Next, place your palms on the parietal tubercles and simultaneously move both bones forward, backward and to the sides.
B. External and internal rotation.
Using a master grip, begin to move the mastoid and main angles of the parietal bones into external rotation, as for SBS flexion.
Fig.15.2. Normalization of the parietal bone in a newborn and an adult.
Wait for the end of inertia and bring the mechanism into balance. If necessary, the impulse of fluid can be directed from the midline at the sacrum, or use the patient's breathing, and this will be sufficient. In internal rotation, reverse movements are used.
B. Parietal rise.
With a consolidated grip, medial compression of the parietal bones is performed to carry out traction of joints with large wings and temporal scales. The bones are then lifted up and into external rotation, eliminating venous congestion, insomnia, hypertension, and the like.
G. Omission of the parietal bones.
It consists in detaching the sagittal suture from the lambda in the ventral direction with the help of 1 fingers and then in bringing the parietal bones into external rotation.
From the consolidated grip with the location of 1 fingers on the dorso-medial angles of the opposite parietal bones immediately anterior to the lambda.
Rice. 15.3. Parietal rise Fig. 15.4 Omission of the parietal bones.
Lower the parietal bones of the day of their release from the receding occipital bone and then disconnect them from each other with 1 fingers, holding them firmly, after which, with the fingers located on the lateral sections, bring the bones into external rotation.
D. Parieto-frontal suture.
Interlace fingers over fornix and apply medial compression
the main angles of tenars. In case of unilateral damage, pressure is used only on the affected side, fixation is carried out on the healthy side. Upon reaching traction, the parietal bones rise to the arch. To reduce damage to C0 - 1 see chapter III.
E. Parietal-basic.
When fixing, when the large wing covers the outer bevel of the main angle of the parietal bone, the parietal-frontal technique is used. If ineffective - control the main bone with one hand through the large wing and lateral pterygoid process, and with the other - bring the parietal bones into balance.
G. Parietal-scaly.
Apply medial compression with thenars placed over the scaly sutures using the lever of the same hand and continue as above. If the parietal notch is not released, move the 1st finger of one hand to the mastoid part, and the tenar of the other to the parietal bone.
Z. Parieto-occipital.
The compression of the mastoid angles of the parietal bones inward and then their rise with simultaneous correction of the position of the SBS and temporal bones by the direct method is used. Place the tenars at the dorso-caudal angles of the parietal bones, interlace the fingers over the sagittal suture. Compress the lower corners medially and then lift them to the vault, holding this position until relaxation occurs. Then place your palms on the upper occipital part, medial to the lambdoid sutures, interlace your fingers and rotate the occipital bone around its transverse axis, bringing it into extension. At the end, place the tenars on the mastoid parts of the temporal bones, and the 1st fingers on the mastoid processes and interlace all other fingers and internally rotate the temporal bones. With a unilateral lesion, use the above actions on the affected side, correcting the torsion position of the SBS and the corresponding rotation of the temporal bone.
PARIETAL RELAXATION (BY E. GIKHIN)
Indications
To restore the physiological movement of the parietal bones in the presence of a limitation of their external and internal rotation. The technique is usually used as an indirect effect.
The position of the patient.
Physician position
Contact points
Slightly changing the consolidated grip, the doctor positions his hands as follows:
I I fingers at ventrocaudal angles;
III fingers immediately above the base of the zygomatic processes of the temporal bones;
I V-e fingers on the parieto-mastoid angles;
The 1st fingers are located nearby, above the skull, forming a support for the action of the muscles - the flexors of the fingers.
Movement
External rotational injury: The fingers exert light traction on the external bevels of the parietal bone by pressing them towards the center of the head during the extension phase. The fingers then bring the bone into external rotation during the flexion phase. This is held until relaxation occurs.
Internal rotation injury: After traction of the parietal bones, they are brought out by internal rotation during the extension phase.
Note
This manipulation is carried out from two sides. If the damage is unilateral, the doctor's action is carried out on the side of the damage. But the joint movement of the 2 parietal bones in the overall movement is more significant. If the impaction is severe enough, the clinician should prefer the more rigorous manipulation techniques described later in this chapter.
PARIETAL LIFT
Indications
Raise the parietal bone and release it from adjacent bones. This technique is designed to improve circulation.
The position of the patient. Lying on your back, comfortable, relaxed.
Physician position.
Contact points - With a slightly modified master grip, the doctor positions his hands as follows: II fingers at the ventro-caudal angles; III fingers - immediately above the base of the zygomatic processes of the temporal bones; IV-e fingers on the parieto-mastoid angles; I fingers intersect above the sagittal suture; each touches the opposite parietal bone.
Movement
1 phase (traction). During the extension phase, the examiner's fingers at the external bevels apply medial pressure, separating the parietal bone from the greater wings of the sphenoid bone and from the temporal squama through internal rotation of the bone.
2 phase (external traction). During the flexion phase of the cranial mechanism, the physician raises the parietal bones into external rotation.
3 phase (climb). At the end of the 2nd phase, the parietal bones rise towards the doctor. This position is held until relaxation occurs.
Various finger contacts allow selective relaxation of the damaged area. Fingers can be located as follows: II finger on the large wing of the main bone and parietal bone; III finger on the scaly suture and IV-e fingers on the parieto-mastoid angles.
DISTRIBUTION OF THE PARIETAL BONES (Spread - TECHNIQUE)
Indications
Regulation of circulation in the longitudinal sinuses, restoration of the normal relationship between the cerebellum and the crescent of the brain.
Patient position - Lying on your back, comfortable, relaxed.
The doctor's position Sitting at the head of the patient, the forearms rest on a couch with an adjusted height. The doctor holds the patient's head in his hands.
Contact points
In a slightly modified master grip, the doctor's fingers touch the patient's head in the following places: II fingers - on the scaly edges of the parietal bones; IV-e fingers - on the mastoid processes; The 1st fingers intersect above the sagittal suture at the dorso-caudal angles of the parietal bones, as close as possible to the lambda region.
Movement
Only the 1st fingers are active, the other fingers easily and firmly hold the patient's head.
During the flexion phase, the doctor exerts pressure with 1 fingers towards the arch, ventrally separating the parietal bones from the occipital and also laterally displacing the 1st fingers in different directions from each other. The pressure is released at the beginning of the extension phase. This is repeated until relaxation is obtained.
Note
In the presence of impaction, this technique is often insufficient. Instead, the technique of disimpacting the lambda region is used.
DISYMPACTION OF THE LAMBDA REGION
Indications
Restoration of functional freedom in the lambda region at the junction of the sagittal and lambdoid sutures.
Patient position - Lying on your back, comfortable, relaxed.
Physician position
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height.
Contact points
In a slightly modified master grip, the doctor touches the patient's head with their fingers in the following areas. V-e fingers (form "" and touch the tops of their distal phalanges) on the upper part of the occipital part, closer to the lambda area; IV-e fingers lateral sagittal suture;
III fingers immediately above the zygomatic processes; II fingers on the anterior-lower corners of the parietal bones. Crossed 1st fingers are located as close as possible to the lambda region, each on the posterior-superior corner of the opposite parietal bone.
Movement
During the extension phase, the 1st fingers separate the parietal corners, exercising pressure on them towards the center of the head.
At the beginning of the V-e flexion phase, the fingers accentuate the occipital bone flexion. At the same time, the 1st fingers displace the postero-inferior corners of the parietal bones towards the arch with a simultaneous attempt to separate them from each other. Other fingers bring the parietal bones into external rotation.
Note
This technique can be performed with the patient sitting and the doctor standing behind him.
OPENING OF THE DORSA PART OF THE INTERPARETHAL SEAM
Indications - Open the dorsal part of the sagittal suture.
Patient position - Lying on your back, comfortable, relaxed.
Physician position
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height. The doctor holds the patient's head in his hands.
Contact points
In this consolidated grip, the 2nd fingers are located on the anterior-lower corners of the parietal bones, the 3rd fingers immediately above the base of the zygomatic processes of the temporal bones, the 4th fingers on the parieto-mastoid angles. I fingers cross over the sagittal suture, touching the opposite parietal bone along the lambdoid margin, as close as possible to the lambda region.
Movement
This technique is carried out in 3 phases: the first during the extension phase, and the others during the flexion phase.
1st phase: (Relaxation). The doctor puts pressure on the parietal bones to release them from the occipital bone;
2nd phase: (Disclosure) The doctor opens the dorsal part of the interparietal suture by moving 1 fingers apart from each other.
3rd phase: (External rotation). Other fingers will rub against the skull, promoting external rotation of the parietal bones.
Note
To separate the surfaces displaced on each other, the doctor can, during 2 phases, move the 1st fingers apart from each other, while scrupulously taking into account the tangible direction of the suture lines.
OPENING OF THE INTERPARETHAL SEAM
Indications
Restore functional freedom between the teeth of the sagittal suture.
Patient position - Lying on your back, comfortable, relaxed.
Physician position
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height. The doctor holds the patient's head in his hands.
Contact points
The 1st fingers are located parallel to each side of the sagittal suture from the bregma area. Other fingers cover the scales of the parietal bones. The doctor must be convinced when he feels limited mobility during the examination. In order to have a certain effect, it is very important to turn Special attention on the accuracy of the direction of relaxation of the weld teeth.
Note
This technique can be done with the patient sitting at the edge of the couch and the doctor standing behind the patient.
Movement
During the flexion phase, the 1st fingers are displaced from each other, while the remaining fingers exacerbate the external rotational movement of the parietal bones.
The doctor should be especially active when he feels the restriction of mobility during the examination.
In order to obtain a certain effect, it is important to pay special attention to the subtle directions of relaxation of the weld teeth.
PARETI-FRONTAL TRACTION LATERAL REGION
Indications
Restore articular functional mobility when the injury has led to compression of the frontal bone between the parietals.
Patient position - Sitting on the edge of a couch of relatively low height.
Physician position
Thenar eminences are located on the lateral areas of the parietal bones, closer to the pterion areas. Elevations of the hypotenars are located on the scales. The other fingers are interlaced at the sagittal suture.
Movement
During the extension phase, using the strength of the flexor muscles of the fingers, the doctor performs medial compression of the parietal bones, separating them from the frontal. During the flexion phase, the physician lifts the parietal bones towards the fornix while maintaining all finger contact.
Note
The technique described above is only for the lateral part of the parieto-frontal suture. For medial injury, closer to the bregma, the clinician should use the technique described on page (bregma dysimpact).
In case of unilateral damage, the fronto-parietal technique can be used.
DISYMPACTION OF THE AREA BREGMA
Indications
Restore physiological functional freedom in the bregma area - the intersection of the sagittal and coronal sutures.
Patient position - Lying on your back, comfortable, relaxed.
Physician position
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height.
Contact points
In a slightly modified master grip, the doctor touches the patient's head with his fingers in the following areas:
II fingers are located behind the external orbital processes, frontal bone;
I fingers intersect above the anterior part of the sagittal suture, located on the anterior-upper corner of the opposite parietal bone;
IV-e fingers - on the mastoid angles of the parietal bones.
Movement
Traction is achieved during the extension phase by pressing 1 fingers on the parietal bones.
During the flexion phase, the 2nd fingers accompany the flexion of the frontal bone and bring it out slightly ventrally. The 1st fingers during the movements diverge, displacing the anterior-upper corners of the parietal bones in the dorsal direction, at the same time, the 4th fingers accentuate the external rotation of these bones. This is held until relaxation occurs.
BASIC-PARETIAL TRACTION BILATERAL
Indications
Restoration of functional freedom of the main-parietal joint, especially traumatic damaged in the anterior-upper part of the parietal bones.
Patient position Lying on your back, comfortable, relaxed.
Position doctor
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height.
Contact points
Thenar eminences are located on the main angles of the parietal bones. The elevations of the hypothenares are located further along the scales of the parietal bones. The other fingers are interlaced and positioned above the sagittal suture.
Movement
During the extension phase of the cranial movement, the doctor's finger flexor muscles compensate for the major angles of the parietal bones medially.
During the flexion phase, the doctor lifts the parietal bones towards the fornix, keeping all finger contacts. The balanced tension position is held until relaxation occurs.
Note
This is a variant of the technique (parieto-frontal traction, lateral part), although it is possible to perform this technique on one side, working on only one side and lightly stabilizing the other is often not effective. In such a situation, it is more appropriate to use the technique described on the page (main-parietal traction, unilateral) when there is unilateral damage.
BASIC-PARETIAL TRACTION ONE-SIDED
Indications
Restoration of functional freedom of the main parietal joint, when there is a unilateral change due to injuries of the anterior part of the parietal bones.
Patient position - Lying on your back, comfortable, relaxed.
The doctor's position Sitting at the head of the patient on the side opposite to the injury, the forearms rest on a couch with an adjusted height.
Contact points
The caudal hand controls the underlying bone as follows:
"clamp" of the 1st and 2nd fingers covers the frontal bone and ends on the large wings; The fifth finger from the oral cavity is located on the outer surface of the pterygoid process. The cranially located hand makes the following contacts with the parietal bones: the 1st finger is located along the coronal suture; II-th finger - at the main angle; other fingers cover the scales.
Movement
During the extension phase of the cranial movement, the II finger of the cranially located hand presses on the main angle of the parietal bone, medially performing traction.
During the flexion phase, this arm, following the external rotation of the bone, controls its respective limit while retracting from the other arm. This continues until relaxation occurs.
Note
To effectively perform this relatively energetic technique, the physician must carefully monitor the progressive relaxation of the periarticular tissues.
PARIETO-OCPITAL TRACTION
Indications
Restoration of functional freedom of the parietal-occipital articulation between bones displaced towards each other after caudal displacement of the posterior-inferior angles of the parietal bones as a result of trauma to the lambdoid region.
. Patient position
Sitting on the edge of a couch that has been adjusted to a lower height.
Physician position
Standing behind the patient, leaning slightly, the fingers of both hands are interlaced and cover the dorsal part of the patient's skull.
Contact points
The doctor places tenar elevations on the posterior-lower corners of the parietal bones. The fingers are interlaced over the sagittal suture, with the 11th fingers positioned as close as possible to the lambdoid suture.
Movement
During the extension phase of the cranial mechanism, the doctor performs medial compression of the posterior-inferior angles of the parietal bones, separating the occipital bone.
During the flexion phase, the doctor lifts the parietal bones slightly towards the arch while penetrating the forearms, causing external rotation of the bones. This continues until relaxation occurs.
Note
Description refers to bilateral damage. With unilateral damage, only one corner is subjected to compression, the other is slightly stabilized.
TEMPOPARETIAL TRACTION
Indications Restoration of functional freedom of the temporo-parietal suture.
Patient position - Lying on your back, comfortable, relaxed.
Physician position
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height. The doctor holds the patient's head in his hands.
Contact points
The doctor's hands in a modified master grip make the following symmetrical contacts on both sides of the patient's skull:
The heads of the wrists on the parietal part of the scaly suture;
II fingers on the zygomatic processes of the temporal bones;
V-e fingers on the front of the mastoid processes.
Movement
During the extension phase of the cranial movement of the head, the metacarpuses press on the parietal part of the squamous suture in the medial direction.
During the flexion phase, the 2nd and 4th fingers exaggerate the external rotation of the temporal bones. At the same time, both hands of the doctor, with the continued action of the tops of the pasterns, raise the parietal bones in the direction of the arch, separating the scaly suture.
Note
In the case of unilateral damage, only one arm is active, the other slightly retains its position.
Functional freedom of the temporomandibular joint must be ensured, since any traumatic impact here can lead to secondary damage to the temporo-parietal suture.
UNILATERAL DEEP POSO-INFEROR ANGLE TRACTION
Indications
Unilateral separation of the posterior-inferior angle (parieto-mastoid suture).
Patient position - Lying on your back, comfortable, relaxed.
Physician position
Sitting at the head of the patient, the forearms rest on a couch with an adjusted height.
Contact points
The interlaced fingers of the doctor's hands lying on the back of the hands hold the dorsal part of the skull. On the side of the injury, the thenar eminence is located on the posterior-lower corner of the parietal bone. On the other side, it touches the lateral angle of the occipital scale. The 1st fingers extend along the corresponding mastoid processes.
Movement
During the extension phase of the cranial movement, both thenar eminences exert a gentle and constant pressure towards the center of the skull.
During the flexion phase, both 1st fingers displace the tops of the mastoid processes in a dorso-medial direction (external rotation). At the same time, the tenar elevation shifts the posterior inferior angle of the corresponding parietal bone in the ventro-cranial direction.
This technique is repeated until the clinician is relieved by tissue relaxation. Relaxation is accompanied by a permanent disconnection of this angle.
Concavity of the parietal bone (according to Shafer)
