Gross & Neuro-Anatomy

1. Norma Frontalis, Laterlais, Basalis,
Verticalis, Occipitalis- Clinical Relevance
Dr. Rabia Inam Gandapore
Assistant Professor
Head of Department Anatomy
(Dentistry-BKCD)
B.D.S (SBDC), M.Phil. Anatomy (KMU),
Dip. Implant (Sharjah, Bangkok, ACHERS) , CHPE
(KMU),CHR (KMU), Dip. Arts (Florence, Italy)

2. Teaching Methodology
 LGF (Long Group Format)
 SGF (Short Group Format)
 LGD (Long Group Discussion, Interactive discussion with the use of models or diagrams)
 SGD (Short Group)
 SDL (Self-Directed Learning)
 DSL (Directed-Self Learning)
 PBL (Problem- Based Learning)
 Online Teaching Method
 Role Play
 Demonstrations
 Laboratory
 Museum
 Library (Computed Assisted Learning or E-Learning)
 Assignments
 Video tutorial method

3. Goal/Aim (main objective)
 Norma Frontalis:
a) Identify the skeletal features of norma frontalis (including Zygoma, Maxilla & Mandible).
b) Describe muscle attachments.
c) Enlist structures passing through foramina.
d) Enumerate relevant clinical problems of Norma frontalis.
 Norma Basalis:
a) Discuss the anterior cranial fossa, middle and posterior cranial fossa.
b) Describe muscle attachments.
c) Enlist structures passing through foramina.
 Norma Lateralis
a) Identify the skeletal features of Norma lateralis.
b) Describe muscle attachments.
c) Enlist structures passing through foramina.
d) Enumerate relevant clinical problems of norma lateralis.
e) Discuss temporal fossa, infra-temporal fossa, and pterygopalatine fossa
 Norma Occipitalis
a) Identify the skeletal features of norma occipitalis.
b) Describe muscle attachments.
c) Describe emissary veins of skull.
 Norma Verticalis
a) Identify the skeletal features of norma verticalis.
b) Enumerate relevant clinical problems of norma verticalis.

4. Specific Learning Objectives (cognitive)
 At the end of the lecture the student will able to:
 Identify the skeletal features of norma frontalis , Lateralis, Basalis, Verticalis,
Occipitalis.
 Describe muscle attachments.
 Enlist structures passing through foramina.
 Enumerate relevant clinical problems

5. Psychomotor Objective: (Guided response)
 Ask student to submit assignment of tabulated form of the structures passing through all foramen and fossa

6. Affective domain
 To be able to display a good code of conduct and moral values in the class.
 To cooperate with the teacher and in groups with the colleagues.
 To demonstrate a responsible behavior in the class and be punctual, regular, attentive and on
time in the class.
 To be able to perform well in the class under the guidance and supervision of the teacher.
 Study the topic before entering the class.
 Discuss among colleagues the topic under discussion in SGDs.
 Participate in group activities and museum classes and follow the rules.
 Volunteer to participate in psychomotor activities.
 Listen to the teacher's instructions carefully and follow the guidelines.
 Ask questions in the class by raising hand and avoid creating a disturbance.
 To be able to submit all assignments on time and get your sketch logbooks checked.

7. Lesson contents
Clinical chair side question: Students will be asked if they know what is clinical relevance of Pterion & Asterion
Outline:
 Activity 1 The facilitator will explain the student's about skeletal features of norma frontalis , Lateralis,
Basalis, Verticalis, Occipitalis.
 Describe muscle attachments.
 Enlist structures passing through foramina.
 Enumerate relevant clinical problems
 Activity 2 The facilitator will ask the students to submit assignment of tabulated form of the structures
passing through all foramen and fossa
 Activity 3 The facilitator will ask the students a few Multiple Choice Questions related to it with flashcards.

8. Recommendations
 Students assessment: MCQs, Flashcards, Diagrams labeling.
 Learning resources: Langman’s T.W. Sadler, Laiq Hussain Siddiqui, Snell Clinical Anatomy, Netter’s Atlas,
BD Chaurasia’s Human anatomy, Internet sources links.

9. Surface
Anatomy

11. Calvaria

12. Calvaria
Norma
Verticalis

13. Calvaria

14. Norma Frontalis

15. Mental Nerve
Norma
Frontalis

16. Supra-Orbital Notch/Foramen= Supraorbital nerve & vessels
Nasal bone & Upper nasal cartilage= External nasal nerve
Infra-Orbital Notch/Foramen= Infra-Orbital Nerve & Vessels
Zygomaticofacial Foramen= Zygomaticofacial Nerve branch of Maxillary Nerve
Mental Foramen= Mental Nerve

17. Mental point
or Gnathion

19. Clinical Relevance:
 Nasal bone= Fractured easily. Mandible & Parrietal eminence next common
 Pterion = Thinnest part of skull has middle meningeal artery & may rupture cause
extradural haemorrhage and compress motor area of brain leading to paralysis of
opposite side.
 Sutures of Norma Frontalis:
1. Internasal
2. Frontonasal
3. NasoMaxillary
4. Lacrimomaxillary
5. Frontomaxillary
6. Intermaxillary
7. Zygomaticomaxillary
8. Zygomaticofrontal

20. Norma Lateralis

21. Norma
Lateralis

22. Squamomastoid suture

23. Pterion (Sylvian point of
cerebrum & Middle
meningeal vessels)
Suprameatal Triangle
(Macewan)
Asterion

25. OSPE TEST?

28.  Tympanomastoid Fissure= Auricular branch of Vagus nerve
 Mastoid Foramen= Emissary vein , Meningeal branch of Occipital artery
 Zygomaticotemporal foramen= Zygomaticotemporal nerve & artery

29. Mid Sagittal
Section

30. Mid Sagittal
Section

31. Thank You

32. The Cranial Base
SUPERIOR AND INFERIOR VIEW

34.  Petrous temporal bone=
Tegmen tympani
 Highest nuchal Line
 Squamo tympanic fissure
 Tympanic plate= C-shaped
Inferior
View

35. Palatine crest
Inferior
view

37. Clinical Relevance
 Skull Fractures common in adult but less so in young child.
 Infant skull: bones more resilient & sutural ligaments begin to ossify during middle
age. Blows to vault result in a series of linear fractures, which radiate out through thin
areas of bone.
 Young child skull: localized blow produces a depression without splintering. This
common type of circumscribed lesion is referred to “pond” fracture.
1. Anterior Cranial Fossa Fractures:
 Cribriform plate of ethmoid bone: damaged in fractures & results in tearing of overlying
meninges & underlying mucoperiosteum. Patient will have bleeding from the nose
(epistaxis) & leakage of CSF into nose (cerebrospinal rhinorrhea).
 Fractures involving orbital plate of the frontal bone result in haemorrhage beneath
conjunctiva & into orbital cavity, causing exophthalmos. Frontal air sinus may be
involved, with haemorrhage into nose.

38. 2. Middle Cranial Fossa Fractures common, weakest part of base of skull due to
presence of numerous foramina & canals. Cavities of middle ear & sphenoid air sinuses
are particularly vulnerable. Leakage of CSF & blood from external auditory meatus is
common. 7th & 8th cranial nerves may be involved as they pass through the petrous part
of the temporal bone. 3rd, 4th, 6th cranial nerves may be damaged if the lateral wall of the
cavernous sinus is torn. Blood & CSF may leak into sphenoid air sinuses & into nose.
3. Posterior Cranial Fossa Fractures blood may escape into neck deep to the
postvertebral muscles. Some days later, appears in the posterior triangle, close to the
mastoid process. Mucous membrane of roof of nasopharynx may be torn, & blood may
escape there. In fractures involving jugular foramen, 9th, 10th, and 11th cranial nerves
may be damaged. The strong bony walls of the hypoglossal canal usually protect the
hypoglossal nerve from injury.

39.  Facial Bone Fractures In adults, presence of well developed, air-filled sinuses &
mucoperiosteal surfaces of alveolar parts of upper & lower jaws means that most facial
fractures should be considered to be open fractures, susceptible to infection, and
requiring antibiotic therapy.
 Anatomy of Common Facial Fractures Signs of fractures of facial bones include
deformity, ocular displacement, or abnormal movement accompanied by crepitation
and malocclusion of teeth.
 Anesthesia or paresthesia of facial skin will follow fracture of bone (branches of
trigeminal nerve).
Muscles of face are thin & weak & prolonged fixation is not needed once a fracture of
the maxilla has been reduced. In mandible, strong muscles of mastication can create
considerable displacement, requiring long periods of fixation.
 Common facial fractures involve nasal bones, followed by zygomatic bone &
mandible.

40.  Nasal Fractures most common facial fractures. Because bones are lined with
mucoperiosteum, fracture is open; overlying skin may be lacerated.
 Maxillofacial Fractures massive facial trauma & extensive facial swelling, midface
mobility of underlying bone on palpation, malocclusion of teeth with anterior open bite
& leakage of CSF (cerebrospinal rhinorrhea) secondary to fracture of cribriform plate
of ethmoid bone. Double vision (diplopia) present, owing to orbital wall damage.
Involvement of infraorbital nerve with anesthesia or paresthesia of the skin of cheek &
upper gum may occur in fractures of body of maxilla. Nose bleeding occur in maxillary
fractures. Blood enters maxillary air sinus & leaks into nasal cavity. Fractures sites
classified as Le Fort type I, II, or III.
 Blowout Fractures of the Maxilla A severe blow to orbit may cause contents of
orbital cavity to explode downward through floor of the orbit into the maxillary sinus.
Damage to infraorbital nerve may occur, resulting in altered sensation in skin of
cheek, upper lip & gum.
 Zygoma or Zygomatic Arch Fractures A blow to side of face can fracture the
zygoma or zygomatic arch. occur as an isolated fracture (clenched fist blow) or
multiple fractures

41. Neo Natal
Skull

42. Neo Natal
Skull
 Disproportionately large cranium.
 Neonatal face to cranium size
ratio is approx 1:8 & adult 1:1.
 Growth of oral apparatus (upper
and lower jaws, teeth, muscles of
mastication, and tongue) and
respiratory system (nasal cavities
and paranasal sinuses) during
childhood results in a great
increase in length of the face

43.  no diploë.
 Vault No sutures & separated by unossified membranous called fontanelles (“soft spots”).
 Anterior (bregmatic) fontanelle: lies between 2 halves of frontal bone & 2 parietal bones. ossifies by 18 months
of age.
 Posterior (lambdoid) fontanelle: lies between 2 parietal bones & occipital bone. closes by end of 1st year.
 Two smaller fontanelles are located on each side of skull.
a. Sphenoidal fontanelle: at junction of frontal, parietal, squamous temporal & greater wing of sphenoid bones.
b. Mastoidal fontanelle: at the junction of temporal, parietal & occipital bones.
 Tympanic part of temporal bone is C-shaped ring at birth & external auditory meatus is cartilaginous in newborn,
and tympanic membrane (eardrum) is nearer surface.
 Mastoid process: not present at birth and develops later due to pull of sternocleidomastoid muscle when child
moves his or her head.
 At birth, the mastoid antrum lies about 3 mm deep to the floor of the suprameatal triangle. At puberty antrum lie 15
mm from surface.
 Symphysis menti fuse by end of the first year & form single mandible. Angle of the mandible is obtuse at birth.
 In old age, the size of the mandible reduces when the teeth are lost. Alveolar part of bone becomes smaller, ramus
becomes oblique in position

44. Clinical Relevance:
Fontanelles Palpation enables physician to determine progress of growth in
surrounding bones, degree of hydration of baby (e.g., if fontanelles are depressed
below the surface, baby is dehydrated) & state of intracranial pressure (a bulging
fontanelle indicates raised intracranial pressure).
Samples of cerebrospinal fluid obtained by passing a long needle obliquely
through anterior fontanelle into subarachnoid space or lateral ventricle.
Clinically, not possible to palpate anterior fontanelle after 18 months, because
frontal & parietal bones have enlarged to close gap.
Tympanic Membrane At birth, tympanic membrane when examined with
otoscope, it lies more obliquely in infant than in adult. Forceps Delivery can
damage Facial Nerve
Mastoid process is not developed in neonate & facial nerve is relatively exposed
as it emerges from stylomastoid foramen. forceps used can damage nerve

48. OSPE TEST?