Professional Documents
Culture Documents
THIRD EDITION
With Atlas of Muscle Atachments
TEXTBOOK OF
THIRD EDITION
With Atlas of Muscle Atachments
INDERBIR SINGH
Published by
Jitendar P Vij
Jaypee Brothers Medical Publishers (P) Ltd
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First Edition:
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Second Edition:
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1990
1994, 1996, 1997, 2000
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ISBN 978-81-8448-300-0
Rohtak
2008
INDERBIR SINGH
This book has been written to meet the requirement of MBBS students.
However, the matter should suffice for postgraduate students as well. For
the benefit of the latter, sections on individual bones of the hands, the feet,
and of the skull are included.
Rohtak
July 1990
SINGH
INDERBIR
Contents
PART 1
Individual Bones
of the body
INTRODUCTION
TO
THE
SKELETON
1
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INTRODUCTION
TO
THE
SKELETON
3
Fig. 1.4B. Section across thorax.
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OSTEOLOGY
INTRODUCTION
TO
THE
SKELETON
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OSTEOLOGY
2
Bones of the Upper Limb
An introduction to the skeleton of the upper limb is given in Chapter 1. Each bone is described
below.
The first step in the study of any bone is to orientate it as it lies in the body. To do this we have
to distinguish the anterior aspect from the posterior; the upper end from the lower ; and the
medial side from the lateral.
Once we have this information we can find out whether the bone belongs to the right limb or
the left one.
The Clavicle
3 is
The clavicle is a long bone having a shaft, and two ends (Figs. 2.1, 2.2). The medial end
much thicker than the shaft and is easily distinguished from the lateral end which is flattened.
The anterior and posterior aspects of the bone can be distinguished by the fact that the shaft
(which has a gentle S-shaped curve) is convex forwards in the medial two-thirds, and concave
forwards in its lateral one-third. The inferior aspect of the bone is distinguished by the presence
of a shallow groove on the shaft, and by the presence of a rough area near its medial end. The
side to which a clavicle belongs can be determined with the information given above.
For purposes of description it is convenient to divide the clavicle into the lateral one-third
which is flattened, and the medial two-thirds which are cylindrical.
The lateral one-third has two surfaces, superior and inferior. These surfaces are separated by
two borders, anterior and posterior. The anterior border is concave and shows a small thickened
area called the deltoid tubercle. The lower surface (of the lateral one-third) shows a prominent
thickening near the posterior border; this is the conoid tubercle. Lateral to the tubercle, there is
a rough ridge that runs obliquely up to the lateral end of the bone, and is called the trapezoid
line.
The medial two-thirds of the shaft has four surfaces: anterior, posterior, superior and inferior,
that are not clearly marked off from each other. The large rough area present on the inferior
aspect of the bone near the medial end forms part of the inferior surface. The middle-third of the
inferior aspect shows a longitudinal groove the depth of which varies considerably from bone to
bone.
The lateral or acromial end of the clavicle bears a smooth facet which articulates with the
acromion of the scapula to form the acromioclavicular joint.
The medial or sternal end of the clavicle articulates with the manubrium sterni, and also
with the first costal cartilage (Fig.2.5). The articular area is smooth and extends on to the
inferior surface of the bone for a short distance. The uppermost part of the sternal surface is
rough for ligamentous attachments.
The clavicle can be easily felt in the living person as it lies just deep to the skin in its entire
extent. The sternal end of the bone forms a prominent bulge which extends above the upper
border of the manubrium sterni.
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The Scapula
The greater part of the scapula consists of a flat triangular plate of bone called the body (Figs.
2.6 to 2.8). The upper part of the body is broad, representing the base of the triangle. The
inferior end is pointed and represents the apex. The body has anterior (or costal) and posterior
(or dorsal) surfaces which can be distinguished by the fact that the anterior surface is smooth,
but the upper part of the posterior surface gives off a large projection called the spine. At its
lateral angle the bone is enlarged and bears a large shallow oval depression called the glenoid
cavity which articulates with the head of the humerus. The side to which a given scapula
belongs can be determined from the information given above.
13
In addition to its costal and dorsal surfaces the body has three angles: superior, inferior and
lateral; and three borders: medial, lateral and superior. Arising from the body there are three
processes. In addition to the spine already mentioned there is an acromion process and a coracoid
process.
The lateral border runs from the glenoid cavity to the inferior angle. The medial border
extends from the superior angle to the inferior angle. The superior border passes laterally from
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the superior angle, but is separated from the glenoid cavity (representing the lateral angle) by
the root of the coracoid process. A deep suprascapular notch is seen at the lateral end of the
superior border.
The costal surface lies against the posterolateral part of the chest wall. It is somewhat concave
from above downwards. The dorsal surface gives attachment to the spine. The part above the
spine forms the supraspinous fossa, along with the upper surface of the spine. The area below
the spine forms the infraspinous fossa (along with the lower surface of the spine). The
supraspinous and infraspinous fossae communicate with each other through the spinoglenoid
notch that lies on the lateral side of the spine.
The part of the body adjoining the lateral border is thickened to form a longitudinal bar of
bone. The dorsal aspect of the scapula adjoining the lateral border is rough for muscular
attachments.
The glenoid cavity (Fig.2.8) is pear shaped and forms the shoulder joint along with the head
of the humerus. Just below the cavity the lateral border shows a rough raised area called the
infraglenoid tubercle. Immediately above the glenoid cavity there is a rough area called the
supraglenoid tubercle. The region of the glenoid cavity is often regarded as the head of the
scapula. Immediately medial to it there is a constriction which constitutes the neck.
The spine of the scapula is triangular in form. Its anterior border is attached to the dorsal
surface of the body. Its posterior border is free: it is greatly thickened and forms the crest of the
spine. The medial end of the spine lies near the medial border of the scapula: this part is
referred to as the root of the spine. The lateral border of the spine is free and forms the medial
boundary of the spinoglenoid notch.
The acromion is continuous with the lateral
end of the spine. It forms a projection that is
directed forwards and partly overhangs the
glenoid cavity. It has a lateral border and a
medial border that meet anteriorly at the tip of
the acromion. The lateral border meets the crest
of the spine at a sharp angle termed the
acromial angle. The medial border of the
acromion shows the presence of a small oval
facet for articulation with the lateral end of
the clavicle. The acromion has upper and lower
surfaces.
The coracoid process is shaped like a bent
finger. The root of the process is attached to
the body of the scapula just above the glenoid
cavity. The lower part of the root is marked by
the supraglenoid tubercle. The tip of the
Fig. 2.8. Upper part of right scapula, seen from the
coracoid process is directed straight forwards.
lateral side.
15
(To appreciate this remember that the costal surface of the body of the scapula faces
anteromedially, not anteriorly. The glenoid cavity faces equally forwards and laterally.). At the
point where the coracoid process bends forwards, its dorsal surface is marked by a ridge.
3
Attachments on the Scapula
A. The muscles attached to the scapula are as follows (Figs. 2.9 to 2.11)
1. The deltoid takes origin from the lower border of the crest of the spine; and from the lateral
margin, tip and upper surface of the acromion.
2. The trapezius is inserted into the upper border of the crest of the spine, and into the medial
border of the acromion.
3. The short head of the biceps brachii arises from the (lateral part of the) tip of the coracoid
process; and the long head from the supraglenoid tubercle.
4. The coracobrachialis arises from
(the medial part of) the tip of the
coracoid process.
5. The long head of the triceps arises
from the infraglenoid tubercle.
6. The pectoralis minor is inserted
into the superior aspect of the
coracoid process.
7. The inferior belly of the omohyoid
arises from the upper border near the
suprascapular notch.
8. The subscapularis arises from the
whole of the costal surface, but for a
small part near the neck.
9. The serratus anterior is inserted
on the costal surface along the medial
border.
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lower 4 or 5 digitations are inserted into a large triangular area over the inferior angle.
10. The supraspinatus arises from the medial two-thirds of the supraspinous fossa, including
the upper surface of the spine.
11. The infraspinatus arises from the greater part of the infraspinous fossa, but for a part
near the lateral border and a part near the neck.
12. The teres minor arises from the upper two-thirds of the rough strip on the dorsal surface,
near the lateral border.
There is a gap in the area of origin for passage of the circumflex scapular vessels.
13. The teres major arises from the lower one-third of the rough strip along the dorsal aspect
of the lateral border. The area is wide and extends over the inferior angle.
14. The levator scapulae is inserted into a narrow strip along the dorsal aspect of the medial
border, extending from the superior angle to the level of the root of the spine.
17
2. The capsule of the acromioclavicular joint is attached to the margins of the facet for the
clavicle.
3. The coracoacromial ligament is attached as follows. Its anteromedial end is attached to the
lateral border of the coracoid process; and its lateral end to the medial aspect of the tip of the
acromion just in front of the clavicular facet.
4. The coracoclavicular ligament is attached to the coracoid process: the trapezoid part on its
superior aspect, and the conoid part near the root.
5. The suprascapular ligament bridges across the suprascapular notch and converts it into a
foramen which transmits the suprascapular nerve. The suprascapular vessels lie above the
ligament.
Ossification of the scapula
The scapula usually has eight centres of ossification.
1. A centre appears in the body during the 8th week of fetal life. The spine is ossified by
extension from this centre.
2. The greater part of the coracoid process is ossified from a centre that appears in the first
year. About the age of puberty a second centre appears in the root of the coracoid process. This
is called the subcoracoid centre. Extension of ossification from this centre is responsible for
forming the upper part of the glenoid cavity.
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3. At about the age of puberty two centres appear in the acromion, and one each in the lower
part of the glenoid cavity, the inferior angle and the medial border.
4. The subcoracoid centre fuses with the body by the 15th year. Other centres fuse with the
body by the 20th year.
The Humerus
The humerus is a long bone. It has a cylindrical central part called the shaft, and enlarged
upper and lower ends (Figs. 2.12, 2.13). The upper end is easily distinguished from the lower
by the presence of a large rounded head. The medial and lateral sides can be distinguished by
the fact that the head is directed medially. The anterior aspect of the upper end shows a prominent
vertical groove called the intertubercular sulcus. The side to which a given bone belongs can
be determined from the information given above.
The head is rounded and has a smooth convex articular surface. It is directed medially, and
also somewhat backwards and upwards. It forms the shoulder joint along with the glenoid
cavity of the scapula. It may be noted that the articular area of the head is much greater than
that of the glenoid cavity.
In addition to the head, the upper end of the humerus shows two prominences called the
greater and lesser tubercles (or tuberosities). These two tubercles are separated by the
intertubercular sulcus (also called the bicipital groove): this is the vertical groove on the
anterior aspect of the upper end mentioned above.
The lesser tubercle lies on the anterior aspect of the bone medial to the sulcus, between it and
the head. It has a smooth upper part and a rough lower part.
The greater tubercle is placed on the lateral aspect of the upper end and parts of it can,
therefore, be seen from both the anterior and posterior aspects.
Its anterior part forms the lateral boundary (or lip) of the intertubercular sulcus. The tubercle
shows three areas (or impressions) where muscles are attached (Fig.2.14). The uppermost of
these is placed on the superior aspect, the lowest on the posterior aspect, and the middle is in
between them.
There are two distinct regions of the upper end of the humerus that are referred to as the neck.
The junction of the head with the rest of the upper end is called the anatomical neck, while the
junction of the upper end with the shaft is called the surgical neck.
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Important relations
1. The intertubercular sulcus lodges the
tendon of the long head of the biceps brachii.
The ascending branch of the anterior
circumflex humeral artery also lies in this
sulcus.
2. The surgical neck of the bone is related
to the axillary nerve and to the anterior and
posterior circumflex humeral vessels.
3. The radial nerve and the profunda
brachii vessels lie in the radial groove
between the attachments of the lateral and
medial heads of the triceps.
25
The Radius
The radius is a long bone having a shaft and two
ends: upper and lower (Figs. 2.19 to 2.23). The upper
end bears a disc shaped head. In contrast the lower
end is much enlarged. The lateral and medial sides
of the bone can be distinguished by examining the
shaft which is convex laterally and has a sharp medial
(or interosseous) border. The anterior and posterior
aspects of the bone may be identified by looking at
the lower end: it is smooth anteriorly, but the posterior
aspect is marked by a number of ridges and grooves.
The side to which a given radius belongs can be
determined from the information given above.
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The Ulna
The ulna has a shaft, an upper end and a lower end (Figs. 2.28 to 2.31). The upper end is
large and irregular, while the lower end is small. The upper end has a large trochlear notch on
its anterior aspect. The medial and lateral sides of the bone can be distinguished by examining
the shaft (Fig. 2.31): its lateral margin is sharp and thin, while its medial side is rounded. The
side to which an ulna belongs can be determined from these facts.
The upper end of the ulna consists of two prominent projections called the olecranon process
and the coronoid process. When seen from behind the olecranon process appears to be a direct
upward continuation of the shaft and forms the uppermost part of the ulna. The coronoid process
projects forwards from the anterior aspect of the ulna just below the olecranon process (Fig.
2.30). The trochlear notch covers the anterior aspect of the olecranon process and the superior
aspect of the coronoid process. It takes part in forming the elbow joint and articulates with the
trochlea of the humerus. The upper and lower parts of the notch may be partially separated
from each other by a non-articular area. The trochlear notch is also divisible into medial and
lateral areas corresponding to the medial and lateral flanges of the trochlea.
In addition to its anterior surface which forms the upper part of the trochlear notch the olecranon
process has superior, posterior, medial and lateral surfaces (Fig. 2.28). When viewed from the
lateral side the uppermost part of the olecranon is seen projecting forwards beyond the rest of
the process (Fig. 2.30).
The coronoid process has an upper surface which forms the lower part of the trochlear notch.
In addition it has anterior, medial and lateral surfaces. The anterior surface is triangular. Its
lower part shows a rough projection called the tuberosity of the ulna. The medial margin of the
anterior surface is sharp and shows a small tubercle at its upper end. The upper part of the
lateral surface of the coronoid process shows a concave articular facet called the radial notch
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The shaft of the ulna has a sharp lateral or interosseous border, and less prominent anterior
and posterior borders (Fig. 2.31). It has anterior, posterior and medial surfaces. The upper part
of the interosseous border is continuous with the supinator crest mentioned above. Its central
part forms a prominent ridge on the lateral aspect of the shaft. The lower part of this border is
indistinct and ends on the lateral side of the head. The anterior border begins at the tuberosity
of the ulna (Fig. 2.28) and runs downwards. Near its lower end it curves backwards to end in
front of the styloid process. The posterior border begins at the apex of the triangular area on
the posterior aspect of the olecranon process (Fig. 2.29) and ends at the styloid process. The
anterior surface of the ulna lies between the interosseous and anterior borders. Its lower part
shows an oblique ridge that runs downwards and medially from the interosseous border. The
medial surface lies between the anterior and posterior
borders. The posterior surface is bounded by the
interosseous and posterior borders. It is marked by
two lines that divide it into three areas. The upper of
these lines runs obliquely downwards and medially
across the upper part of the surface. It starts at the
posterior end of the radial notch and terminates by
joining the posterior border. The part of the posterior
surface above the line is triangular. The part below
the oblique line is subdivided into medial and lateral
Fig. 2.31. T.S. across the middle of the
parts by a vertical ridge.
shaft of the ulna to show its surfaces and
borders.
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35
2. The oblique cord is attached to the lateral side of the tuberosity (Fig. 2.32).
3. The capsular ligament of the elbow joint is attached to the margins of the trochlear notch
(i.e., to the coronoid and olecranon processes).
4. The annular ligament is attached to the anterior and posterior borders of the radial notch
(Figs. 2.32 and 2.33).
5. The ulnar collateral ligament of the wrist is attached to the styloid process.
6. The articular disc of the inferior radio-ulnar joint is attached by its apex to a small rough
area just lateral to the styloid process (Fig. 2.36).
D. The tendon of the extensor carpi ulnaris lies in a groove on the posterior aspect of the lower
end of the ulna.
Ossification of the ulna
1. A primary centre appears in the shaft in the 8th fetal week and forms the greater part of the
ulna.
2. A centre for the lower end appears around the 5th or 6th year and joins the shaft by the
18th year.
3. The greater part of the olecranon is ossified by extension from the primary centre. The
proximal part of the process is ossified from two centres that appear about the 10th year and
join the shaft around the 15th year.
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Fig. 2.38. Skeleton of the hand, seen from the palmar aspect.
37
bones. The distal row is made up (from lateral to medial side) of the trapezium, trapezoid,
capitate and hamate bones.
The carpal bones of the proximal row (except the pisiform) take part in forming the wrist joint.
The distal row of carpal bones articulate with the metacarpal bones. Each carpal bone articulates
with neighbouring carpal bones to form intercarpal joints.
We will now take up the consideration of individual bones of the hand. Many of the features to
be described can be identified in the articulated hand (Fig. 2.38), and these are the ones that
need to be known for understanding the attachments of various structures. Some further details
can be seen only on isolated bones. Most teachers of anatomy no longer expect undergraduate
students to be able to assign individual bones to the right or left side. This information is
included for the use of postgraduate students, or for the occasional undergraduate student who
may wish to use it.
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39
2. The proximal aspect bears a convex facet (for the radius) while the distal aspect bears a
concave facet (for the capitate).
3. The medial surface bears a square facet (for the triquetral) while the lateral surface bears a
semilunar facet (for the scaphoid bone).
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2. The distal aspect can be distinguished from the proximal aspect because of the fact that the
facet for the pisiform is located on the distal part of the palmar surface.
3. The medial surface bears a convex facet (for the wrist joint) while the lateral surface bears
a concavo-convex facet (for the hamate bone).
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The Trapezium
This bone can be distinguished because
it bears a thick prominent ridge on its
palmar aspect (Figs. 2.38, 2.39, 2.44). This
ridge is called the tubercle.
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A. Muscles of the front of the forearm that gain insertion into bones of the
hand.
1. The flexor carpi radialis is inserted into the palmar surface of the bases of the 2nd and 3rd
metacarpal bones.
2. The flexor carpi ulnaris is inserted into the proximal part of the pisiform bone.
3. The flexor digitorum superficialis is inserted on both sides of the middle phalanges of all
digits except the thumb.
4. The flexor digitorum profundus is inserted on the bases of the distal phalanges of all digits
except the thumb.
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Fig. 2.57. Skeleton of the right hand showing attachments on the palmar aspect.
O = Origin. I = Insertion.
5. The flexor pollicis longus is inserted into the palmar surface of the base of the distal phalanx
of the thumb.
B. Muscles on the back of the forearm that gain insertion into bones of the hand
(Fig. 2.58)
1. The extensor carpi ulnaris is inserted into the medial side of the base of the fifth metacarpal
bone.
2. The extensor carpi radialis brevis is inserted into the dorsal aspect of the bases of the 2nd
and 3rd metacarpal bones.
3. The extensor carpi radialis longus is inserted into the dorsal aspect of the base of the 2nd
metacarpal bone.
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4. The abductor pollicis longus is inserted into the lateral side of the base of the first metacarpal
bone.
5. The extensor pollicis brevis is inserted on the dorsal aspect of the base of the proximal
phalanx of the thumb.
6. The extensor pollicis longus is inserted on the base of the distal phalanx of the thumb.
7. The extensor digitorum is inserted into the bases of middle phalanges, and of distal
phalanges, of all digits except the thumb.
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2. The opponens pollicis arises from the middle of the tubercle of the trapezium. It is inserted
into the lateral part of the palmar surface of the shaft of the first metacarpal bone.
3. The flexor pollicis brevis has two heads. The superficial head arises from the distal part of
the tubercle of the trapezium; and the deep head from the trapezoid and capitate bones. It is
inserted into the lateral side of the base of the proximal phalanx of the thumb.
4. The adductor pollicis has two heads. The oblique head arises from the bases of the 2nd and
3rd metacarpal bones, and from the capitate. The transverse head arises from the distal two
thirds of the ridge separating the medial and lateral surfaces of the third metacarpal bone. The
muscle is inserted into the medial side of the base of the proximal phalanx of the thumb.
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Fig. 2.59. Attachments of palmar interossei. Note insertions into dorsal digital expansions.
Fig. 2.60. Attachments of dorsal interossei of the hand. Note insertions into dorsal digital expansions.
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5. The first dorsal interosseous muscle arises from the dorsal aspect of the contiguous sides of
the shafts of the 1st and 2nd metacarpal bones.
6. The second dorsal interosseous muscle arises similarly from the contiguous sides of the
shafts of the 2nd and 3rd metacarpals.
7. The third dorsal interosseous muscle arises similarly from the contiguous sides of the
shafts of the 3rd and 4th metacarpal bones.
8. The fourth dorsal interosseous muscle arises similarly from the contiguous sides of the
shafts of the 4th and 5th metacarpal bones.
All the interossei are inserted mainly into dorsal digital expansions. Each dorsal interosseous
muscle also gains insertion into the base of one proximal phalanx.
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2nd month
Hamate:
3rd month
Triquetral:
3rd year
Lunate:
4th year
Scaphoid:
Pisiform:
2. Each metacarpal has a primary centre for the shaft that appears in the 9th fetal week. The
first metacarpal has a secondary centre for the base that appears in the 2nd or 3rd year, and
unites with the shaft at about 16 years. The other metacarpal bones have secondary centres
(not in the base but) in the heads. These appear at about 2 years of age and unite with the shaft
between 16 and 18 years of age.
3. Each phalanx has a primary centre for the shaft and a secondary centre for its proximal
end. The primary centre appears first in the distal phalanges (about the 8th week); next in the
proximal phalanges (about the 10th week); and last in the middle phalanges (about the 12th
fetal week). The secondary centres appear first in the proximal phalanges (2nd year) and later
in the middle and distal phalanges (3rd or 4th year). They unite with the shafts between 16 to
18 years of age.
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3
Bones of the Lower Limb
A brief introduction to the bones of the lower limb has been given in Chapter 1. We will now
consider each bone one by one.
BONES
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Fig. 3.1. Pelvis viewed from the front. The sacrum is shown only in its left half,
and the femur only on the right side.
We will now consider the features of the ilium, the ischium and the pubis in detail. Features
seen on the lateral aspect are shown in figure 3.2 and those seen on the medial aspect are
shown in figure 3.3.
The Ilium
In addition to the features already mentioned note the following.
The anterior end of the iliac crest projects forwards as the anterior superior iliac spine. The
posterior end of the crest also forms a projection called the posterior superior iliac spine. The
iliac crest may be subdivided into a ventral segment, consisting of the anterior two-thirds of
the crest, and a dorsal segment consisting of the posterior one third. The whole length of the
ventral segment shows a broad intermediate area which is bounded by inner and outer lips (Fig.
3.4A). The outer lip of the iliac crest is most prominent about 5 cm behind the anterior superior
iliac spine. This prominence is called the tubercle of the iliac crest. The dorsal segment of the
iliac crest has medial and lateral surfaces separated by a ridge (Fig. 3.4B).
The anterior border of the ilium extends from the anterior superior iliac spine to the acetabulum.
Its lowest part presents a prominence called the anterior inferior iliac spine.
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The posterior border of the ilium extends from the posterior superior iliac spine to the back of
the acetabulum. A few centimetres below the posterior superior iliac spine the posterior border
presents another prominence called the posterior inferior iliac spine. The lower part of the
posterior border forms the upper boundary of a deep notch called the greater sciatic notch.
The lateral aspect of the ilium constitutes its gluteal surface. This surface is marked by three
ridges called the anterior, posterior and inferior gluteal lines. The posterior gluteal line is
vertical. It extends from the iliac crest, above, to the posterior inferior iliac spine below.
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The anterior gluteal line is convex upwards and backwards. Its anterior end meets the iliac
crest in front of the tubercle; while its posterior end reaches the greater sciatic notch. The
inferior gluteal line is horizontal. Its anterior end lies just above the anterior inferior iliac
spine; and its posterior end reaches the greater sciatic notch. The gluteal surface of the ilium
bears a prominent groove just above the acetabulum. The lower part of the gluteal surface
extends behind the acetabulum where it becomes continuous with the ischium. The lowest part
of the ilium forms the upper two-fifths of the acetabulum.
The medial surface of the ilium is divisible into the following parts. The iliac fossa is smooth
and concave and forms the wall of the greater pelvis: it occupies the anterior part of the medial
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surface. The sacropelvic surface lies behind the iliac fossa. It can be subdivided into three
parts. The upper part is rough and constitutes the iliac tuberosity.
The middle part articulates with the lateral side of the sacrum. This part is called the auricular
surface because of a resemblance to the pinna. The pelvic part of the medial surface lies below
and in front of the auricular surface. It is smooth and takes part in forming the wall of the lesser
pelvis. This surface is often marked (specially in the female) by a rough groove called the
preauricular sulcus. The iliac fossa and the sacropelvic surface are separated by the medial
border of the ilium. This border is sharp in its upper part where it separates the iliac fossa from
the auricular surface. Its lower part is rounded and forms the arcuate line. The lower end of the
arcuate line reaches the junction of the ilium and pubis. This junction shows an enlargement
called the iliopubic eminence.
Fig. 3.6.
Medial part
of right
hip bone:
anterosuperior
aspect.
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The Ischium
The ischium consists of a main part called the body, and a projection called the ramus. The
upper end of the body forms the inferior and posterior part of the acetabulum. The lower part of
the body has three surfaces: dorsal, femoral and pelvic. The lower part of the dorsal surface has
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a large rough impression called the ischial tuberosity. This tuberosity is divided into upper and
lower parts by a transverse ridge (Fig. 3.5). Each of these parts is again divided into medial
and lateral parts.The part of the dorsal surface above the ischial tuberosity shows a wide shallow
groove. Superiorly, the dorsal surface of the ischium becomes continuous with the gluteal surface
of the ilium. The posterior border of the dorsal surface of the ischium forms part of the lower
margin of the greater sciatic notch. Just below this notch the border projects backwards and
medially as the ischial spine. Between the ischial spine and the upper border of the ischial
tuberosity we see a shallow lesser sciatic notch.
The femoral surface of the ischium is directed downwards, forwards and laterally. It is
continuous with the external surface of the ramus of the ischium which is attached to the
medial side of the lower end of the body. The ramus has an anterior (external) surface and a
posterior (internal) surface.
The Pubis
The pubis consists of a body, a superior ramus and an inferior ramus. The body (Fig. 3.6)
forms the anterior and most medial part of the hip bone. It has an anterior surface and a
posterior surface. The upper border of the body forms a prominent ridge called the pubic crest.
The crest ends laterally in a projection called the pubic tubercle.
The superior ramus of the pubis is attached to the upper and lateral part of the body. It runs
upwards backwards and laterally. Its lateral extremity takes part in forming the pubic part of
the acetabulum. It meets the ilium at the iliopubic eminence. The superior ramus is triangular
in cross section (Fig. 3.7). It has three borders and three surfaces.
The anterior border is called the obturator crest. The posterior border is sharp and forms the
pecten pubis or pectineal line. The inferior border is also sharp and forms the upper margin of
the obturator foramen. The surface between the obturator crest and the pecten pubis is the
pectineal surface. The pelvic surface lies between the pecten pubis and the inferior border. The
surface between the obturator crest and the
inferior border is called the obturator surface.
A groove runs forwards and downwards across
it and is called the obturator groove.
The inferior ramus is attached to the lower
and lateral part of the body of the pubis. It
passes downwards and laterally to meet the
ramus of the ischium. These two rami form the
medial boundary of the obturator foramen.
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In the intact pelvis (Fig. 3.1) the conjoined rami of the pubis and ischium of the two sides form
the boundaries of the pubic arch which lies below the pubic symphysis. The inferior ramus of
the pubis has an anterior (or outer) surface, and a posterior (or inner) surface. These surfaces
are continuous with corresponding surfaces of the ischial ramus.
The Acetabulum
The acetabulum is a deep cup like cavity that lies on the lateral aspect of the hip bone. It forms
the hip joint with the head of the femur. It is directed laterally and somewhat downwards and
forwards. The margin of the acetabulum is deficient in the anteroinferior part: the gap in the
margin is called the acetabular notch. The floor of the acetabulum is partly articular and
partly non-articular. The articular area for the head of the femur is shaped like a horse-shoe and
is called the lunate surface. This surface is widest superiorly. The inner border of the lunate
surface forms the margin of the non-articular part of the floor which is called the acetabular
fossa. The contributions to the acetabulum by the ilium, the ischium and the pubis are shown
in figures 3.6 and 3.9.
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6. The quadratus lumborum arises from the posterior one third of the inner lip of the ventral
segment of the iliac crest.
7. The gluteus maximus arises from the lateral surface of the dorsal segment of the iliac crest
and from the gluteal surface of the ilium behind the posterior gluteal line.
8. The erector spinae arises from the medial surface of the dorsal segment of the iliac crest.
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B. The muscles attached to the external aspect of the hip bone (excluding the
iliac crest) are as follows (Fig. 3.8)
1. See origin of gluteus maximus described above.
2. The gluteus medius arises from the gluteal surface of the ilium between the anterior and
posterior gluteal lines.
3. The gluteus minimus arises from the gluteal surface of the ilium between the anterior and
inferior gluteal lines.
4. The sartorius arises from the anterior superior iliac spine and from a small area below the
spine.
5. The straight head of the rectus femoris arises from the anterior inferior iliac spine; and its
reflected head from the groove above the acetabulum.
6. A few fibres of the piriformis arise from the upper border of the greater sciatic notch near
the posterior inferior iliac spine.
7. The pectineus arises from the upper part of the pectineal surface of the superior ramus of
the pubis.
8. The rectus abdominis (lateral head) arises from the pubic crest.
9,10. The pyramidalis and the adductor longus arise from the anterior surface of the body of
the pubis.
11. The gracilis arises from the anterior surface of the body, and the inferior ramus, of the
pubis; and from the ramus of the ischium.
12. The adductor brevis arises from the anterior surface of the body of the pubis and its
inferior ramus, lateral to the origin of the gracilis.
13. The obturator externus arises from the superior and inferior rami of the pubis, and from
the ramus of the ischium, immediately around the obturator foramen.
14. The adductor magnus arises from the lower lateral part of the ischial tuberosity, and from
the ramus of the ischium.
15,16. The semitendinosus and the biceps femoris (long head) arise from the upper medial
part of the ischial tuberosity.
17. The semimembranosus arises from the upper lateral part of the ischial tuberosity.
18. The quadratus femoris arises from the femoral surface of the ischium just lateral to the
ischial tuberosity.
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19. The superior gemellus arises from the dorsal surface of the ischial spine.
20. The inferior gemellus arises from the ischium just above the ischial tuberosity.
C. The muscles arising from the internal aspect of the hip bone are as follows
(Fig. 3.9)
1. The iliacus arises from the upper two thirds of the iliac fossa.
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2. The obturator internus arises from the pelvic surfaces of the superior and inferior rami of
the pubis, and the ramus of the ischium, immediately adjoining the obturator foramen; and
from the pelvic surfaces of the ischium and of the ilium.
3. The most posterior fibres of the levator ani arise from the pelvic surface of the ischial spine;
and its most anterior fibres from the posterior surface of the body of the pubis.
4. The psoas minor is inserted into the pecten pubis and into the iliopectineal eminence.
5. The coccygeus arises from the pelvic surface of the ischial spine.
6. The superficial transversus perinei and the ischiocavernosus arise from the posterior surface
of the ramus of the ischium.
7. The sphincter urethrae arises from the posterior surfaces of the inferior pubic and ischial
rami.
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Pelvis as a whole
We have seen that the bony pelvis is made up of the two hip bones, the sacrum and the coccyx
(Fig. 3.10). (Note: References made to the sacrum and coccyx will be clear after these bones
have been studied. They are described in Chapter 4). It may be subdivided into the greater (or
false) pelvis and the lesser (or true) pelvis. The walls of the greater pelvis are formed by the
broad upper parts of the two iliac bones (iliac fossae), and posteriorly by the base of the sacrum.
Note that the greater pelvis has no bony anterior wall, and that it is merely the lower part of the
abdomen. The communication between the greater and lesser pelvis is called the superior pelvic
aperture or pelvic inlet. The margins of the aperture constitute the pelvic brim. The pelvic
brim is formed behind by the sacral promontory, and the ridge separating the superior and
anterior surfaces of the sacrum; on either side by the arcuate line of the ilium (also see Fig. 3.3);
and anteriorly by the pecten pubis and by the pubic crest. The arcuate line, the pecten pubis and
the pubic crest are collectively referred to as the linea terminalis.
The cavity of the lesser pelvis is bounded in front by the body and rami of the pubis; on
either side by the pelvic surfaces of the ilium and ischium below the arcuate line; and behind by
the anterior surfaces of the sacrum and coccyx.
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The inferior pelvic aperture is highly irregular. It is bounded anteriorly by the pubic arch;
laterally, in that order, by the ischial tuberosity, the lesser sciatic notch, the ischial spine and
the greater sciatic notch. Posteriorly, it is formed by the lateral margin of the sacrum and coccyx.
When the ligaments are intact the lateral margins are formed by the sacrotuberous ligaments
(that stretch from the side of the sacrum and coccyx to the ischial tuberosity. The inferior
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aperture then appears to be rhomboidal (Fig. 3.12).
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However, all the features have to be taken together, no one feature being decisive.
(1) The subpubic angle (i.e. the angle between the right and left ischiopubic rami) is almost
ninety degrees in the female, but is only fifty to sixty degrees in the male (a in Figs. 3.14 A,B).
The angle is sharp in the male, but tends to be rounded in the female.
(2) The medial edges of the ischiopubic rami may be markedly everted in the male (b in Fig.
3.15A) for attachment of the crura of the penis.
(3) In Figs. 3.14 A and B lines xy represent the distance from the pubic symphysis to the
anterior margin of the acetabulum. Lines yz represent the total width of the acetabulum. In the
male (Fig. 3.14A) xy = yz; but in the female (Fig. 3.14B) xy is distinctly more than yz.
(4) The pubis, the ischium and the ilium meet at a point in the floor of the acetabulum (m in
Figs. 3.14A,B). Line mn represents the height of the ischium, and xm is the length of the pubis.
The value xm / mn x 100 is less than ninety in the male and more than ninety in the female.
This is called the puboischial index (of Washburn).
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(8) The pelvic inlet is rounded in the female, but tends to be heart shaped in the male. The
male inlet is smaller in all diameters (Fig. 3.17).
(9) The preauricular sulcus is deeper and more prominent in the female.
The Femur
The femur (Figs. 3.18 to 3.24) is a long bone having a shaft, an upper end and a lower end.
The upper end is easily distinguished from the lower end by the presence of a rounded head
which is joined to the shaft by an elongated neck. The head is directed medially to articulate
with the acetabulum of the hip bone. The anterior and posterior aspects of the bone can be
distinguished by examining the shaft: it is convex forwards and the anterior aspect is smooth,
while the posterior aspect is marked by a prominent vertical ridge called the linea aspera. The
information given above is sufficient to distinguish between a femur of the right or left side.
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The Shaft
The shaft of the femur has a forward
convexity and is smooth anteriorly. Its
posterior aspect is marked by a rough
vertical ridge called the linea aspera. A
section across the shaft is seen in Fig. 3.22.
We see that the shaft is triangular having
three borders (lateral, medial and posterior)
and three surfaces (anterior, lateral and
medial). The lateral and medial borders are
rounded. The posterior border corresponds
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to the linea aspera. It will be seen from figure 3.22 that in addition to the directions indicated by
their names the medial and lateral surfaces also face backwards. The linea aspera has distinct
medial and lateral lips. When traced upwards to the upper one third of the shaft the lips diverge.
The medial lip becomes continuous with the spiral line. The lateral lip of the linea aspera
becomes continuous with a broad rough area called the gluteal tuberosity. The upper end of
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the gluteal tuberosity reaches the greater trochanter. The area between the gluteal tuberosity
(laterally) and the spiral line (medially) constitutes a fourth surface (posterior) over the upper
one third of the shaft. The two lips of the linea aspera also diverge from each other over the
lower one third of the shaft to become continuous with ridges called the medial and lateral
supracondylar lines. Here again, the shaft has an additional surface directed posteriorly: this
surface is triangular and is called the popliteal surface.
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When seen from the lateral aspect the lateral condyle of the femur is seen to be more or less
flat (Fig. 3.24). A little behind the middle it is marked by a prominence called the lateral
epicondyle. Behind and below the epicondyle there is a prominent groove that is divided into
an anterior deeper part and a shallower posterior part.
When seen from the medial aspect the medial condyle is seen to be convex. The most prominent
point on it is called the medial epicondyle (Fig. 3.23). The uppermost part of the medial condyle
is marked by a prominence called the adductor tubercle (Fig. 3.21). This tubercle lies above
and behind the medial epicondyle and is continuous with the lower end of the medial
supracondylar line.
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12. The adductor longus is inserted into the middle one third of the linea aspera.
13. The adductor magnus is inserted into the medial margin of the gluteal tuberosity, the
linea aspera, and the medial supracondylar line. The hamstring part of the muscle ends in a
tendon which is attached to the adductor tubercle.
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3. The capsular ligament of the knee joint is attached to the femoral condyles and to the
posterior margin of the intercondylar fossa. On the lateral condyle it is attached above the
origin of the popliteus. The capsule is deficient anteriorly, where it is replaced by the patella.
4. The anterior cruciate ligament is attached to the medial surface of the lateral condyle.
5. The posterior cruciate ligament is attached to the lateral surface of the medial condyle.
The femur is the second long bone in the body to start ossifying (the first being the
clavicle). The primary centre appears in the shaft during the 7th fetal week. It may be
noted that the neck of the femur ossifies from the primary centre.
2.
Three secondary centres appear at the upper end of the bone, one each for the head (first
year), the greater trochanter (4th year), and the lesser trochanter (around the 12th year).
Each centre fuses independently with the shaft in the reverse order of appearance: the
lesser trochanter at about 13 years, the greater trochanter at about 14 years, and the head
around 16 years.
3. One centre appears for the distal end. This centre appears before birth in the 9th month of
fetal life. It fuses with the shaft between the 16th and 18th years.
The Patella
The tendons of some muscles have, embedded in them, small bones that help them to glide
over bony surfaces. Such bones are called sesamoid bones. The largest sesamoid bone in the
body is to be seen in the tendon of the quadriceps femoris as it passes in front of the knee joint.
It is called the patella.
The patella is shaped somewhat like a disc (Figs. 3.27, 3.28). It roughly triangular in outline.
It has anterior and posterior surfaces that are separated by three borders: superior, medial, and
lateral. The superior border is also called the base. The inferior part of the bone shows a downward
projection representing the apex of the triangle.
The anterior surface is rough and can be felt through the overlying skin. The upper part of
the posterior surface is articular. This part articulates with the patellar surface on the anterior
aspect of the condyles of the femur. It consists of a larger lateral part and a smaller medial part,
the two parts being separated by a ridge. The most medial part of the articular area may be
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recognizable as a separate area: this part articulates with the medial condyle of the femur only
in extreme flexion of the knee joint. The lower part of the posterior surface is nonarticular. It is
rough for attachment of the ligamentum patellae.
The superior border gives attachment to the rectus femoris and to the vastus intermedius.
2.
The medial margin gives attachment to the medial patellar retinaculum (which is an
expansion from the tendon of the vastus medialis).
3.
The lateral margin gives attachment to the lateral patellar retinaculum (which is an
expansion from the tendon of the vastus lateralis).
4.
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The Tibia
The tibia is the medial bone of the leg. It has
a shaft, an upper end and a lower end (Figs.
3.29 to 3.35). The upper end can be
distinguished from the lower end as it is much
larger. The medial and lateral sides of the bone
can be distinguished by examining the lower
end: this end has a prominent downward
projection, the medial malleolus, on its medial
side. The anterior and posterior aspects of the
bone can be distinguished by examining the
shaft. The shaft is triangular in section (Fig.
3.31) and has a sharp anterior border. The side
to which a tibia belongs can be determined from
the information given above.
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The Shaft
If we cut a section across the shaft of the tibia
(Fig. 3.31) we see that the shaft is triangular.
It has anterior, medial and lateral (or
interosseous) borders; and medial, lateral and
posterior surfaces.
The anterior border runs downwards from
the tibial tuberosity. Its lower part turns
medially and reaches the anterior margin of
the medial malleolus.
The interosseous or lateral border begins a
little below and in front of the articular facet
for the fibula. It descends along the lateral
aspect of the shaft. Its lower end forms the
anterior margin of a rough triangular area seen
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3
The medial surface lies between the anterior
and medial borders. The upper end of the
surface is rough just in front of the medial
border. The rest of the surface is smooth and
can be felt through the overlying skin.
The lateral surface lies between the anterior
and interosseous borders. Because of the fact
that the anterior border turns medially in its
lower part, the lateral surface extends on to
the anterior aspect of the lower part of the
shaft.
The posterior surface (Fig. 3.33) lies between
the medial and interosseous borders. Over the
upper one-third of the shaft this surface is
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11. The flexor retinaculum is attached to the posterior surface of the medial malleolus.
Some Relations of the Tibia
1. The anterior aspect of the lower end of the tibia (which is continuous with the lateral
3
surface of the shaft) is crossed by the tendons of the following muscles (from medial to lateral
side).
(a) Tibialis anterior
(b) Extensor hallucis longus
(c) Extensor digitorum longus.
(d) Peroneus tertius.
2. The anterior tibial vessels and the deep peroneal nerve cross the anterior aspect of the
lower end of the bone lying between the tendons of the extensor hallucis longus and the extensor
digitorum longus.
3. The posterior aspect of the lower end of the tibia is crossed by tendons of the following
muscles (from medial to lateral side).
(a) Tibialis posterior
(b) Flexor digitorum longus
(c) Flexor hallucis longus
The tendon of the flexor digitorum longus crosses that of the tibialis posterior near the lower
end of the bone.
4. The posterior tibial vessels and nerve cross the posterior aspect of the lower end of the bone
lying between the tendons of the flexor digitorum longus and the flexor hallucis longus.
Ossification of the Tibia
The tibia has three centres of ossification.
1. The primary centre (for the shaft) appears in the 7th week of fetal life.
2. A secondary centre for the upper end appears towards the end of fetal life. It fuses with the
shaft between the 16th and 18th years.
3. A secondary centre for the lower end appears during the first year, and fuses with the shaft
between the 15th and 17th years.
4. A separate centre may exist for the tibial tuberosity.
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The Fibula
The fibula has a shaft, an upper end and a lower
end (Figs. 3.40 to 3.44). The upper end is irregularly
expanded in all directions. In contrast the lower
end is flattened from side to side and forms the
lateral malleolus. The medial side of the malleolus
bears a triangular articular surface (for the
talus)(Figs. 3.40, 3.41). Just behind this articular
surface the malleolus shows a deep malleolar fossa
(Fig. 3.41); and this fact enables the anterior and
posterior aspects of the bone to be distinguished
from one another. The side to which a fibula belongs
can be determined with the help of the information
given above.
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The Shaft
The surfaces and borders of the shaft show considerable variation
from bone to bone and may be difficult to identify. To trace them it
is important to first orientate the bone correctly by examining the
lower end as described above.
The shaft has three borders: anterior, posterior and interosseous
(or medial).
The anterior border is sharp (Fig. 3.40). It begins just below the
anterior aspect of the head. Near its lower end it turns laterally to
join the apex of the triangular area of the shaft already identified
above the lateral malleolus. The lowest part of the anterior border
forms the posterior margin of the triangle.
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6. The superior extensor retinaculum of the ankle is attached to the anterior border of the
triangular area present above the lateral malleolus.
7. The superior peroneal retinaculum is attached to the posterior margin of the lateral malleolus.
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Fig. 3.49. Skeleton of the foot seen from above (dorsal aspect)
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Fig. 3.50. Skeleton of the foot seen from below (plantar aspect)
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The Calcaneus
The calcaneus can be correctly orientated, and its side determined using the following
information (Figs. 3.49, 3.50 to 3.52) .
(1) The bone is elongated anteroposteriorly. The anterior aspect is easily distinguished from
the posterior as it is covered by a large articular facet, while the posterior aspect is non-articular.
(2) The superior aspect can be distinguished from the inferior as it bears three facets, while
the inferior aspect is nonarticular.
(3) The medial aspect can be distinguished from the lateral aspect as it bears a prominent
projection.
Having orientated the bone correctly the
following facts can now be appreciated.
The calcaneus has anterior, posterior,
superior, inferior, medial and lateral
surfaces. The anterior surface is fully
covered by a large articular facet for the
cuboid bone. The posterior surface is
non-articular. It is divisible into upper,
middle and inferior parts. The lateral
surface is more or less flat. Its anterior
part shows a small elevation called the
peroneal trochlea (or tubercle). The
anterosuperior and the posteroinferior
aspects of the tubercle are grooved. The
medial surface is easily distinguished as
it bears a large projection called the
sustentaculum tali that projects medially
from its anterior and upper part. The
inferior aspect of the sustentaculum tali
is marked by a groove. The superior or
dorsal surface bears three facets:
anterior, middle and posterior that
articulate with corresponding facets on
the talus. The middle facet lies on the
upper surface of the sustentaculum tali.
It is separated from the posterior facet by
a deep groove called the sulcus calcanei.
In the articulated foot the sulcus calcanei
comes into apposition with a similar
groove on the talus (called the sulcus tali),
to form the sinus tarsi.
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The plantar (or inferior) surface of the calcaneus shows a prominence in its posterior part
called the calcaneal tuberosity. The lateral and medial parts of the tuberosity extend further
forwards than its central part and are called the lateral and medial processes, respectively, of
the tuberosity. The anterior part of the plantar surface shows another elevation called the anterior
tubercle.
The Talus
The talus can be orientated correctly, and its side determined using the following information
(Figs. 3.49, 3.50, 3.53 to 3.56).
(1) The bone is elongated antero posteriorly. The anterior end (or head) can
be distinguished from the posterior end as
it is rounded and has a large convex
articular surface.
(2) The superior aspect of the bone bears
a large pulley shaped surface that is convex
upwards. The inferior aspect bears three
facets.
(3) The lateral surface bears a large
triangular facet, while the medial side
shows a comma shaped facet.
The talus is seen from above in figure
3.53. In this figure we see that the bone
has a head, a neck and a body. The distal
surface of the head has a large convex
surface that articulates with the navicular
bone. The upper surface of the body is
covered by a large trochlear articular
surface which articulates with the lower
end of the tibia. This surface is convex from
front to back, and concave from side to
side.
The lateral and medial sides of the bone
are shown in figures 3.54 and 3.55
respectively. The lateral surface bears a
large triangular facet for articulation with
the lateral malleolus of the fibula, while
the medial surface bears a comma
shaped facet that is broad anteriorly and
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(c) The lateral aspect of the bone can be identified by the fact that the groove on the plantar
surface extends onto the lateral surface also. Further, the lateral end of the ridge is enlarged to
form the tuberosity. The medial surface bears a facet for the lateral cuneiform bone, and
occasionally one for the navicular bone.
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cuneiform bone; medially with the second metatarsal bone; and laterally with the fourth
metatarsal bone.
The base of the fourth metatarsal bone articulates proximally with the cuboid bone; medially
with the lateral cuneiform bone and with the base of the third metatarsal; and laterally with the
base of the fifth metatarsal bone.
The fifth metatarsal bone articulates proximally with the cuboid bone and medially with the
fourth metatarsal bone.
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(a) The facet on the proximal surface of the base of the fourth metatarsal is quadrangular,
while the facets on the second and third metatarsals are triangular.
(b) The triangular facet on the proximal surface of the base of the third metatarsal is flat,
while that on the second metatarsal is concave.
Additional confirmation about the medial and lateral sides of the metatarsal bones can be
obtained by examining facets present on the medial and lateral sides of their bases. These are
shown in figures 3.64 to 3.67. However, it may be noted that these facets are subject to
considerable variation and may be misleading.
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B. The tendons descending from the leg to gain insertion on to the plantar
aspect of the skeleton of the foot are as follows (Fig. 3.70)
1. The tibialis posterior is inserted mainly into the tuberosity of the navicular bone and the
medial cuneiform bone.
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Slips from the tendon (not shown in the diagram) also reach the sustentaculum tali, the
intermediate cuneiform bone, the lateral cuneiform bone, the cuboid, and the bases of the 2nd,
3rd and 4th metatarsal bones.
2. The tibialis anterior is inserted into the medial cuneiform bone (on its medial and plantar
3
aspects) and into the medial side of the base of the first metatarsal bone.
3. The peroneus longus is inserted into the lateral side of the medial cuneiform bone, and into
the lateral side of the base of the first metatarsal bone.
4. See peroneus brevis, above.
5. The flexor hallucis longus is inserted into the plantar aspect of the base of the distal phalanx
of the great toe.
6. The flexor digitorum longus is inserted into the plantar surfaces of the bases of the distal
phalanges of all digits except the great toe.
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6. The abductor digiti minimi takes origin from both the lateral and medial processes of the
tuberosity of the calcaneus. It is inserted into the lateral side of the proximal phalanx of the 5th
toe (along with the flexor digiti minimi brevis).
7. The flexor digiti minimi brevis arises from the plantar surface of the base of the 5th metatarsal
bone. It is inserted into the lateral side of the proximal phalanx of the 5th toe (along with the
abductor digiti minimi).
D. The attachments of the interossei of the foot are as follows (Figs. 3.71, 3.72)
1. The first plantar interosseous muscle arises from the plantar aspect of the shaft of the third
metatarsal bone. The second plantar interosseous muscle has a similar origin from the fourth
metatarsal; and the third plantar interosseous muscle from the fifth metatarsal. The plantar
interossei are inserted into the medial side of the base of the proximal phalanx of the
corresponding digit (and also into the dorsal digital expansion).
2. Each dorsal interosseous muscle arises from the adjacent sides of the shafts of two metatarsal
bones as follows:
(a) The first muscle from the 1st and 2nd
metatarsals.
(b) The second muscle from the 2nd and
3rd metatarsals.
(c) The third muscle from the 3rd and 4th
metatarsals.
(d) The fourth muscle from the 4th and
5th metatarsals.
The dorsal interossei are inserted as
follows.
(a) The first muscle on the medial side of
the base of the proximal phalanx of the 2nd
digit.
(b) The second muscle on the lateral side
of the base of the proximal phalanx of the
2nd digit.
(c) The third muscle on the lateral side of
the base of the proximal phalanx of the 3rd
digit.
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3
E. Other attachments on the bones
of the foot.
1. The bones of the foot give attachment
to numerous ligaments connected with the
ankle, intertarsal, and tarsometatarsal
joints; and with the joints of the digits. The
more important of these are as follows.
(a) The anterior and posterior talofibular
ligaments are attached to the lateral side of
the talus.
(b) The anterior and posterior tibiotalar
ligaments are attached on the medial side
of the talus.
(c) The calcaneofibular ligament is
attached to the lateral surface of the
calcaneus.
(d) The cervical ligament is attached (above) to the inferolateral aspect of the neck of the
talus; and (below) to the superior surface of the calcaneus.
(e) The long plantar ligament is attached posteriorly to the plantar surface (tuberosity) of the
calcaneus; and anteriorly to the plantar surface of the cuboid bone distal to the groove for the
peroneus longus (Fig. 3.70). Some fibres of the ligament reach the bases of the 2nd, 3rd, and
4th metatarsal bones.
(f) The short plantar ligament passes from the anterior tubercle of the calcaneus to the cuboid
bone (proximal to the groove for the peroneus longus) (Fig. 3.70).
(g) The plantar calcaneonavicular ligament or spring ligament passes from the anterior margin
of the sustentaculum tali of the calcaneus to the plantar surface of the navicular bone (Fig.3.70).
(h) The bifurcate ligament is Y-shaped. The stem of the Y is attached (posteriorly) to the
upper surface of the calcaneus. The limbs are attached (anteriorly) to the dorsal aspect of the
cuboid and navicular bones.
(i) The interosseous talocalcaneal ligament passes from the sulcus tali (on the talus) to the
sulcus calcanei (on the calcaneus).
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2. The lateral end of the inferior extensor retinaculum (of the ankle) is attached to the upper
surface of the calcaneus.
3. The lower end of the flexor retinaculum (of the ankle) is attached to the medial surface of
the calcaneus.
4. The peroneal retinacula are attached to the lateral surface of the calcaneus.
5. The fibrous flexor sheath of each digit is attached to the sides of the phalanges, on the
plantar aspect.
Each metatarsal bone has a primary centre for the shaft appearing in the 9th or 10th fetal
week. The first metatarsal has a secondary centre for its base appearing in the 3rd year. The
other metatarsals have secondary centres for their heads (not bases) appearing in the 3rd or 4th
year. The secondary centres unite with the shafts between the 17th and 20th years.
Each phalanx has a primary centre for the shaft (appearing in the 7th to 15th fetal weeks);
and a secondary centre for the base (appearing between the 2nd to 8th years) which unites with
the shaft by the 18th year.
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The superior facet of one vertebra articulates with the inferior facet of the vertebra above it.
Two adjoining vertebrae, therefore, articulate at three joints: two between the right and left
articular processes and one between the bodies of the vertebrae (through the intervertebral
disc).
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(8) In figure 4.3 note that the pedicle is much narrower than the body (in vertical diameter)
and is attached nearer its upper border. As a result there is a large inferior vertebral notch
below the pedicle. The notch is bounded in front by the posterior surface of the body of the
vertebra, and behind by the inferior articular process. Above the pedicle there is a much shallower
superior vertebral notch. The superior and inferior notches of adjoining vertebrae join to form
3
the intervertebral foramina which give passage to spinal nerves emerging from the spinal
cord.
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slightly upwards and slightly laterally (Also see Fig. 4.2). The inferior facets face forwards,
slightly downwards and slightly medially.
In the lumbar region the facets are vertical. They are curved from side to side (Fig. 4.13). The
superior facets are slightly concave (Also see Fig. 4.6) and are directed equally backwards and
medially. The inferior facets are slightly convex, and are directed equally forwards and laterally
(Also see Fig. 4.8). Each superior articular process of a lumbar vertebra bears a rough projection
called the mamillary process, on its posterior border.
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In the cervical region the superior and inferior articular processes form a solid articular
pillar that helps to transmit some weight from one vertebra to the next lower one. This is not so
in the thoracic and lumbar regions.
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Attachments on Vertebrae
Vertebrae give attachment to numerous muscles and ligaments. The muscles attached to
vertebrae vary from vertebra to vertebra, and no useful purpose is served by trying to list them.
The ligaments concerned are those that hold adjoining vertebrae together. Adjoining vertebrae
are connected to each other at three joints. There is one median joint between the vertebral
bodies, and two joints (one right and one left) between the articular processes.
1. Adjoining vertebral bodies are connected to each other by intervertebral discs, made up of
fibrocartilage. Each disc has an outer fibrous part called the annulus fibrosus, and an inner
soft part called the nucleus pulposus.
2. The joints between the articular processes are synovial joints. The capsules of these joints
are attached along the margins of articular facets.
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3. Apart from the intervertebral discs and the capsular ligaments, adjoining vertebrae are
connected to one another by a series of ligaments that are shown schematically in figure 4.14.
These ligaments are as follows:
(a) The anterior longitudinal ligament passes from the anterior surface of the body of one
vertebra to another. Its upper end reaches the basilar part of the occipital bone.
(b) The posterior longitudinal ligament is present on the posterior surface of the vertebral
bodies (within the vertebral canal). Its upper end reaches the body of the axis beyond which it
is continuous with the membrana tectoria.
(c) The intertransverse ligaments connect adjacent transverse processes.
(d) The interspinous ligaments connect adjacent spinous processes.
(e) The supraspinous ligaments connect the tips of the spines of vertebrae from the 7th
cervical to the sacrum. (In the neck they are replaced by the ligamentum nuchae).
(f) The ligamenta flava (singular = ligamentum flavum) connect the laminae of adjacent
vertebrae. The right and left ligaments meet in the middle line.
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The first cervical vertebra is called the atlas. It looks very different from a typical cervical
vertebra as it has no body, and no spine (Figs. 4.15, 4.16).
It consists of two lateral masses joined anteriorly by a short anterior arch, and posteriorly
by a much longer posterior arch. The arches give the atlas a ring like appearance. A large
transverse process, pierced by a foramen transversarium, projects laterally from the lateral
mass. The superior aspect of each lateral mass shows an elongated concave facet which articulates
with the corresponding condyle of the occipital bone (to form an atlanto-occipital joint). The
long axis of the facet runs forwards and medially. The facet may be constricted at its middle or
may even be divided into two. Nodding and lateral movements of the head take place at the two
(right and left) atlanto-occipital joints. The inferior aspect of each lateral mass (Fig. 4.16) shows
a large oval (almost circular) facet for articulation with the corresponding superior articular
facet of the axis (second cervical vertebra) to form a lateral atlanto-axial joint. The facet is
more or less flat and is directed downwards and medially and somewhat backwards. The medial
side of the lateral mass shows a tubercle which gives attachment to the transverse ligament of
the atlas (shown in dotted line in figure 4.15). This ligament divides the large foramen (bounded
by the lateral masses and the arches) into anterior and posterior parts. The posterior part
corresponds to the vertebral foramen of a typical vertebra: the spinal cord passes through it.
The anterior part is occupied by the dens (which is an upward projection from the body of the
axis). The dens articulates with the posterior aspect of the anterior arch, which bears a circular
facet for it. The dens also articulates with the transverse ligament, these two articulations
collectively forming the median atlanto-occipital joint. In side to side movements of the head
the atlas moves with the skull around the pivot formed by the dens.
The anterior arch bears a small midline projection called the anterior tubercle. The posterior
arch bears a similar projection, the posterior tubercle, which may be regarded as a rudimentary
spine. The upper surface of the posterior arch is grooved by the vertebral artery. The groove is
continuous laterally with the foramen transversarium.
The transverse processes are large. Their tips are believed to correspond to the posterior tubercles
of the transverse processes of a typical cervical vertebra.
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2. The first cervical nerve crosses the posterior arch deep to the vertebral artery and divides
here into anterior and posterior primary rami.
3. Structures passing through the vertebral canal include the spinal cord, the meninges, the
spinal part of the accessory nerve, and the anterior and posterior spinal arteries.
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(d) The obliquus capitis superior arises from the posterior part of the upper surface of the
transverse process.
(e) The obliquus capitis inferior, and the splenius cervicis are inserted into the inferior aspect
of the transverse process.
(f) The levator scapulae arises from the lateral margin of the transverse process.
(g) Some fibres of the upper oblique part of the longus colli are inserted on the anterior
tubercle.
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THE SACRUM
The sacrum lies below the fifth lumbar vertebra. It is made up of five sacral vertebrae that are
fused together (Figs. 4.25 to 4.31). It is wedged between the two hip bones and takes part in
forming the pelvis (See Fig. 2.1). As a whole the bone is triangular. It has an upper end or base
which articulates with the fifth lumbar vertebra; a lower end or apex which articulates with the
coccyx; a concave anterior (or pelvic) surface; a convex posterior or (dorsal) surface (Fig.
4.27); and right and left lateral surfaces that articulate with the ilium of the corresponding side
(Fig. 4.29).
When viewed from the front (Fig. 4.25) the pelvic surface of the sacrum shows the presence of
four pairs of anterior sacral foramina. The first foramen is the largest and the fourth the
smallest.
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The lower end of the bone (apex) bears an oval facet for articulation with the coccyx (Fig.
4.28). At the sides of the sacral hiatus we see two small downward projections called the sacral
cornua. They represent the inferior articular processes of the fifth sacral vertebra. They are
connected to the coccyx by ligaments.
When the sacrum is viewed from the side we see that the pelvic aspect of the bone is concave
forwards, while the dorsal aspect is convex backwards. The lateral surface bears a large Lshaped auricular area (or facet) for articulation with the ilium. (It is so called because its
shape resembles that of the auricle or pinna). It consists of a cranial limb present on the first
sacral vertebra, and a caudal limb that lies on the second and third sacral vertebrae. The area
behind the auricular surface is rough and gives attachment to strong ligaments that connect
the sacrum to the ilium.
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THE COCCYX
The coccyx consists of four rudimentary vertebrae fused together (Figs. 4.30, 4.31).
It has pelvic and dorsal surfaces. The base or upper end has an oval facet for articulation with
the apex of the sacrum. Lateral to the facet there are two cornua that project upwards and are
connected to the cornua of the sacrum by ligaments. The first coccygeal vertebra has rudimentary
transverse processes. The remaining vertebrae are represented by nodules of bone.
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(c) The coccygeus is inserted into the lateral side of the pelvic aspect of the last piece of the
sacrum and to the coccyx.
(d) The levator ani is inserted into the sides of the lower two segments of the coccyx.
3 and
(e) The gluteus maximus arises from the lateral margin of the lowest part of the sacrum,
that of the coccyx.
(f) The erector spinae has a linear U-shaped origin from the dorsal aspect of the sacrum. The
medial limb of the U is attached to the spinous tubercles, and the lateral limb to the transverse
tubercles.
(g) The multifidus arises from a large area within the U-shaped origin of the erector spinae.
Fig. 4. 32. Attachments on the pelvic aspect of the sacrum and coccyx.
Some related structures are also shown.
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(c) The iliolumbar ligament is attached to the lateral part of the ala.
(d) The sacrotuberous ligament is attached to the lower lateral part of the dorsal surface of
the sacrum.
(e) The sacrospinous ligament is attached to the lower part of the lateral margin of the sacrum
and to the adjoining lateral margin of the coccyx.
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6. The ventral and dorsal sacral foramina give passage to the corresponding rami of sacral
nerves.
Ossification of the Vertebral Column
A typical vertebra has three primary centres of ossification. One centre appears in the3body
and one in each half of the neural arch. These centres appear between 9 and 12 weeks of fetal
life (at different times in different parts of the vertebral column.) The posterolateral parts of the
body of the vertebra are ossified by extension from the centres for the neural arches. The remaining
part of the body is called the centrum. For some time the centrum is connected to the neural
arches by plates of cartilage forming the neurocentral joints.
Sometimes the vertebral body may ossify from two primary centres. If one of these centres
fails to develop one half of the body may be missing. This condition is called hemivertebra or
cuneiform vertebra.
The two neural arches fuse (posteriorly) after birth during the first year. They unite with the
centrum between the 3rd and 6th years.
Five secondary centres appear in each vertebra after puberty. These are:
(i) One at the tip of the spinous process.
(ii) and (iii) At the tips of transverse processes.
(iv) and (v) Centres that form ring shaped epiphyses over the upper and lower surfaces of the
vertebral body.
The epiphyses derived from the secondary centres fuse with the rest of the vertebra at about 25
years.
The atlas vertebra ossifies from three centres, one appearing in each lateral mass and one in
the anterior arch. The posterior arch is formed by extension from the centre for the lateral
masses.
The axis has five primary centres: one for each half of the vertebral arch, one for the centrum,
and two for the dens.
The lumbar vertebrae ossify like typical vertebrae, but have additional secondary centres for
the mamillary processes.
The ossification of the sacrum is complicated. It is significant to note that each piece of the
sacrum ossifies like a typical vertebra. The upper pieces have additional centres for the parts
derived from the costal elements. The pieces of the sacrum are united to each other by cartilage
till the age of about 20 years after which they fuse with each other.
Each segment of the coccyx has one primary centre. The centres for most segments appear
after birth. The segments usually unite with each other by about the 20th year.
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5
The Sternum and Ribs
The Sternum
The sternum lies in the anterior wall of the thorax, in the midline (Figs. 5.1 to 5.3). It is
elongated vertically. It is flat and has anterior and posterior surfaces. Although it is (by
convention) spoken of as a single bone it consists of three separate parts. From above downwards
these are the manubrium, the body, and the xiphoid process.
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4. The aponeurosis of the external oblique muscle of the abdomen, which covers the rectus
abdominis, is attached just beyond the insertion of the latter. (The attachment of the aponeurosis
is shown in green lines in figure 5.2).
5. The aponeuroses of the internal oblique muscle of the abdomen, and of the transversus
abdominis, are attached to the sides of the xiphoid process.
6. The linea alba is attached to the apex (lower end) of the xiphoid process.
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The Ribs
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TYPICAL RIBS
The ribs are curved long bones that
form the side walls of the thorax (Figs.
5.4, 5.5). There are twelve ribs on either
side. They vary considerably in length:
the seventh rib is the longest, those
above and below it becoming
progressively shorter. Adjacent ribs are
separated by intercostal spaces.
The ribs are attached behind to the
thoracic vertebrae. The anterior ends of
the upper seven ribs are attached to bars
of cartilage (costal cartilages) through
which they gain attachment to the
sternum. They are called true ribs. The
anterior ends of the eighth, ninth and
tenth ribs also end in costal cartilages.
These cartilages do not reach the
sternum, but end by gaining attachment
to the next higher costal cartilage. They
are, therefore, called false ribs. The
anterior ends of the eleventh and twelfth
ribs have small pieces of cartilage
attached to their ends: these ends are
free and these ribs are, therefore, called
floating ribs.
At the posterior end of a typical rib we
see a head, a neck and a tubercle. The
head articulates partly with the superior
costal facet on the body of the
numerically corresponding vertebra;
and partly with the inferior costal facet
on the next higher vertebra (Fig. 4.7). It
is also attached to the intervertebral
disc. The part of the rib immediately
lateral to the head is called the neck. It
lies in front of the transverse process of
the numerically corresponding vertebra.
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It has a sharp upper border called the crest of the neck. Just lateral to the neck the posterior
aspect of the rib presents an elevation called the tubercle. The tubercle has a medial articular
part which bears a facet that articulates with the costal facet on the transverse process of the
corresponding vertebra; and a lateral part that is rough for attachment of ligaments.
The anterior end of the rib shows a cup shaped depression for attachment of the costal cartilage.
The part of the rib between the anterior and posterior ends is called the shaft. It is curved like
the letter C. The shaft is flat: it has inner and outer surfaces, and upper and lower borders.
The upper border is rounded. The lower border is sharp. The inner surface is concave. Just above
the lower border the inner surface shows a costal groove running along the length of the shaft.
The external surface of the shaft is convex. A short distance lateral to the tubercle it is marked
by a rough line. At this point the rib appears to be bent: this point is, therefore, called the angle.
The shaft is also somewhat twisted along its long axis. As a result the external surface faces
somewhat downwards in the posterior part and somewhat upwards in its anterior part.
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9. The sympathetic trunk descends vertically across the anterior aspect of the heads of lower
ribs.
10. The internal surfaces of the ribs are covered by costal pleura.
3
ATYPICAL RIBS
The First Rib
The first rib (Fig. 5.6) can be distinguished by its small size, and by the fact that its shaft is
broad and flat having upper and lower surfaces (instead of outer and inner), and inner and
outer borders (instead of upper and lower). The head has a single facet as this rib articulates
only with the first thoracic vertebra. The tubercle is prominent and coincides with the angle.
The upper surface of the shaft has two shallow, but wide grooves (for the subclavian artery and
vein). Near the inner border of the rib these two grooves are separated by a prominence called
the scalene tubercle. The lower surface of the rib is smooth and does not have a costal groove.
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3. The subclavius arises from the anterior end of the upper surface of the rib; and from the
adjoining part of the first costal cartilage.
4. The first digitation of the serratus anterior arises from the outer border of the rib near the
groove for the subclavian artery.
5. The outer border also gives attachment to intercostal muscles of the first space.
6. The costoclavicular ligament is attached to the rough area in front of the groove for the
subclavian vein.
7. The inner border gives attachment to the suprapleural membrane.
8. The inferior surface of the rib is related to pleura and lung.
9. The groove for the subclavian artery lodges this artery, and also the lower trunk of the
brachial plexus. The subclavian vein lies in its own groove.
10. Three important structures lie on the anterior aspect of the neck of the first rib. From
medial to lateral side these are
(a) the sympathetic trunk (cervicothoracic
ganglion);
(b) the superior intercostal artery
(accompanied by the first posterior
intercostal vein); and
(c) the ventral ramus of the first thoracic
nerve (which ascends across the first rib to
join the brachial plexus).
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Fig. 5.10. Twelfth rib (right) seen from the front. Note
absence of neck, tubercle, angle and costal groove.
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6. The lateral arcuate ligament is attached to the lower border at the lateral end of the area for
attachment of the quadratus lumborum.
7. The medial part of the posterior surface of the rib gives attachment to the lowest levator
costae, and to part of the erector spinae.
8. The lateral part of the posterior surface gives attachment to slips for the latissimus dorsi,
the external oblique muscle of the abdomen, and the serratus posterior inferior.
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3
Ossification of Ribs
A typical rib has a primary centre that appears in the shaft during the second month of fetal
life. Secondary centres appear around the age of puberty: one for the head, and one each for the
articular and non-articular parts of the tubercle. The last mentioned centre is absent in the
lower ribs. As the eleventh and twelfth ribs have no tubercles the relevant centres are absent in
them.
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2. The anterior surfaces of the first six or seven cartilages give origin to the pectoralis major.
The 5th, 6th and 7th cartilages receive the insertion of the rectus abdominis. The 7th, 8th and
9th cartilages give attachment to the aponeurosis of the internal oblique muscle of the abdomen.
3. The posterior surfaces of the 2nd to 6th cartilages give attachment to the sternocostalis;
and the 7th to 12th give origin to the transversus abdominis.
4. The first costal cartilage gives origin to the subclavius (anteriorly) and gives origin
(posteriorly) to part of the sternothyroid. The upper surface of the cartilage also gives attachment
to the costoclavicular ligament, and to the articular disc of the sternoclavicular joint.
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6
3
Fig. 6.1 Some features of the skull as seen from the lateral side.
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Fig. 6.4.
Bones of the skull
that can be seen
from the front.
For details see
3
figure 6.8.
Fig. 6.5.
Lateral view
of the skull
showing the
position of
individual
bones. For
further
details see
figures 6.14
to 6.17.
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surface of the skull. Lying in the area between the two orbits we see the right and left nasal
bones. They lie just above the nasal aperture.
The bones to be seen when the skull is viewed from the lateral side are shown in figure 6.5.
Many of these have already been seen from the front, from above, or from behind. These include
the frontal, parietal, and occipital bones (in the vault), and the ethmoid, lacrimal, nasal and
zygomatic bones (in the facial region). The maxilla, the mandible, and the greater wing of the
sphenoid are also seen. Below the parietal bone the lateral wall of the cranium is formed by the
squamous part of the temporal bone. Lower down the mastoid part of the same bone lies in
relation to the base of skull. The temporal bone gives off a process that joins (a process of) the
zygomatic bone to form the zygomatic arch.
When the skull is viewed from below (Fig. 6.6) we see parts of several bones already identified.
These are the maxilla (shaded orange), the sphenoid (violet), the temporal (green) and the
occipital bone (blue). We also see parts of the zygomatic bone and of the vomer; and the palatine
bone which is seen for the first time.
The maxillae bear the upper teeth. Lateral to the teeth a part of the maxilla is seen articulating with the zygomatic bone. Medial to the teeth the maxilla forms the anterior part of the
bony palate. The posterior part of the palate is formed by the right and left palatine bones.
Above the posterior edge of the palate we see the posterior openings of the right and left nasal
cavities which are separated by the vomer. Part of the vomer has been seen on the front of the
skull through the anterior nasal aperture.
Behind the vomer we see the sphenoid which is an unpaired bone. It has a median part, the
body. On either side of the body there is a greater wing (which is seen partly on the base of the
skull and partly on the lateral wall: figure 6.5).
Posteriorly, the body of the sphenoid is continuous with the basilar part of the occipital bone.
Just behind the basilar part, the occipital bone has a large foramen, the foramen magnum
through which the cranial cavity communicates with the vertebral canal. Posterior to the foramen
magnum the occipital bone forms a large part of the base of the skull.
The lateral part of the base of the skull is formed by the temporal bone which is wedged in
between the sphenoid and occipital bones. It consists of a medial petrous (= stone like) part, a
posterolateral mastoid part, and an anterolateral squamous part that is seen mainly on the
lateral wall of the skull. The temporal bone gives off a process that joins the zygomatic bone to
form the zygomatic arch. (Some other parts of the temporal bone will be identified later).
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Fig. 6.6. Some features of the skull as seen from below. For details
see figures 6.21, 6.25 and 6.26.
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When the top of the skull (skull cap) is removed by a transverse cut we can view the floor of
the cranial cavity (Fig. 6.7). It is seen to be divided into three depressions called the cranial
fossae: anterior, middle (shaded with dots), and posterior. The floor of the anterior cranial
fossa is formed mainly by the frontal bone, but near the midline, anteriorly, a small part is
formed by the ethmoid. This bone lies mainly in the wall of the nasal cavity. A part of it has
Fig. 6.7. Bones of the skull as seen in the floor of the cranial cavity. The skull is viewed from
above after removing the skull cap. Also see figures 6.28 and 6.30.
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been seen in the wall of the orbit, and another part through the anterior nasal aperture. More
posteriorly the median part of the floor of the anterior fossa is formed by a part of the body of
the sphenoid; and the lateral parts by the lesser wings of the sphenoid.
The floor of each half of the anterior cranial fossa has a sharp posterior margin that separates
3 of
it from the middle cranial fossa. The medial part of the margin is formed by the lesser wing
the sphenoid, and its lateral part by the frontal bone.
The floor of the middle cranial fossa is narrow (antero-posteriorly) in its median part, and
broad laterally. The narrow median part is formed by the body of the sphenoid. The broad
lateral part (which is also much deeper) is formed by the greater wing of the sphenoid, the
squamous part of the temporal bone, and by the anterior surface of the petrous part of the same
bone.
The greater part of the floor of the posterior cranial fossa is formed by the occipital bone.
The foramen magnum is seen in the deepest part of the fossa. The anterolateral part of the floor
is formed by the posterior surface of the petrous temporal bone.
The various bones to be seen on different aspects of the skull have been identified. We will
now proceed to undertake a more detailed study of the skull as seen from various aspects.
Articulations
Lateral to the orbit the frontal bone ends in the zygomatic process which joins the frontal
process of the zygomatic bone at the frontozygomatic suture. The nasal part of the frontal
bone projects downwards between the two orbits. On either side of the midline it meets the
frontal process of the maxilla at the frontomaxillary suture, and the nasal bone at the
frontonasal suture. The nasal bones join each other at the internasal suture, and the frontal
process of the maxilla at the nasomaxillary suture. Below the nasal aperture the right and left
maxillae meet at the intermaxillary suture. Laterally, the maxilla has a prominent zygomatic
process which articulates with the maxillary process of the zygomatic bone at the zygomaticomaxillary suture.
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Fig. 6. 8. Some details of features of the skull as seen from the front. Compare with figure 6.4.
For details within the orbit see figure 6.11.
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the orbit. The part of the frontal process behind the crest takes part in forming the lacrimal
groove. (Also see figure 6.11). In the lower part of the nasal aperture, in the midline, the maxillae
show a sharp forward projection called the anterior nasal spine. The part of the maxilla that
bears the teeth is called the alveolar process. Each maxilla bears eight teeth. Beginning from
the midline there are two incisors, one canine, two premolars and three molars. Just above the
3
canine tooth the maxilla shows a vertical elevation produced by the root of this tooth: this is
the canine eminence. Medial to this eminence and above the incisor teeth there is a depression
called the incisive fossa; and lateral to it there is another depression, the canine fossa.
Foramina
At the junction of the medial one-third and the lateral two-thirds of the upper margin of the
orbit we see the supraorbital notch which is sometimes converted into a foramen (Fig. 6.8).
Medial to it a smaller frontal notch (or foramen) is often seen. On the lateral surface of the
zygomatic bone we see the zygomatico-facial foramen which is sometimes double. About a
centimeter below the inferior margin of the orbit there is a large infraorbital foramen on the
anterior surface of the maxilla.
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2. The corrugator supercilii arises from the medial end of the superciliary arch.
3. The zygomaticus major arises from the lateral surface of the zygomatic bone in front of the
zygomatico-temporal suture.
4. The zygomaticus minor arises from the lateral surface of the zygomatic bone just behind
the zygomatico-maxillary suture.
5. The levator labii superioris arises from the lower margin of the orbit, partly from the maxilla
and partly from the zygomatic bone.
6. The levator anguli oris arises from the canine fossa of the maxilla below the infraorbital
foramen.
7. The levator labii superioris alaeque nasi arises from the frontal process of the maxilla.
8. The procerus arises from the lower part of the nasal bone.
9. The nasalis has two parts. The transverse part arises from the maxilla just lateral to the
nasal notch; and the alar part from the maxilla below and medial to the transverse part.
10. The depressor septi arises from the maxilla just above the central incisor tooth.
11. The incisivus labii superioris arises from the maxilla above the lateral incisor tooth.
In figure 6.10 we also see parts of the attachments of the temporalis, the masseter and the
buccinator. These are better seen from the lateral side.
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The Orbit
Orbital Margins
The upper margin of the orbit is formed by the frontal bone (Fig. 6.1). The lateral margin is
formed mainly by the zygomatic bone: its upper part is formed by the zygomatic process of the
frontal bone. The inferior margin is formed in its lateral part by the zygomatic bone, and in its
medial part by the maxilla. The medial margin is formed mainly by the frontal process of the
maxilla: its upper part is formed by the nasal part of the frontal bone.
Fig. 6.11. The orbit and surrounding structures. The figure is schematic to the extent that all
features shown cannot be seen from one fixed angle of viewing.
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The roof is formed mainly by the orbital plate of the frontal bone. Posteriorly, a small part of
it is formed by the lesser wing of the sphenoid. Note that these bones also form the floor of the
anterior cranial fossa. The anterolateral part of the roof has a depression called the lacrimal
fossa. Close to the orbital margin, at the junction of the roof and medial wall, there is a small
depression called the trochlear fossa.
The floor is formed mainly by the maxilla (This part of the maxilla is its orbital surface). The
anterolateral part of the floor is formed by the zygomatic bone. Posteromedially, a small part of
the floor is formed by a part of the palatine bone (called the orbital process).
The lateral wall is formed, in its anterior part by the zygomatic bone, and in its posterior part
by the greater wing of the sphenoid.
The medial wall is formed mainly by the orbital plate of the ethmoid. Posterior to the ethmoid
a small part of this wall is formed by the body of the sphenoid. Anterior to the ethmoid the wall
is formed by the lacrimal bone, and still further anteriorly by the frontal process of the maxilla.
The region of the medial wall formed by the lacrimal bone and by the maxilla shows a deep
lacrimal groove (for the lacrimal sac). The groove is bounded anteriorly by the anterior lacrimal
crest on the frontal process of the maxilla; and posteriorly by the crest of the lacrimal bone
(which is a sharp vertical ridge). The suture joining the maxilla and the lacrimal bone runs
vertically in the floor of the lacrimal groove. The groove is continuous, inferiorly, with the
nasolacrimal canal, the lower end of which opens into the nasal cavity.
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Fig. 6.12. Features seen on the skull when viewed from above.
Compare with figure 6.2.
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Fig. 6.13. Features seen on the skull when viewed from behind. Compare with figure 6.3.
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bone at the parietosquamous and parieto-mastoid sutures. The posterior border of the bone
is joined to the occipital bone through the lambdoid suture. Each parietal bone articulates with
the the parietal bone of the opposite side through the sagittal suture. Near the anteroinferior
angle of the parietal bone the sutures form an H shaped arrangement. Four bones, the parietal,
frontal, sphenoid (greater wing) and temporal (squamous part) come together and a small circle
3
drawn here encloses parts of all these bones. The area enclosed by the circle is called the pterion.
(The centre of the pterion lies 4 cm above the zygomatic arch, and 3.5 cm behind the
frontozygomatic suture. This fact is of surgical importance). We have already seen that the
frontal process of the zygomatic bone joins the frontal bone, and that its maxillary process
articulates with the maxilla. The bone also gives off a temporal process that runs backwards to
join the zygomatic process of the temporal bone to form the zygomatic arch. Posteriorly, the
frontal process of the zygomatic bone articulates with the anterior margin of the greater wing
of the sphenoid (This suture is hidden from view by the frontal process: it is indicated in dotted
line in Fig. 6.14).
The temporal bone articulates with the parietal bone above; in front with the greater wing of
the sphenoid, and through its zygomatic process with the zygomatic bone; and behind (through
its mastoid part) with the occipital bone. Inferiorly, it bears a fossa for articulation with the
head of the mandible to form the temporomandibular joint.
The occipital bone articulates with the two parietal bones at the lambdoid suture. Lower down
it articulates with the mastoid part of the temporal bone.
The posterior border of the maxilla is joined to a part of the sphenoid bone called the pterygoid
process, and to a small part of the palatine bone called the pyramidal process.
Foramina
The parietal foramen and the zygomaticofacial foramen have already been identified. The
zygomatico-temporal foramen is present on the temporal surface of the zygomatic bone (Fig.
6.18), and the mastoid foramen is situated on or near the occipitomastoid suture.
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Fig. 6.15. Some features seen on the lateral aspect of the skull. Also see figures.
6.1, 6.5, 6.14, 6.16 and 6.17.
bone, and is continuous anteriorly with the posterior root of the zygomatic process (see below).
Just below this root we see an aperture leading into a bony tube called the external acoustic
meatus. This meatus forms part of the external ear.
The region between the temporal lines (above) and the zygomatic arch (below) is called the
temporal fossa. In its floor we see parts of the frontal and parietal bones; of the squamous part
of the temporal bone; and of the greater wing of the sphenoid bone. The anterior wall of the
fossa (Fig. 6.18) is formed mainly by the temporal surface of the zygomatic bone. It also receives
contributions from the greater wing of the sphenoid, and from the frontal bone.
The mastoid part of the temporal bone lies behind the external acoustic meatus. In the young
it is separated from the squamous part by the squamomastoid suture. Remnants of this suture
may be visible in the adult. We have noted that the mastoid part of the temporal bone articulates
with the parietal bone at the parietomastoid suture, and with the occipital bone at the
occipitomastoid suture. The point at which these two sutures meet is called the asterion. Just
behind the external acoustic meatus the mastoid part of the temporal bone shows a large
downward projection called the mastoid process (Mastoid = like the breast). The styloid process
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Fig. 6.16. Additional features seen on the lateral aspect of the skull. Also see figures 6.1, 6.5,
6.14, 6.15 and 6.17.
(Styloid = needle like) is also a part of the temporal bone. It projects downwards and forwards
from the inferior aspect of the bone.
A number of additional features, located in the region of the zygomatic arch, are shown in
figure 6.16. Note the following.
The anterior part of the zygomatic arch is formed by the temporal process of the zygomatic
bone. The posterior part of the arch is formed by the zygomatic process of the temporal bone. At
its posterior end the zygomatic process of the temporal bone divides into anterior and posterior
roots. The posterior root passes backwards along the lateral margin of the mandibular fossa,
and then above the external acoustic meatus to become continuous with the supramastoid
crest. The anterior root of the zygomatic process passes medially in front of the mandibular
fossa. Two projections are seen in relation to the roots of the zygomatic process. At the junction
of the anterior root with the process (i.e., just in front of the mandibular fossa) there is the
tubercle of the root of the zygoma. The other projection is seen just behind the mandibular
fossa: it is called the postglenoid tubercle.
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The bone around the opening of the external acoustic meatus is rough and serves to give
attachment to the cartilaginous part of the meatus. Part of this area which forms the anterior
margin, the inferior margin and the lower part of the posterior margin of the meatus belongs to
the tympanic part of the temporal bone, also called the tympanic plate. Posteriorly, the
tympanic part joins the mastoid part of the bone. The tympanic plate has a broad anterior
surface which lies behind the mandibular fossa (which is formed by the squamous part of the
temporal bone). The two are separated by the squamotympanic fissure.
Just above and behind the external acoustic meatus there is an area called the suprameatal
triangle. Its upper border is formed by the supramastoid crest. Its anteroinferior border is
formed by the posterosuperior part of the external acoustic meatus. Its posterior border is an
imaginary vertical line touching the posterior margin of the meatus. The importance of the
triangle is that an important cavity, the mastoid antrum, lies deep to it in the substance of the
petrous part of the temporal bone. The triangle itself is, however, formed by bone belonging to
the squamous part of the temporal bone.
Some features on the lateral side of the skull are obscured from view by the zygomatic arch
and can be seen when the arch is cut away (Fig. 6.17). The temporal surface of the greater wing
of the sphenoid has been seen in the floor of the temporal fossa. Inferiorly, this surface ends in
Fig. 6.17. Some details seen on the lateral aspect of the skull after removing the zygomatic arch.
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a sharp ridge called the infratemporal crest. Medial to the crest we see the infratemporal
surface of the greater wing: this surface faces downwards.
Further medially, we see another part of the sphenoid called the pterygoid process. This
process projects downwards from the junction of the body and the greater wing. When viewed
3
from behind (Fig. 6.18) the process is seen to be made up of medial and lateral pterygoid
plates that are free posteriorly, but meet anteriorly to enclose the pterygoid fossa. When viewed
from the side (Fig. 6.17) we see the surface of the lateral pterygoid plate. Below and medial to
the mandibular fossa we see another projection from the sphenoid called the spine.
The irregular space lying lateral to the pterygoid process is called the infratemporal fossa. Its
roof is formed mainly by the infratemporal surface of the greater wing of the sphenoid, with a
small contribution from the squamous temporal. More laterally the fossa com-municates with
the temporal fossa through the gap between the zygomatic arch and the side of the skull. The
anterior wall of the infratemporal fossa is formed by the posterior surface of the maxilla (Fig.
6.18). The lowest part of this surface (which corresponds to the posterior end of the alveolar
process) forms a projection called the maxillary tuberosity. The medial wall is formed by the
pterygoid process, but in its lower part it is formed by a small part of the palatine bone called
the pyramidal process. The anterior and medial walls of the infratemporal fossa meet below,
but they are separated in the upper part by the pterygo-maxillary fissure. The fissure is
continuous above with the inferior orbital fissure.
The pterygomaxillary fissure leads into a space called the pterygo-palatine fossa which is
described below.
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3. The buccinator arises from the lateral aspect of the maxilla (a little above the three molar
teeth). Note that this muscle also arises from the mandible.
4. The lateral pterygoid arises by two heads. The lower head arises from the lateral surface of
the lateral pterygoid plate.
The upper head arises from the infratemporal surface and crest of the greater wing of the
sphenoid bone.
Fig. 6.20. Attachments on the skull, seen from the lateral side.
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5. The superficial slip of the medial pterygoid muscle arises from the lateral aspect of the
pyramidal process of the palatine bone and from the maxillary tuberosity (The main part of the
muscle arises from the medial surface of the lateral pterygoid plate).
6. The temporalis arises from the whole of the temporal fossa. The area of origin is bounded
above by the temporal line and below by the zygomatic arch. It includes parts of the frontal,
parietal, and squamous temporal bones; and of the greater wing of the sphenoid bone.
7. The sternocleidomastoid muscle is inserted into the lateral half of the superior nuchal line;
and into the lateral surface of the mastoid process (from its apex to its superior border).
8. The trapezius arises from the medial one third of the superior nuchal line, and from the
external occipital protuberance (The attachment is better seen from below).
9. The occipitalis (or occipital belly of the occipitofrontalis) arises from the lateral part of the
highest nuchal line and from the mastoid process.
10. The splenius capitis is inserted into the mastoid process and into the occipital bone just
below the lateral one-third of the superior nuchal line (deep to the sternocleidomastoid).
11. The longissimus capitis is inserted into the mastoid process deep to the splenius capitis.
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projects backwards and laterally. We have already seen that it occupies the gap between the
lower ends of the medial and lateral pterygoid plates. It has been viewed from the lateral side in
figure 6.17, and from behind in figure 6.18; and it is now seen from below.
The part of the palate formed by the palatine bone shows the greater and lesser palatine
foramina. The greater palatine foramen lies on the most lateral part of the horizontal plate,
just medial to the last molar tooth. It is the lower opening of the canal of the same name already
seen in relation to the floor of the pterygopalatine fossa. Anteriorly, the foramen is continuous
with a vascular groove that runs forwards along the lateral margin of the palate. The lesser
palatine foramina, usually two, are present on the pyramidal process just behind the greater
palatine foramen.
Just above the posterior margin of the hard palate there are two posterior nasal apertures.
(Note that as the skull is being viewed from below the palate appears to form the roof of the
aperture, but is really the floor). Each aperture is bounded, below, by the posterior edge of the
horizontal plate of the palatine bone. The lateral wall of the aperture is formed by another part
of the palatine bone which is called the perpendicular plate. As indicated by its name the
perpendicular plate is placed at right angles to the horizontal plate. The posterior edge of the
perpendicular plate is fused to the medial pterygoid plate of the sphenoid bone, the two together
forming a flat plate of bone that forms the lateral wall of the region where the nose and pharynx
meet. The perpendicular plate separates the nasal cavity from the pterygopalatine fossa. At this
stage it is useful to recapitulate the various parts of the palatine bone. These are the horizontal
and perpendicular plates, the pyramidal process, and the orbital process (which forms a small
part of the floor of the orbit). A small part of the palatine bone, called the sphenoidal process
has not been mentioned so far. It projects medially from the upper end of the perpendicular
plate and takes part in forming the roof of the posterior nasal aperture (Fig. 6.22). (Also see
below).
The vomer is a flat plate of bone that forms part of the nasal septum. It has been seen through
the anterior nasal aperture (Fig. 6.8). Now we see it separating the right and left posterior nasal
Fig. 6.22.
Scheme to show
the bones around
the posterior
nasal aperture.
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The pterygoid process has already been seen from the lateral aspect (Fig. 6.17). We have seen
that it projects downwards from the junction of the body of the sphenoid with the greater wing,
and that it consists of medial and lateral pterygoid plates. These plates meet anteriorly, but
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Fig. 6.25. Part of the base of the skull formed by the temporal and sphenoid bones.
Some adjoining areas are also shown
posteriorly they are free. The space between them is called the pterygoid fossa. Anteriorly, the
pterygoid process is fused to the posterior aspect of the maxilla in its middle part. Higher up it
is separated from the maxilla by the pterygomaxillary fissure. In figure 6.24A note how the
perpendicular plate of the palatine bone closes the pterygopalatine fossa medially, and at the
same time meets the anterior margin of the medial pterygoid plate. In their lowest parts the
pterygoid plates are separated by a gap (Fig. 6.23) which is filled by the pyramidal process of
the palatine bone (Figs. 6.24C, 6.25). This process can be seen from behind forming the lower
part of the floor of the pterygoid fossa (Fig. 6.18) and also from the lateral side, in the medial
wall of the infratemporal fossa (Fig. 6.17).
The medial pterygoid plate is directed backwards so that it has medial and lateral surfaces,
and a free posterior border. The upper end of this border divides to enclose a triangular depression
called the scaphoid fossa (Fig. 6.25). Medial to this fossa there is a small tubercle which projects
into the foramen lacerum (see below). It hides from view the posterior opening of the pterygoid
canal: the anterior end of this canal opens on the posterior wall of the pterygopalatine fossa.
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The lower end of the posterior border is prolonged downwards and laterally to form the pterygoid
hamulus.
The lateral pterygoid plate projects backwards and laterally. It has medial and lateral surfaces.
At its upper end its lateral surface becomes continuous with the infratemporal surface of the
3
greater wing (Figs. 6.17, 6.23).
The greater wing of the sphenoid (Fig. 6.25) has infratemporal and temporal surfaces that
can be seen from below; and an orbital surface that has already been seen in the lateral wall of
the orbit (Fig. 6.11). The temporal surface has been described earlier. The anterior margin of the
infratemporal surface is separated from the maxilla by the inferior orbital fissure. Laterally, it
is separated from the temporal surface by the infratemporal crest. The posterior margin of the
lateral part of the infratemporal surface articulates with the infratemporal surface of the
squamous part of the temporal bone.
Medially, the infratemporal surface of the greater wing is continuous with the body of the
sphenoid. Posteriorly, the greater wing meets the anterior margin of the petrous temporal bone.
Fig. 6.26. Posterior part of base of skull (formed by the temporal and occipital bones)
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Two important foramina are seen near the posterior border of the greater wing. The foramen
ovale lies posterolateral to the upper end of the lateral pterygoid plate. Posterolateral to the
foramen ovale there is a smaller round foramen called the foramen spinosum. It is so called
because it lies just in front of a downward projection called the spine of the sphenoid. A third
small foramen is sometimes seen medial to the foramen ovale. It is called the emissary
sphenoidal foramen (Fig. 6.25, 6.32). Between the foramen ovale and the foramen spinosum
another small foramen the canaliculus innominatus may be present . Posteromedial to these
foramina, and to the spine of the sphenoid, the posterior margin of the greater wing forms the
anterior wall of a prominent groove. The posterior wall of this groove is formed by the petrous
temporal bone. The two bones meet in the floor of the groove which is meant for the cartilaginous
part of the auditory tube. Traced laterally, the groove ends in relation to the opening of the
bony part of the auditory tube.
C. Additional features on the temporal and occipital bones (Fig. 6.25, 6.26)
In earlier pages we have seen that the temporal bone consists of squamous, petrous, mastoid
and tympanic parts, and that the styloid process also belongs to it. Several landmarks that have
been identified on the bone from the lateral aspect (Fig. 6.16) can be seen again from below.
These are the zygomatic process, the tubercle of the root of the zygoma, the postglenoid tubercle,
the mastoid process, the tympanic plate, the squamotympanic fissure, and the styloid process.
We shall now examine some further details.
The squamous part of the temporal bone has a temporal surface that has been seen from the
lateral aspect: part of it can be seen from below. Inferior and medial to the temporal surface the
squamous part has an infratemporal surface which takes part in forming the roof of the
infratemporal fossa (along with the infratemporal surface of the greater wing of the sphenoid).
Behind its infratemporal surface, the squamous part bears the mandibular fossa. This fossa is
bounded anteriorly by a rounded eminence called the articular tubercle. The articular area for
the mandible extends on to the tubercle.
The tympanic plate separates the mandibular fossa from the external acoustic meatus. (The
arrow in figure 6.25 points to the opening of the meatus which cannot be seen from below). The
junction of the fossa (squamous part) with the tympanic plate is marked by the squamotympanic
fissure. Projecting through the fissure we sometimes see the lower edge of a plate of bone called
the tegmen tympani. The tegmen tympani belongs to the petrous part of the temporal bone.
When present it divides the squamotympanic fissure into a petro-squamous part (anteriorly),
and a petro-tympanic part (posteriorly). The posterior part of the tympanic plate partially
surrounds the base of the styloid process and is fused with the mastoid part of the temporal
bone. We have already seen that the plate has a rough lateral margin surrounding the opening
of the external acoustic meatus.
The petrous part of the temporal bone runs forwards and medially between the greater wing
of the sphenoid (anterolaterally), and the occipital bone (posteromedially). Its apex is separated
from the body of the sphenoid, the root of the pterygoid process, and the basilar part of the
occipital bone by a very irregular aperture called the foramen lacerum. The inferior surface of
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the petrous temporal bone is marked by a large round opening. This is the lower opening of the
carotid canal through which the internal carotid artery enters the cranial cavity. The canal
passes medially, through the substance of the petrous temporal bone and opens into the posterior
wall of the foramen lacerum. Behind the opening of the carotid canal there is another large
depression, the jugular fossa. This fossa leads posteriorly into the jugular foramen which is
3
bounded posteriorly and below by the occipital bone, and opens into the posterior cranial fossa.
In the mastoid part of the temporal bone we have already noted the presence of the mastoid
process, and of the mastoid foramen. Medial to the mastoid process there is a deep mastoid
notch. Near the anterior end of the notch, and just behind the styloid process we see the
stylomastoid foramen. Medial to the mastoid notch the bone is grooved by the occipital artery.
The greater part of the occipital bone is seen when the skull is viewed from below. The most
conspicuous feature on it is the large foramen magnum through which the cranial cavity
communicates with the vertebral canal. The part of the bone anterior to the foramen magnum is
the basilar part. Anteriorly, the basilar part is directly continuous with the body of the sphenoid
bone. These two bones are separated by a plate of cartilage in the young, but fuse with each
other in the adult. (In figure 6.25 the position of this cartilage is shown in dotted line) A short
distance in front of the foramen magnum the basilar part shows a small elevation in the midline
called the pharyngeal tubercle.
The parts of the occipital bone lateral to each side of the foramen magnum are its lateral (or
condylar) parts. Here we see the prominent occipital condyles. The long axis of each condyle
is directed forwards and medially, the condyle being markedly convex in this direction. Each
condyle (right or left) articulates with the corresponding superior articular facet on the atlas
vertebra to form an atlanto-occipital joint. There are two canals closely related to the occipital
condyles. The hypoglossal (or anterior condylar) canal opens on the surface of the skull just
above the lateral border of the anterior part of the condyle, and is hidden from view by the
condyle. (It is, therefore, shown in dotted line). The canal runs backwards to open into the
posterior cranial fossa. Behind the condyle there is a depression, the condylar fossa in which
the opening of the posterior condylar canal is sometimes seen.
The part of the occipital bone lateral to the condyle is called the jugular process. It forms the
posterior (and inferior) wall of the jugular fossa and foramen. The jugular foramen passes
backwards and medially from the fossa. It is often partially divided by projecting spicules of
bone into anterior, middle and posterior parts. The position of two small foramina present in
relation to the jugular fossa should be noted. One is present on the lateral wall of the fossa and
is called the mastoid canaliculus. The other is present on the ridge of bone that separates the
jugular fossa from the opening of the carotid canal: this is the canaliculus for the tympanic
nerve (tympanic canaliculus).
The part of the occipital bone behind the foramen magnum is the squamous part. It articulates
with the mastoid part of the temporal bone at the occipitomastoid suture, on or near which we
see the mastoid foramen. Posteriorly, the squamous part forms the posterior part of the vault of
the skull and joins the right and left parietal bones at the lambdoid suture. Its external surface
is marked by the external occipital protuberance; the external occipital crest; the inferior, superior
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and highest nuchal lines; and by numerous unnamed ridges that give it a rough surface for
muscular attachments.
The attachments on the base of the skull are described below.
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14. The semispinalis capitis is inserted into the medial part of the area between the superior
and inferior nuchal lines.
15. The obliquus capitis superior is inserted into the lateral part of the area between the
superior and inferior nuchal lines.
16. The trapezius arises from the medial one third of the superior nuchal line and from the
external occipital protuberance.
17. Other muscles whose attachments are seen in figure 6.27 are the occipitalis, the
sternocleidomastoid, the splenius capitis, and the longissimus capitis.
18. The pharyngeal tubercle (on the basilar part of the occipital bone) gives attachment to the
uppermost fibres of the superior constrictor muscles of the pharynx. It also gives attachment to
the upper end of a fibrous raphe that receives the insertion of lower fibres of these muscles.
19. The pterygomandibular ligament is attached to the tip of the pterygoid hamulus.
20. The pterygospinous ligament extends between the spine of the sphenoid and the upper
part of the lateral pterygoid plate.
21. The sphenomandibular ligament is attached to the spine of the sphenoid.
22. The upper end of the ligamentum nuchae is attached to the external occipital protuberance,
and to the external occipital crest.
23. The alar ligaments (of the dens) are attached to the occipital bone just medial to the
condyles.
24. The anterior and posterior atlanto-occipital membranes are attached to corresponding
margins of the foramen magnum.
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Fig. 6..28. Parts of the anterior and posterior cranial fossae seen from above.
Compare with figure 6.7.
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The anterior and posterior ethmoidal canals (already seen on the medial wall of the orbit) open
into the anterior cranial fossa near the lateral edge of the cribriform plate, but they are difficult
to see. The posterior part of the floor of the anterior cranial fossa is formed by the sphenoid
bone. In the median part it is formed by the anterior part of the superior surface of the body of
the sphenoid: this region is called the jugum sphenoidale. Lateral to the jugum sphenoidale
the floor is formed by the lesser wing of the sphenoid. The lesser wing also forms the sharp
posterior edge of the floor of the anterior cranial fossa. The medial edge of each lesser wing
projects backwards as the anterior clinoid process.
The middle cranial fossa (Figs. 6.28 to 6.30) has a raised median part formed by the body of
the sphenoid bone, and two large deep hollow areas on either side (Fig. 6.29). The features to be
seen in relation to the body of the sphenoid are as follows. Immediately behind the jugum
sphenoidale the body of the sphenoid is crossed by a transverse shallow groove that connects
the two optic canals, and is called the sulcus chiasmaticus (even though the optic chiasma
does not lie over the sulcus). Behind the sulcus the superior surface of the body of the sphenoid
shows a median elevation, the tuberculum sellae; and behind the tuberculum there is a
depression called the hypophyseal fossa. Posterior to the fossa there is a vertical plate of bone
called the dorsum sellae. The deep hollow bounded anteriorly by the tuberculum sellae, and
posteriorly by the dorsum sellae is called the sella turcica. The superolateral angles of the
dorsum sellae are called the posterior clinoid processes. The sides of the body of the sphenoid
slope downwards (Fig. 6.29) into the floor of the deep lateral part of the middle cranial fossa. In
this situation each side of the body of the sphenoid is marked by a shallow carotid groove.
Posteriorly, the groove becomes continuous with the foramen lacerum. Anteriorly, it turns
upwards medial to the anterior clinoid process.
On either side, the anterior wall of the middle cranial fossa is formed (Fig. 6.29) by the
greater and lesser wings of the sphenoid. The lesser wings are attached to the sides of the body
of the sphenoid by two roots: anterior (or upper),
and posterior (or lower). The optic canal passes
forwards and laterally between the body of the
sphenoid and the two roots of the lesser wing. The
greater and lesser wings are separated by the
superior orbital fissure which leads into the orbit.
Just below the medial end of the fissure, and just
lateral to the carotid groove we see the foramen
rotundum. We have already noted that this foramen
opens anteriorly into the pterygopalatine fossa.
The posterior wall of the middle cranial fossa (Fig.
6.30) is formed, on either side, by the anterior
sloping surface of the petrous temporal bone. The
apex of the bone is separated from the body of the
sphenoid by the foramen lacerum already seen from
below. A little above and lateral to the foramen the
surface of the petrous temporal bone shows a
shallow depression called the trigeminal
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Fig. 6.30. Features to be seen in the floor of the middle and posterior cranial fossae.
Compare with figure 6.7.
impression. Lateral to this impression we see two grooves running downwards and medially.
The upper and more prominent groove begins at a minute aperture called the hiatus for the
greater petrosal nerve. Below and lateral to it we have another groove which begins at the
hiatus for the lesser petrosal nerve. More laterally, the anterior surface is marked by an
elevation called the arcuate eminence.
Lateral to the arcuate eminence the anterior surface of the petrous temporal bone is formed by
a thin plate of bone that separates the middle cranial fossa from the cavities of the middle ear,
the auditory tube and the mastoid antrum. This plate is called the tegmen tympani. It is the
lower end of this plate which appears in the squamotympanic fissure.
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The floor of the deep lateral part of the middle cranial fossa is formed by the greater wing of
the sphenoid, medially, and by the squamous part of the temporal bone, laterally. Near the
posterior margin of the greater wing we see the foramen ovale, the foramen spinosum, and
sometimes the emissary sphenoidal foramen, all of which have already been seen from below.
The lateral wall of the middle cranial fossa is formed, anteriorly, by the greater wing of the
sphenoid, and posteriorly by the squamous temporal bone. The anteroinferior angle of the parietal
bone contributes to the most anterior part of the lateral wall (in the region of the pterion). A
vascular groove (for the middle meningeal vessels) starts at the foramen spinosum and runs
forwards on the floor. It divides into an anterior (or frontal) branch and a posterior (or parietal)
branch. The frontal branch runs upwards and forwards to the region of the inner surface of the
pterion: here the groove is often converted into a canal. It then runs upwards and backwards on
the inner surface of the parietal bone. The parietal branch runs backwards first on the squamous
temporal, and then on the parietal bone.
The most prominent landmark in the posterior cranial fossa (Fig. 6.30) is the foramen
magnum already seen from below. Anterior to the foramen magnum the wall of the fossa is
formed by the basilar part of the occipital bone which is continuous above with the posterior
surface of the body of the sphenoid: this area is called the clivus. The lateral margin of the
basilar part of the occipital bone is separated from the petrous temporal bone by the petrooccipital fissure, which ends below in the jugular foramen. We have already noted that projections
from the walls of the foramen partially divide it into anterior, middle and posterior parts.
Between the jugular foramen, laterally, and the anterior part of the foramen magnum, medially,
there is a rounded elevation called the jugular tubercle. In the interval between the jugular
tubercle and the foramen magnum there is a fossa. The hypoglossal canal opens into this
fossa. When present, the posterior condylar canal opens just lateral to the jugular tubercle
immediately behind the jugular foramen. The lateral part of the anterior wall of the posterior
cranial fossa is formed by the posterior surface of the petrous temporal bone. A little above the
jugular foramen this surface presents the opening of the internal acoustic meatus. Posterolateral
to this opening a slit in the bone leads into a canal called the aqueduct of the vestibule. The
floor and lateral walls of the posterior cranial fossa are formed, posteriorly, by the squamous
part of the occipital bone; and in the anterolateral part by the mastoid part of the temporal
bone. The posteroinferior angle of the parietal bone makes a small contribution to the anterior
part of the lateral wall. Behind the foramen magnum the two halves of the fossa are separated
by a ridge called the internal occipital crest. Posteriorly, the crest ends in an elevation called
the internal occipital protuberance. Running laterally from the protuberance, in the transverse
plane, we see a prominent wide groove (transverse sulcus) in which the transverse sinus is
lodged. The groove on the right side is generally more prominent than that on the left. The
groove first lies on the occipital bone, and near its lateral (or anterior) end it crosses the
posteroinferior angle of the parietal bone. It then runs downwards and medially with an Sshaped curve, deeply grooving the petrous and mastoid parts of the temporal bone to reach the
jugular foramen. This S-shaped part of the groove is called the sigmoid sulcus. The terminal
part of the groove lies on the occipital bone just behind the jugular foramen. The mastoid
foramen (already seen on the external surface of the skull) opens into the part of the sigmoid
sulcus formed by the mastoid temporal bone.
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185
Fig. 6.31. Structures passing through the optic canal, the superior orbital
fissure, and the inferior orbital fissure.
4. The infraorbital groove and canal transmit the infraorbital nerve (continuation of maxillary
nerve) and the infraorbital vessels.
5. The nasolacrimal canal transmits the nasolacrimal duct.
6. The lateral wall of the orbit has openings for the zygomaticotemporal and zygomaticofacial nerves and vessels. These structures pass through the thickness of the zygomatic bone.
The zygomaticofacial nerve and vessels appear on the lateral surface of the bone through the
zygomatico-facial foramen. The zygomatico-temporal nerves and vessels appear on the
temporal surface of the bone (on the anterior wall of the temporal fossa) through the
zygomaticotemporal foramen.
7. The medial wall of the orbit shows the openings of the anterior and posterior ethmoidal
canals. The openings lie on the suture between the frontal and ethmoid bones. The canals pass
through the interval between these bones to reach the floor of the anterior cranial fossa at the
lateral edge of the cribriform plate. They transmit the anterior and posterior ethmoidal nerves
and vessels.
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Fig. 6.32.
Structures passing
through the
foramen ovale,
and through
smaller foramina
near it. The lesser
petrosal nerve
sometimes passes
through the
canalis
innominatus.
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3. The foramen ovale (Fig. 6.32) transmits the mandibular division of the trigeminal nerve,
the accessory meningeal artery, and emissary veins connecting the cavernous sinus to the
pterygoid venous plexus. When the canaliculus innominatus is not present the foramen ovale
transmits the lesser petrosal nerve also.
3
4. The foramen spinosum (Fig. 6.32) transmits the middle meningeal artery, a meningeal
branch of the mandibular nerve, and an emissary vein.
5. The canalis innominatus (Fig. 6.32) is not always present. When present it transmits the
lesser petrosal nerve.
6. The emissary sphenoidal foramen (present occasionally) transmits some veins connecting
the cavernous sinus to the pterygoid plexus of veins.
7. The carotid canal and the foramen lacerum:
When the skull is viewed from below we see an opening on the inferior aspect of the petrous
temporal bone. This is the lower opening of the carotid canal (Fig. 6.33). The canal itself passes
forwards and medially through the substance of the petrous temporal bone and opens on the
posterior wall of the foramen lacerum . The internal carotid artery enters the skull by passing
through the carotid canal and through the upper part of the foramen lacerum. Inferiorly, the
foramen lacerum is closed by a plate of cartilage. In addition to the internal carotid artery the
structures passing through the carotid canal and the foramen lacerum include: (a) the sympathetic
plexus on the artery; (b) and a venous plexus which connects the cavernous sinus with the
pharyngeal venous plexus. In addition the foramen contains (c) the deep petrosal nerve which
arises from the sympathetic plexus, in the foramen; (d) the greater petrosal nerve which enters
the foramen from above; and (e) the nerve of the pterygoid canal formed by the union of (c) and
(d). The only structures passing through the whole length of the foramen are (f) a meningeal
branch of the ascending pharyngeal artery; and (g) some emissary veins that pierce the cartilage
closing the lower end of the foramen.
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189
10. The foramen magnum is the largest foramen in the skull. Through it the cranial cavity
communicates with the vertebral canal. The structures passing through it are as follows.
(a) Lower end of medulla surrounded by meninges, and accompanied by the anterior and
posterior spinal arteries.
(b) Lying in the subarachnoid space around the medulla there are (on each side) the lower end
of the tonsil of the cerebellum, the vertebral artery, and the spinal root of the accessory nerve.
(c) The anterior (narrow) part of the foramen magnum gives passage to the apical ligament of
the dens, the superior band of the cruciform ligament, and the membrana tectoria.
The alar ligaments of the dens are attached just below the lateral margin of the foramen.
11. The hypoglossal canal
transmits
(a) the hypoglossal nerve,
(b) a meningeal branch of the
ascending pharyngeal artery,
and
(c) an emissary vein
connecting the sigmoid sinus
to the internal jugular vein.
12. When present the (posterior)
condylar canal transmits an
emissary vein that connects the
lower end of the sigmoid sinus to
occipital veins.
Fig. 6.36. Scheme to show the arrangement of structures
passing through the foramen magnum.
13. The stylomastoid foramen gives exit to the facial nerve. It also transmits the stylomastoid
branch of the posterior auricular artery.
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nerves and vessels run forwards and enter the nasal cavity by passing through slit-like foramina
on the sides of the crista galli. (The slits are difficult to see).
4. The posterior ethmoidal canals, which transmit the posterior ethmoidal nerves and vessels,
open at the posterolateral corner of the cribriform plate.
5. The foramen rotundum opens posteriorly into the middle cranial fossa, and anteriorly into
the pterygopalatine fossa. The maxillary division of the trigeminal nerve passes through the
foramen: then through the upper part of the pterygopalatine fossa; and finally through the
inferior orbital fissure to reach the orbit where we have already seen it.
6. The greater and lesser petrosal nerves enter the middle cranial fossa by emerging through
the hiatuses for these nerves present on the anterior aspect of the petrous temporal bone. We
have seen that the greater petrosal nerve descends to the foramen lacerum (Fig. 6.33) and that
the lesser petrosal nerve leaves the skull through the foramen ovale, or through the canaliculus
innominatus.
7. The internal acoustic meatus is seen on the posterior aspect of the petrous temporal bone.
The structures entering it are:
(a) the facial nerve (motor root and nervus intermedius);
(b) the vestibulocochlear nerve, and
(c) the labyrinthine vessels.
The vestibulocochlear nerve terminates within the petrous temporal bone by supplying the
membranous labyrinth. The facial nerve follows a complicated course through the bone and
finally emerges on the base of the skull through the stylomastoid foramen. A little above its exit
from this foramen the facial nerve gives off the chorda tympani nerve. This nerve passes through
a posterior canaliculus to enter the cavity of the middle ear, which it leaves through an anterior
canaliculus that opens to the outside through the medial end of the petrotympanic fissure. Here
the nerve comes to lie just medial to the spine of the sphenoid. It is of interest to note that the
spine is related to another nerve, the auriculotemporal, on its lateral side.
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Fig. 6.37. Bones in the lateral wall of the nose. A. Medial aspect of maxilla. B. Palatine bone
overlapping maxilla. C. Lacrimal bone and inferior nasal concha overlapping the maxilla and
palatine bone. Also see figure 6.38.
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Fig. 6.38. Lateral wall of the nasal cavity seen with the ethmoid bone in place. The parts shown in
dotted line can be seen only when the middle concha is lifted off.Compare with figure 6.37C.
its medial wall being formed by the palatine bone. Note also that the palatine bone overlaps the
posterior part of the maxillary hiatus reducing its size.
In figure 6.37C we see two additional bones. Behind the frontal process of the maxilla we see
the lacrimal bone. Articulating with its lower border we see the inferior nasal concha. The lower
part of the lacrimal bone, and the upper part of the inferior nasal concha (lacrimal process)
convert the nasolacrimal groove of the maxilla into a canal and form its medial wall. The
inferior concha is attached anteriorly to the conchal crest of the maxilla (Fig. 6.37A) and
posteriorly to the conchal crest of the palatine bone (Fig. 6.37B). Its upper margin overlaps the
lower part of the maxillary hiatus. Here a downward projection of the concha called the maxillary
process descends deep to the rest of the concha to articulate with the lower edge of the hiatus.
Another projection, the ethmoidal process juts upwards into the hiatus. The space between the
concha (medially) and the maxilla and palatine bones (laterally) is the inferior meatus.
In figure 6.38 we see part of the ethmoid bone overlapping the lacrimal bone and the upper
parts of the maxilla and palatine bones. The relationship of the ethmoid to the nasal cavity is
best visualised by the study of a coronal section through the region (Figs. 6.9, 6.42). The ethmoid
bone consists of a labyrinth that is closed medially by a vertical medial plate. It is this plate that
is seen in the lateral wall of the nasal cavity. The plate descends vertically from the cribriform
plate; and its lower part which is free forms the middle nasal concha. Above the middle concha
a smaller projection, the superior nasal concha, arises from the medial plate. The spaces deep to
these conchae are called the middle and superior meatuses respectively. The middle concha
almost completely hides the maxillary hiatus from view. Deep to the concha a rounded prominence
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Fig. 6.39. Main bones taking part in forming the nasal septum.
called the bulla ethmoidalis is seen in relation to the upper part of the hiatus. A little below the
bulla a curved plate of bone runs downwards and backwards. This is the uncinate process of the
ethmoid. Its posterior end joins the ethmoidal process of the inferior concha. The curved gap
between the bulla ethmoidalis and the uncinate process is called the hiatus semilunaris.
The floor of the nasal cavity is formed by the upper surface of the bony palate. We have
already seen that each half of the palate is formed anteriorly by the palatine process of the
maxilla, and posteriorly by the horizontal plate of the palatine bone.
Several bones take part in forming the roof of the nasal cavity. From front to back these are
parts of the nasal bone, the frontal bone, the cribriform plate of the ethmoid and the anterior
surface of the body of the sphenoid bone.
The medial wall or nasal septum (Fig. 6.39) is formed in its upper part by the perpendicular
plate of the ethmoid bone (see also Fig. 6.9), and its lower part by the vomer. Anteriorly, there is
a gap in the septum which is filled in by cartilage. Around the edges of the septum there are
small contributions from the nasal, frontal, sphenoid, maxillary and palatine bones.
The openings into the nasal cavity are described along with the paranasal sinuses (See below).
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Fig. 6.40.
Lateral wall of the
nasal cavity seen after
removal of the medial
plate of the ethmoid
bone to expose the
ethmoidal air sinuses.
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The ethmoidal air sinuses are located within the lateral part (or labyrinth) of the ethmoid
bone. Each labyrinth (right or left) is bounded medially by the medial plate and laterally by the
orbital plate. The ethmoidal air sinuses lie between these plates. They can be divided into anterior,
middle and posterior groups. In figure 6.40 they are seen from the medial side after removing
the superior and middle nasal conchae, and the medial plate. The walls of some of these sinuses
3
are incomplete. In the intact skull they are completed by parts of the frontal, maxillary, lacrimal,
sphenoidal and palatine bones.
The anterior ethmoidal sinuses open
into the ethmoidal infundibulum, or into
the upper part of the hiatus semilunaris.
The middle ethmoidal sinuses open on
or near the bulla ethmoidalis. The
posterior ethmoidal sinuses open into
the superior meatus.
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These are the frontal, parietal, zygomatic, palatine, nasal, and lacrimal bones, the maxilla
and the vomer.
(b) Bones that are formed entirely in cartilage:
These are the occipital, sphenoid and temporal bones; and the mandible.
The times at which individual skull bones begin to ossify is highly variable. Centres of
ossification appear in many of them in the 7th or 8th prenatal week; but in some ossification
begins after birth.
The number of ossification centres is also highly variable.
The zygomatic, palatine, lacrimal and nasal bones; the vomer; and the inferior nasal
concha have only one centre each.
The parietal bone ossifies from two centres that appear in the region of the future tuber. Also
see fontanelles below.
The frontal bone has two centres on each side. At birth the bone is in two halves. The two
halves occasionally remain separate and are united by a midline suture called the metopic
suture.
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The ethmoid bone has three centres of ossification: one for the perpendicular plate, and one
for each labyrinth.
Each maxilla has one main centre, but additional centres appear in its anterior part. There is
considerable controversy on whether or not the anterior centres correspond to the premaxilla.
The occipital bone ossifies from several centres. In the newborn this bone consists of separate
squamous, condylar (lateral) and basilar parts that are united by cartilage. These parts fuse
with one another by the 6th year. The basilar part of the occipital bone fuses with the
corresponding part of the sphenoid bone between 18 and 25 years.
The sphenoid bone also ossifies from several centres. At birth the bone is in three pieces: one
central, and right and left lateral. The central piece consists of the body and lesser wings; while
each lateral piece consists of a greater wing and a pterygoid process. The pieces unite during
the first year of life. The body of the sphenoid fuses with the basilar part of the occipital bone
between 18 and 25 years of age.
The temporal bone ossifies from several centres. The squamous, tympanic, and styloid parts
ossify independently. The petrous and mastoid parts constitute one petromastoid morphological
element, that has several centres of ossification. The squamous part is the first to ossify. At
birth the tympanic part is rudimentary and is U-shaped (It is miscalled the tympanic ring).
Subsequently, this part grows laterally forming the bony part of the external acoustic meatus. It
also extends backwards to surround the base of the styloid process, and medially to reach the
carotid canal. At birth the mastoid part is poorly developed and a mastoid process is not seen.
Postnatally, mastoid air cells develop leading to formation of the mastoid process (by about 2
years of age). The facial canal and the stylomastoid foramen are at first near the lateral surface
of the bone, but with the formation of the mastoid process they become deeper.
The Fontanelles
In the skull of the new born, there are some gaps in the vault of the skull that are filled by membrane.
These gaps are called fontanelles or fonticuli. They are located in relation to the angles of the parietal
bone as follows.
(a) The anterior fontanelle is large and rhomboid in shape. It lies at the junction of the sagittal,
coronal and frontal sutures. (Note that at birth the frontal bone is in two halves that are separated by a
frontal suture).
(b) The posterior fontanelle is triangular. It lies at the junction of the sagittal and lambdoid sutures.
(c) The sphenoidal (anterolateral) fontanelle is present in relation to the antero-inferior angle of the
parietal bone, where it meets the greater wing of the sphenoid.
(d) The mastoid fontanelle (posterolateral) is present in relation to the posteroinferior angle of the
parietal bone (which meets the mastoid bone).
The fontanelles disappear (by growth of the bones around them) at different ages after birth.
The posterior and sphenoidal fontanelles disappear within two or three months after birth; the
mastoid fontanelle by the end of the first year; and the anterior fontanelle by the middle of the
second year.
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7
Individual Bones of the Skull
The Mandible
The mandible is the bone of the lower jaw and bears the lower teeth (Figs. 7.1 to 7.5). It
consists of an anterior U-shaped body, and of two rami (right and left) that project upwards
from the posterior part of the body. The bone has internal (or medial) and external (or lateral)
surfaces. The body has an upper part that bears the teeth (alveolar process), and a lower
border that is called the base. The ramus has a posterior border, a sharp anterior border, and a
lower border that is continuous with the base of the body. The posterior and inferior borders of
the ramus meet at the angle of the mandible.
The anterior border of the ramus is continued
downwards and forwards on the lateral
surface of the body as the oblique line. This
line ends anteriorly near the mental tubercle
(see below). A little above the anterior part
of the oblique line we see the mental
foramen which lies vertically below the
second premolar tooth. Just below the incisor
teeth the external surface of the ramus shows
a shallow incisive fossa.
Arising from the upper part of the ramus
there are two processes. The anterior of these
is the coronoid process. It is flat (from side
to side) and triangular. The posterior or
condylar process is separated from the
coronoid process by the mandibular notch.
The upper end of the condylar process is
expanded to form the head of the mandible.
Fig.7.1. Mandible seen from above.
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The head is elongated transversely and is convex both transversely and in an anteroposterior
direction. It bears a smooth articular surface that articulates with the mandibular fossa of the
temporal bone to form the temporomandibular joint. The part immediately below the head is
constricted and forms the neck. Its anterior surface has a rough depression called the pterygoid
fovea.
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Fig. 7.6. Attachments on the mandible as seen from the lateral side.
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B. The muscles attached on the internal surface of the mandible are as follows
(Figs. 7.7, 7.8)
1. The temporalis is inserted into the medial surface of the coronoid process including its
apex, and its anterior and posterior borders. The insertion extends downwards along the anterior
3
border of the ramus (Also see Fig. 7.6).
2. The lateral pterygoid is inserted into the fovea on the anterior aspect of the neck.
3. The medial pterygoid is inserted into the medial surface of the angle and the adjoining part
of the ramus.
5. The genioglossus
takes origin from the
upper mental spine.
6. The geniohyoid
takes origin from the
lower mental spine.
Fig. 7.7. Attachments on the mandible as seen from the medial side.
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E. Other relations.
1. Part of the bone adjoining the alveolar border is covered by mucosa.
2. The lingual nerve is closely related to the medial aspect of the body just above the posterior
end of the mylohyoid line.
3. The sublingual gland lies over the sublingual fossa; and the submandibular gland over the
submandibular fossa. The parotid gland is related to the upper part of the posterior border of
the ramus.
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The Maxilla
The right and left maxillae are seen when the skull is viewed from the front (Figs. 6.4, 6.8).
They bear the upper teeth. Each maxilla takes part in forming the palate, the floor and lateral
wall of the nasal cavity, and the floor of the orbit.
Each maxilla has a body, an alveolar process, a zygomatic process, a frontal process, and a
palatine process (Figs. 7.9, 7.10).
The Body
The body has anterior (actually anterolateral), posterior, medial and superior surfaces. Inferiorly,
the body is continuous with the alveolar process which has sockets for the teeth. The body
encloses the maxillary air sinus.
The upper margin of the anterior surface (of the maxilla) becomes continuous with the
superior surface at the inferior margin of the orbit. Medially, the anterior surface ends at the
nasal notch which bounds the anterior nasal aperture. Other features to be seen on the anterior
surface have been described earlier (Fig. 6.8). These are the infraorbital foramen, the incisive
and canine fossae, the canine eminence, and the anterior nasal spine.
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The superior (or orbital) surface forms the floor of the orbit (Fig. 6.11). Posterolaterally it
forms the lower margin of the inferior orbital fissure. The infraorbital groove runs forwards
over the orbital surface. This groove starts at the inferior orbital fissure and ends a short distance
from the inferior orbital margin by becoming continuous with the infraorbital canal (which
opens on the anterior surface at the infraorbital foramen). Anteromedially, the orbital surface
has a notch which forms the lateral margin of the upper opening of the nasolacrimal canal. The
margins of the orbital surface articulate with the zygomatic, ethmoid, and lacrimal bones, and
with the orbital process of the palatine bone.
The medial (or nasal) surface of the maxilla takes part in forming the lateral wall of the
nose. The features on this surface have already been examined (Figs. 6.37, 7.10). They include
the maxillary hiatus, the nasolacrimal groove, the groove for the greater palatine canal,
and the conchal crest. This aspect of the bone comes into intimate contact with the palatine,
ethmoid and lacrimal bones, and with the inferior nasal concha.
The posterior (or infratemporal) surface forms the anterior wall of the infratemporal fossa
and of the pterygopalatine fossa (Figs. 6.18, 6.19). Inferiorly, this surface bears a projection,
the maxillary tuberosity which is the posterior end of the alveolar process. The upper margin
of this surface becomes continuous with the orbital surface at the inferior orbital fissure. Here
the surface is grooved by the maxillary nerve as the latter runs forwards to reach the infraorbital
groove. Lower down the infratemporal surface bears small openings for the posterior superior
alveolar nerves and vessels. The infratemporal surface meets the pterygoid process of the
sphenoid bone at the lower end of the pterygomaxillary fissure.
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Frontal Process
The frontal process of the maxilla extends upwards and medially from the body. Its upper edge
meets the nasal part of the frontal bone. Medially (and anteriorly) it articulates with the nasal
bone; and posteriorly it articulates with the lacrimal bone (Fig. 6.8). The frontal process has
external and internal surfaces. The external surface bears a vertical ridge called the anterior
lacrimal crest: this crest is continuous with the inferior orbital margin. Behind this crest there
is a vertical groove which forms the lacrimal groove along with the groove on the lacrimal bone.
Determination of Side
The maxilla can be correctly orientated and its side determined by examining the alveolar
process alone. The alveolar process bearing the teeth (or sockets for them) lies inferiorly, and
laterally. The sockets for the teeth reach the midline anteriorly.
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it separates the lateral and temporal surfaces. The posteroinferior border forms the anterior
part of the lower border of the zygomatic arch. It extends from the zygomatico-maxillary suture
to the zygomatico-temporal suture.
The temporal surface ends medially in a posteromedial border which articulates with the
greater wing of the sphenoid (in the anterior wall of the temporal fossa: Fig. 6.18) and inferiorly
with the maxilla. Note that the entire area between the anteroinferior and posteromedial borders
is rough for articulation with the maxilla.
Determination of side
The bone can be correctly orientated and its side determined by looking at the orbital margin.
The orbital margin lies at the upper end of the anterior aspect. This margin contributes to the
inferior and lateral margins of the orbit.
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Zygomatic Process
The zygomatic process passes downwards and laterally to meet the frontal process of the
zygomatic bone.
Orbital part
The orbital plates (right and left) of the frontal bone are separated by a wide notch which is
filled, in the intact skull, by the ethmoid bone (Fig. 7.14). Immediately anterior to the notch
there are the openings into the right and left frontal air sinuses. Immediately lateral to the
notch, the inferior aspect of the orbital plate shows two or three depressions: these are the
upper parts of ethmoidal air cells that are completed in the intact skull by similar depressions
on the labyrinth of the ethmoid bone. More laterally, the inferior surface of each orbital plate
forms the greater portion of the roof of the corresponding orbit. The anterolateral part of the
roof shows a shallow depression, the lacrimal fossa, for the lacrimal gland. The anteromedial
part of the roof bears a small depression, the trochlear fossa. The superior surface of the
orbital plate of the frontal bone forms the greater part of the floor of the anterior cranial fossa.
(Also see Figs. 6.9, 6.11).
Nasal Part
The nasal part of the frontal bone projects downwards between the right and left supraorbital
margins. The lower part of the projection lies behind the nasal bones and the frontal process of
the maxillae, and helps to support the bridge of the nose. The nasal part bears a median projection,
the nasal spine, which contributes to the nasal septum (Fig. 6.38).
Articulations
The frontal bone articulates posteriorly with the right and left parietal bones (at the coronal
suture); and with the greater wing of the sphenoid. Through its zygomatic process it articulates
with the zygomatic bone. The nasal part articulates with the nasal bones, and with the frontal
processes of the maxillae. The nasal spine meets the perpendicular plate of the ethmoid bone.
The orbital parts articulate with the greater and lesser wings of the sphenoid, with the orbital
plate of the ethmoid bone, and with the lacrimal bone of the corresponding side.
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Articulations
The right and left parietal bones articulate with each other at the sagittal suture.Anteriorly,
each parietal bone articulates with the frontal bone at the coronal suture.
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The anteroinferior angle articulates with the greater wing of the sphenoid. The inferior border
articulates with the temporal bone (squamous and mastoid), and the posterior border with the
occipital bone (at the lambdoid suture).
Determination of side
The side to which a given parietal bone belongs can be determined using the following facts.
1. The superior or sagittal border is straight, while the inferior border has an irregular shape.
2. The posterior aspect can be distinguished because the posteroinferior angle bears a groove
(for the sigmoid sinus).
3. The medial surface is concave, while the lateral surface is convex.
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Squamous Part
The squamous part contributes to the posterior wall of the vault of the skull. It has external
and internal surfaces. The features to be seen on the external surface have been examined
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(Figs. 6.13, 7.17). These are the external occipital protuberance; the external occipital crest,
and the highest, superior and inferior nuchal lines. The internal surface of the squamous part
is marked by four deep fossae (Fig. 7.18). The area where the fossae meet is raised to form the
internal occipital protuberance. Above the protuberance there a wide median groove for the
superior sagittal sinus; and on either side of the protuberance there is an equally wide groove
for the transverse sinus. These grooves have prominent lips. Inferior to the protuberance the
internal surface bears a median ridge called the internal occipital crest.
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Articulations
The squamous part articulates (on each side) with the corresponding parietal bone at the
lambdoid suture; and with the corresponding mastoid temporal bone at the occipitomastoid
suture. The anterior margin of the lateral part of the bone meets the petrous temporal, the two
being partially separated by the jugular fossa. Anteriorly, the basilar part is separated from the
apex of the petrous temporal bone by the foramen lacerum.
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of the squamous temporal bone we see the infratemporal surface, the mandibular fossa and
the articular tubercle (Figs. 6.25, 6.26).
The cerebral surface of the squamous part forms the lateral portion of the floor, and the lateral
wall, of the middle cranial fossa. This surface shows vascular grooves (Fig. 6.30).
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Within its substance the mastoid temporal bone contains several air filled spaces called the
mastoid air cells. The largest of these is the mastoid antrum, which is closely related to the
middle ear.
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The Body
The body of the sphenoid bone has superior, inferior, anterior, posterior, and right and left
lateral surfaces.
The inferior surface of the body lies in the roof of the posterior part of the nasal cavity and in
the roof of the nasopharynx. Projecting downwards from the body there is a median ridge called
the rostrum (which fits into the gap between the alae of the vomer (Fig. 6.22).
The superior surface of the body forms the median part of the floor of the (posterior part of
the) anterior cranial fossa, and of the median part of the middle cranial fossa. The features to
be seen here have been examined (Figs. 6.28, 6.29). They include the jugum sphenoidale, the
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sulcus chiasmaticus, the tuberculum sellae, the hypophyseal fossa, and the dorsum sellae
with the posterior clinoid processes.
The lateral surfaces of the body of the sphenoid are also seen in the floor of the middle
cranial fossa. Each lateral surface is marked by the carotid groove.
Posteroinferiorly, the body of the sphenoid is continuous with the basilar part of the occipital
bone. Along with the latter it forms the median part of the sloping anterior wall (clivus) of the
posterior cranial fossa.
The anterior surface of the body of the sphenoid takes part in forming the roof of the nasal
cavity. This surface can be seen only in the disarticulated bone (Fig. 7.22). It bears a median
sphenoidal crest on either side of which there is the opening of the corresponding sphenoidal
air sinus. The lower margin of each opening is formed by a thin plate of bone called the
sphenoidal concha.
The sphenoidal air sinuses lie within the body of the sphenoid.
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The cerebral surface is concave. It forms part of the floor of the middle cranial fossa (Figs.
6.28, 6.29). Anteriorly and medially this surface has a sharp edge which is separated from the
lesser wing by the superior orbital fissure. Just below the medial end of the fissure we see the
foramen rotundum. Posteromedially, the greater wing is separated from the apex of the petrous
temporal bone by the foramen lacerum. Near the posterior margin of the cerebral surface of the
greater wing we see three or four foramina. These are the foramen ovale, the foramen spinosum,
the emissary sphenoidal foramen, and sometimes the canaliculus innominatus.
The lateral surface of the greater wing is convex. It is divisible into an upper part, the temporal
surface; and a lower part, the infratemporal surface by the infratemporal crest. The features
to be seen on the infratemporal surface have been described (Figs. 6.18, 6.25). They include the
foramen ovale, the foramen spinosum, the emissary sphenoid foramen, the canaliculus
innominatus, the spine of the sphenoid, and the groove for the auditory tube.
When viewed from the front the greater wing presents an orbital surface. We have seen that
this surface forms the posterior part of the lateral wall of the orbit (Fig. 6.11). Medially, it has a
free edge that forms the infero-lateral margin of the superior orbital fissure. Inferiorly, it forms
the upper boundary of the inferior orbital fissure.
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Each greater wing articulates, posteriorly, with the petrous temporal; posterolaterally, with
the squamous temporal; anteromedially with the frontal bone; anteriorly and laterally with the
zygomatic bone; and superiorly with the anteroinferior angle of the parietal bone (Figs. 6.11
and 6.14).
The lesser wing articulates anteriorly with the orbital plate of the frontal bone.
The lower part of the pterygoid process articulates, anteriorly, with the maxilla. The anterior
margin of the medial pterygoid plate articulates with the perpendicular plate of the palatine
bone. The pyramidal process of the palatine bone fits into the interval between the lower ends
of the medial and lateral pterygoid plates. The vaginal plate (arising from the medial side of the
pterygoid process) articulates anteriorly with the sphenoidal process of the palatine bone, and
medially with the ala of the vomer (Fig. 6.22).
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maxillary tuberosity (anteriorly) and the pterygoid process (posteriorly) and occupies the interval
between the lower ends of the medial and lateral pterygoid plates. The lesser palatine foramina
are seen on the inferior aspect of the pyramidal process.
The orbital process of the palatine bone (Figs. 6.11, 7.24) arises from the anterosuperior angle
of the perpendicular plate. It forms a small part of the floor of the orbit.
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The walls of many ethmoidal air cells are incomplete. In the intact skull they are completed by
parts of the maxilla and of the frontal, lacrimal, sphenoid and palatine bones.
Articulations
The perpendicular plate of the ethmoid articulates anteroinferiorly with the septal cartilage of
the nose, posteroinferiorly with the vomer, anteriorly with the frontal and nasal bones, and
posteriorly with the sphenoid (Fig. 6.39). The cribriform plate articulates laterally with the
orbital plate of the frontal bone, and posteriorly with the sphenoid (rig. 6.28).
The labyrinth articulates above with the frontal bone, posteriorly with the sphenoid, and
laterally with the maxilla, the palatine bone and the lacrimal bone. The medial aspect of the
labyrinth gives attachment to part of the inferior nasal concha.
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The posterior surface of the bone is grooved and takes part in forming the anterior part of the
roof of the nasal cavity. The medial margins of the two nasal bones are thickened (on this
aspect) and project into the nasal cavity as a crest which contributes to the nasal septum.
3
The Vomer
The vomer is a flat plate of bone that forms the postero-inferior part of the nasal septum (Figs.
6.4, 6.6, 6.8, 6.9, 6.21, 6.22, 6.29). It articulates antero-superiorly with the perpendicular plate
of the ethmoid. Postero-superiorly the vomer articulates with the body of the sphenoid. Here the
vomer has two alae: the rostrum of the sphenoid fits into the interval between the alae. Inferiorly,
the vomer is attached to the palatine processes of the maxillae, and to the horizontal plates of
the palatine bones. Anteriorly, the vomer gives attachment to the septal cartilage of the nasal
septum.
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(d) The sternohyoid is inserted into the medial part of the inferior border of the body.
(e) The superior belly of the omohyoid is attached to the lateral part of the inferior border of
the body.
(f) The middle constrictor of the pharynx arises from the upper surface of the greater cornu,
and from the posterolateral aspect of the lesser cornu.
(g) The hyoglossus arises from the upper surface of the greater cornu (lateral to the origin of
the middle constrictor), and from the lateral part of the body.
(h) The stylohyoid muscle is inserted into the upper surface of the greater cornu near its
junction with the body.
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Fig. 7.28.
Attachments on the
hyoid bone,
anterosuperior
aspect. 3
(c) The fibrous loop for the tendon of the digastric is attached to the lateral part of the upper
surface of the greater cornu, behind the insertion of the stylohyoid muscle.
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Atlas of
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PLATE 8.9
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PLATE 8.12
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PLATE 8.14
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PLATE 8.15
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PLATE 8.16
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PLATE 8.18
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PLATE 8.22
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PLATE 8.24
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PLATE 8.25
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PLATE 8.27
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PLATE 8.29
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PLATE 8.30
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PLATE 8.31
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PLATE 8.32
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PLATE 8.33
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PLATE 8.34
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PLATE 8.35
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PLATE 9.1
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PLATE 9.2
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PLATE 9.3
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PLATE 9.6
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PLATE 9.7
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PLATE 9.8
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PLATE 9.9
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PLATE 9.10
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PLATE 9.11
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PLATE 9.12
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PLATE 9.13
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PLATE 9.14
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PLATE 9.16
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PLATE 9.22
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PLATE 9.28
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CHAPTER
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PLATE 10.3
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PLATE 10.5
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PLATE 10.6
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PLATE 10.7
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PLATE 10.8
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PLATE 10.11
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Chapter
11: Some Muscles of the
Thorax
and
Abdomen
PLATE 11.1
CHAPTER
11
SOME
MUSCLES
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THORAX
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ABDOMEN
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PLATE 11.2
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PLATE 11.3
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PLATE 11.5
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PLATE 11.7
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INDEX
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Index
3
Acetabulum, 62
Acromion, 14
Air cells, mastoid, 218
Angle
sternal, 135
subpubic, 71
Annulus fibrosus, 119
Antrum, mastoid, 164, 218
Aperture
nasal, anterior, 153
nasal, posterior, 170
Aponeurosis ,plantar, 308
Aquaeduct, of vestibule, 182, 218
Arch
pubic, 62
superciliary, 152, 208
zygomatic, 161, 163, 216
vertebral, 113
Asterion, 162
Attachments. See individual bones
Bar,
costotransverse, 117
intertubercular, 117
Bone. See individual names
Border. See individual bones
Bregma, 158
Calcaneus, 98
Canal
adductor, 276
carotid, 175, 183, 187, 218
condylar, 215
condylar, anterior, 175
condylar, posterior, 175, 182, 189
ethmoidal, anterior, 185, 189
ethmoidal, posterior, 185, 190
hypoglossal, 175, 182, 183, 189, 215
infraorbital, 185, 205
Canal (continued)
nasolacrimal, 185
optic, 157, 180, 183, 184, 222
palatinovaginal, 166, 171
pterygoid, 166
vertebral, 113
vomerovaginal, 171
Canaliculus
mastoid, 175, 188, 218
tympanic, 175, 188, 218
Canalis innominatus, 174,187, 222
Capitate bone, 43
Capitulum, 20
Carpal bones, 36
Carpal tunnel, 45
Cartilage, costal, 143
Cavity
glenoid, 14
nasal, 191
of skull, 143
Clavicle, 9
Clivus, 214, 221
Coccyx, 130
Column, vertebral, 113
Concha
nasal, 225
nasal, inferior, 227
sphenoidal, 221
Condyle
occipital, 175, 215
of humerus, 20
of tibia, 81
Cornua
of hyoid bone, 228
sacral, 129
Costal element, 118
Cranium, 145
336
Crest
conchal, 205, 224
ethmoidal, 224
frontal, 179, 208
infratemporal, 165
intertrochanteric, 74
lacrimal, anterior, 152
nasal, 224
obturator, 61
occipital, external, 159
occipital, internal, 182, 214
palatine, 169, 224
sacral, 129
sphenoidal, 221
supinator, 32
supramastoid, 161
Crista galli, 179, 225
Cuboid bone, 101
Cuneiform bone
intermediate, 102
lateral, 103
medial, 102
Femur, 72
Fibula, 88
Fissure
squamotympanic, 174
orbital, inferior, 157
orbital, superior, 157, 180, 183, 184
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OSTEOLOGY
Fissure (continued)
petrooccipital, 182
petrosquamous, 174
petrotympanic, 174
pterygomaxillary, 165, 172, 186
Fontanelles, 158, 197
Foot, skeleton of, 95
Foramen
caecum, 179, 189, 208
emissary sphenoidal, 174,182, 187, 222
ethmoidal, 157
frontal, 153, 208
incisive, lateral, 169, 186
infraorbital, 153, 184
jugular, 175, 183, 188, 215, 218
lacerum, 174, 180, 187
magnum, 175, 182, 183, 189
mandibular, 199
mastoid, 161, 182, 186, 217
mental, 198
obturator, 62
ovale, 174, 182, 183, 187, 222
palatine, greater, 170, 186
palatine, lesser, 170
parietal, 158, 186, 211
rotundum, 166, 180, 183, 190, 222
sacral, anterior, 127
sacral, posterior, 128
sphenopalatine, 166, 186, 224
spinosum, 174, 182, 187, 222
stylomastoid, 175, 183, 189, 217, 219
supraorbital, 153, 184, 208
transversarium, 115
vertebral, 113
zygomaticofacial, 153, 185, 207
zygomaticotemporal, 161, 185, 207
Foramina. See individual bones
Fossa
acetabular, 62
canine, 153
condylar, 175, 215
coronoid, 21
cranial, anterior, 179
cranial, middle, 180
cranial, posterior, 182
digastric, 199
hypophyseal, 180
iliac, 59
INDEX
Fossa (continued)
incisive, 153, 169, 198
infraspinous, 14
jugular, 175, 215, 218
lacrimal, 157, 210
malleolar, 90
mandibular, 174, 216, 217
olecranon, 21
pterygoid, 172
pterygopalatine, 165
radial, 21
scaphoid, 172
sublingual, 199
submandibular, 199
supraspinous, 14
temporal, 162
trochanteric, 73
trochlear, 157, 210
Fovea
in head of femur, 72
pterygoid, 199
Frontal bone, 146, 151,156, 179,
194, 208
Glabella, 152
Groove
carotid, 180
for greater palatine canal, 205
infraorbital, 157, 185, 205
lacrimal, 153, 157
mylohyoid, 199
nasolacrimal, 205
obturator, 61
radial, 20
Hamate bone, 44
Hamulus, lacrimal, 226
Hamulus, pterygoid, 173
Hand
synovial sheaths of, 268
bones of, 36
Hiatus
for greater petrosal nerve, 181, 218
for lesser petrosal nerve, 181, 218
maxillary, 205
sacral, 129
Hip bone, 56
337
Humerus, 18
Hyoid bone, 227
Iliac crest, 57
Ilio-tibial tract, 270
Ilium, 57
Inferior nasal concha, 146, 153, 191, 227
Ischium, 61
Jugum sphenoidale, 180
Lacrimal bone, 146, 157, 226
Lambda, 158
Lamina, of vertebra, 113
Line
anterior oblique, 26
arcuate, 60
gluteal, anterior, 59
gluteal, inferior, 59
iliac, gluteal, posterior, 58
intertrochanteric, 74
mylohyoid, 199
nuchal, highest, 159
nuchal, inferior, 159
nuchal, superior, 159
oblique, of mandible, 198
pectineal, 61
spiral, 74
temporal, 152, 161, 211
trapezoid, 9
Linea aspera, 74, 276
Linea terminalis, 68
Lingula, 199
Lunate bone, 39
Malleolus
lateral, 88
medial, 84
Mandible, 145, 198
Manubrium, 134
Maxilla, 145, 152, 156, 169, 191,
194, 204
Meatus
acoustic, external, 162
acoustic, internal, 182, 183,
190, 218
338
Metacarpal bones, 45
fifth, 47
first, 46
fourth, 47
second, 46
third, 47
Metatarsal bones, 104
Muscle
abductor digiti minimi, 254, 307
abductor hallucis, 307
abductor pollicis brevis, 254
abductor pollicis longus, 266
adductor brevis, 278
adductor hallucis, 311
adductor longus, 276
adductor magnus, 279
adductor pollicis, 255
anconeus, 264
anterior vertebral, 322
biceps brachii, 243
biceps femoris, 289
brachialis, 244
brachioradiais, 258
buccinator, 313
coccygeus, 334
coracobrachialis, 244
deltoid, 239
diaphragm, 328
erector spinae, 324
extensor carpi radialis brevis, 260
extensor carpi radialis longus, 259
extensor carpi ulnaris, 264
extensor digiti minimi, 263
extensor digitorum, 261
extensor digitorum brevis, 294
extensor digitorum longus, 293
extensor hallucis longus, 292
extensor indicis, 267
extensor pollicis brevis, 267
extensor pollicis longus, 266
external oblique of abdomen, 329
flexor carpi radialis, 247
flexor carpi ulnaris, 248
flexor digiti minimi, 254
flexor digiti minimi brevis, 310
flexor digitorum accessorius, 309
flexor digitorum brevis, 306
flexor digitorum longus, 303
TEXTBOOK
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HUMAN
Muscle (continued)
flexor digitorum profundus, 250
flexor digitorum superficialis, 249
flexor hallucis brevis, 310
flexor hallucis longus, 302
flexor pollicis brevis, 254
flexor pollicis longus, 252
gastrocnemius, 299
gemelli, 285
gluteus maximus, 280
gluteus medius, 282
gluteus minimus, 282
gracilis, 274
infrahyoid, 319
infraspinatus, 241
intercostal, 326
internal oblique, of abdomen, 330
interossei, 256, 311
dorsal of hand, 257
dorsal of foot, 312
of foot, 311
palmar, 256
plantar, 312
lateral vertebral, 321
latissimus dorsi, 237
levator ani, 334
levator scapular, 238
longus capitis, 322
longus colli, 322
lumbrical, of hand, 253
lumbricals, of foot, 309
masseter, 315
obliquus capitis inferior, 323
obliquus capitis superior, 323
obturator externus, 286
obturator internus, 284
omohyoid, 319
opponens digiti minimi, 255
opponens pollicis, 255
pectineus, 275
pectoralis major, 233
pectoralis minor, 234
peroneus brevis, 298
peroneus longus, 297
peroneus tertius, 295
piriformis, 283
plantaris, 300
platysma, 317
OSTEOLOGY
INDEX
Muscle (continued)
popliteus, 301
pronator quadratus, 246
pronator teres, 246
psoas major, 269
psoas minor, 269
pterygoid, lateral, 315
pterygoid, medial, 315
quadratus femoris, 285
quadratus lumborum, 333
quadriceps femoris, 272
rectus abdominis, 332
rectus capitis anterior, 322
rectus capitis lateralis, 322
rectus capitis posterior major, 323
rectus capitis posterior minor, 323
rhomboideus major, 238
rhomboideus minor, 238
sartorius, 271
scalenus anterior, 321
scalenus medius, 321
scalenus minimus, 321
scalenus posterior, 321
semimembranosus, 288
semispinalis capitis, 325
semitendinosus, 287
serratus anterior, 235
soleus, 300
splenius capitis, 325
sternocleidomastoid, 318
sternocostalis, 327
sternohyoid, 319
sternothyroid, 319
subclavius, 234
subcostales, 327
subocipital, 323
subscapularis, 242
supinator, 265
supraspinatus, 240
temporalis, 314
tensor fasciae latae, 270
teres major, 242
thyrohyoid, 319
tibialis anterior, 291
tibialis posterior, 304
transversus abdominis, 331
trapezius, 236
triceps, 245
339
340
Phalanges
of fingers, 49
of foot, 107
Pisiform bone, 39
Plate
articular, of tympanic, 174
cribriform, 179, 225
horizontal, of ethmoid, 225
horizontal, of palatine bone, 169, 223
medial, of ethmoid, 225
median, of ethmoid, 225
orbital, of ethmoid, 225
perpendicular of palatine, 170
perpendicular, of ethmoid, 225
perpendicular, of palatine bone, 224
pterygoid, lateral, 165, 173, 222
pterygoid, medial, 165, 172, 222
tympanic, 164, 219
vaginal, of sphenoid, 171
Premaxilla, 169
Process
accessory, 118
alveolar, 153, 169, 198
articular of vertebra, 114
clinoid, anterior, 180
clinoid, posterior, 180
condylar, 198
coracoid, 14
coronoid, 30, 198
frontal, of maxilla, 206
jugular, 175
mamillary, 118
mastoid, 162, 217
olecranon, 30
orbital, of palatine bone, 225
palatine, of maxilla, 206
pterygoid, 165, 171, 222
pyramidal, 165, 169, 224
sphenoidal, of palatine bone, 170, 225
styloid,
of skull, 162
of fibula, 88
of radius, 27
of ulna, 32
xiphoid, 134
zygomatic, of frontal bone, 208
zygomatic, of maxilla, 206
zygomatic, of temporal, 216
TEXTBOOK
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OSTEOLOGY
INDEX
341
342
Tuberosity
calcaneal, 99
deltoid, 19
gluteal, 75
iliac, 60
ischial, 61
maxillary, 165, 169, 205
of cuboid bone, 101
of fifth metatarsal, 105
of navicular bone, 100
radial, 25
tibial, 81
ulnar, 30
TEXTBOOK
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HUMAN
cervical, 115
cervical,first, 121
cervical,second, 123
cervical,seventh, 125
lumbar, 115
lumbar, fifth, 126
thoracic, 115
thoracic, eleventh, 125
thoracic, first, 125
thoracic, tenth, 125
thoracic, twelfth, 125
typical, 113
Vertebral column, 113
Vomer, 146, 153, 170, 227
Ulna, 30
Xiphoid process, 134
Vertebra
atlas, 121
axis, 123
OSTEOLOGY