Skull and Face Fractures

Published on 16/04/2015 by admin

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Last modified 16/04/2015

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1 Skull and Face Fractures

Anatomy of the Skull and Facial Skeleton

Anterior and Lateral Aspects

Skull and Facial Bones

• Neurocranium (cranial vault): frontal, ethmoid, sphenoid, temporal, parietal, occipital bones

• Viscerocranium (facial skeleton): maxilla, nasal, lacrimal, zygomatic, vomer, palatine, mandible bones

• Base of skull: occipital, sphenoid, temporal, palatine, maxilla bones

• Most of the bones of the skull are flat (type), with inner and outer “tables” (layers) of compact (cortical) bone surrounding trabecular bone and marrow space (diploë).

• Emissary veins connect diploic spaces with cerebral veins/sinuses (intracranial) and scalp and superficial veins: potential route for intracranial spread of infection.

Thin fibrous joints found only between skull and facial bones

Produced by intramembranous ossification

May be indented (e.g., coronal suture), planar, or squamous

• Most cranial and facial bones are pharyngeal arch derivatives.

• Occipital, sphenoid, and ethmoid bones modified vertebrae and developed around notochord.

Scalp Layers

• Skin: thin (thicker in occipital region); well supplied with arteries, veins, lymphatic drainage

• Connective tissue: dense subcutaneous layer with rich neurovascular supply

• Aponeurosis of occipitofrontalis muscle, with lateral attachments of temporoparietalis and posterior auricular muscles (collectively the epicranius)

• Loose areolar tissue: allows aponeurosis movement; danger space for infections owing to emissary vein drainage into diploic spaces of cranium

• Pericranium: external periosteum, fibrously fused to sutures

Neurovascular Supply

Superficial Arteries and Veins of Face and Scalp

Arteries of Face and Cranium

External Carotid (Proximal to Distal)

• Lingual: to tongue and floor of mouth, may have common origin with facial

• Facial: superior, inferior labial, lateral nasal, angular branches; to anteromedial face

• Posterior auricular: posterior to ear and mastoid regions

• Occipital: lateral aspect of head behind ear

• Maxillary: deep auricular, anterior tympanic, deep temporal, middle meningeal, inferior alveolar, posterior alveolar, infraorbital branches; to deep face

• Transverse facial: lateral face, parallel to parotid duct

• Superficial temporal: anterior, lateral aspect of crania

Internal Carotid

• Anterior cerebral

Ophthalmic artery: supraorbital, supratrochlear, anterior and posterior ethmoid branches

• Middle cerebral

Other

• Vertebral: basilar, pontine, posterior and inferior cerebellar, posterior cerebral, posterior communicating branches

• Facial: face richly perfused, with anastomoses across midline, anterior to posterior, and between intra- and extracranial branches

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