The Meatus of the Nose

Sphenopalatine Recess

• This space is posterosuperior to the superior concha.
• The sphenoidal sinus opens into this recess.

Superior Meatus

• This is a narrow passageway between the superior and middle nasal conchae.
• The posterior ethmoidal sinuses open into it by one or more orifices.

Middle Meatus

• This is longer and wider than the superior one.

• The anterosuperior part of this meatus lead into a funnel-shaped opening, called the infundibulum, through which the frontonasal duct leads to the frontal sinus.
• There is one duct for each frontal sinus and since there may be several, there may be several frontonasal ducts.

• When the middle concha is removed, rounded elevation called the ethmoidal bulla (L. bubble), is visible
• The middle ethmoidal air cells open on the surface of the ethmoidal bulla.

• Inferior to this bulla is a semicircular groove called the hiatus semilunaris.
• The frontal sinus opens into this hiatus anterosuperiorly.
• Near the hiatus are the openings of the anterior ethmoid air cells.
• The maxillary sinus also opens into the middle meatus.

Inferior Meatus

• This is a horizontal passage, inferolateral to the inferior nasal concha.
• The nasolacrimal duct opens into the anterior part of this meatus.
• Usually, the orifice of this duct is wide and circular.

The Temporomandibular Joint

• This articulation is a modified hinge type of synovial joint.
• The articular surfaces are: (1) the head or condyle of the mandible inferiorly and (2) the articular tubercle and the mandibular fossa of the squamous part of the temporal bone.

• An oval fibrocartilaginous articular disc divides the joint cavity into superior and inferior compartments. The disc is fused to the articular capsule surrounding the joint.

• The articular disc is more firmly bound to the mandible than to the temporal bone.

• Thus, when the head of the mandible slides anterior on the articular tubercle as the mouth is opened, the articular disc slides anteriorly against the posterior surface of the articular tubercle

The Orbital Margin

• The frontal, maxillary and zygomatic bones contribute equally to the formation of the orbital margin.

• The supraorbital margin is composed entirely of the frontal bone.
• At the junction of its medial and middle thirds is the supraorbital foramen (sometimes a notch), which transmits the supraorbital nerves and vessels.

• The lateral orbital margin is formed almost entirely of the frontal process of the zygomatic bone.

• The infraorbital margin is formed by the zygomatic bone laterally and the maxilla medially.

• The medial orbital margin is formed superiorly by the frontal bone and inferiorly by the lacrimal crest of the frontal process of the maxilla.
• This margin is distinct in its inferior half only.

-> Most of the facial skeleton is formed by nine bones: four paired (nasal, zygomatic, maxilla, and palatine) and one unpaired (mandible).
-> The calvaria of the new-born infant is large compared with the relatively small fascial skeleton.
-> This results from the small size of the jaws and the almost complete absence of the maxillary and other paranasal sinuses in the new-born skull.
-> These sinuses form large spaces in the adult facial skeleton. As the teeth and sinuses develop during infancy and childhood, the facial bones enlarge.
-> The growth of the maxillae between the ages of 6 and 12 years accounts for the vertical elongation of the child’s face.

The Nasal Bones 

-> These bones may be felt easily because they form the bridge of the nose.
-> The right and left nasal bones articulate with each other at the internasal suture.
-> They also articulate with the frontal bones, the maxillae, and the ethmoid bones.
-> The mobility of the anteroinferior portion of the nose, supported only by cartilages, serves as a partial protection against injure (e.g., a punch in the nose). However, a hard blow to the anterosuperior bony portion of the nose may fracture the nasal bones (broken nose).
-> Often the bones are displaced sideways and/or posteriorly.

The Maxillae 

-> The skeleton of the face between the mouth and the eyes is formed by the two maxillae.
-> They surround the anterior nasal apertures and are united in the medial plane at the intermaxillary suture to form the maxilla (upper jaw).
-> This suture is also visible in the hard palate, where the palatine processes of the maxillae unite.
-> Each adult maxilla consists of: a hollow body that contains a large maxillary sinus; a zygomatic process that articulates with its mate on the other side to form most of the hard palate; and alveolar processes that form sockets for the maxillary (upper) teeth.
-> The maxillae also articulate with the vomer, lacrimal, sphenoid, and palatine bones.
-> The body of the maxilla has a nasal surface that contributes to the lateral wall of the nasal cavity; an orbital surface that forms most of the floor of the orbit; an infratemporal surface that forms the anterior wall of the infratemporal fossa; and an anterior surface that faces partly anteriorly and partly anterolaterally and is covered buy facial muscles.
-> The relatively large infraorbital foramen, which faces inferomedially, is located about 1 cm inferior to the infraorbital margin; it transmits the infraorbital nerve and vessels.
-> The incisive fossa is a shallow concavity overlying the roots of the incisor teeth, just a shallow concavity overlying the roots of the incisor teeth, just inferior to the nasal cavity. This fossa is the injection site for anaesthesia of the maxillary incisor teeth.
-> If infected maxillary teeth are removed, the bone of the alveolar processes of the maxillae begins to be reabsorbed. As a result, the maxilla becomes smaller and the shape of the face changes.
-> Owing to absorption of the alveolar processes, there is a marked reduction in the height of the lower face, which produces deep creases in the facial skin that pass posteriorly from the corners of the mouth.

The Mandible 

-> This is a U-shaped bone and forms the skeleton of the lower jaw and the inferior part of the face. It is the largest and strongest facial bone.
-> The mandibular (lower) teeth project superiorly from their sockets in the alveolar processes.
-> The mandible (L. mandere, to masticate) consists of two parts: a horizontal part called the body, and two vertical oblong parts, called rami.
-> Each ramus ascends almost vertically from the posterior aspect of the body.
-> The superior part of the ramus has two processes: a posterior condylar process with a head or condyle and a neck, and a sharp anterior coronoid process.
-> The condylar process is separated from the coronoid process by the mandibular notch, which forms the concave superior border of the mandible.
-> Viewed from the superior aspect, the mandible is horseshoe-shaped, whereas each half is L-shaped when viewed laterally.
-> The rami and body meet posteriorly at the angle of the mandible.
-> Inferior to the second premolar tooth on each side of the mandible is a mental foramen (L. mentum, chin) for transmission of the mental vessels and the mental nerve.
-> In the anatomical position, the rami of the mandible are almost vertical, except in infants and in edentulous (toothless) adults.
-> On the internal aspect of the ramus, there is a large mandibular foramen.
-> It is the oblong entrance to the mandibular canal that transmits the inferior alveolar vessels and nerve to the roots of the mandibular teeth.
-> Branches of these vessels and the mental nerve emerge from the mandibular canal at the mental foramen.
-> Running inferiorly and slightly anteriorly on the internal surface of the mandible from the mandibular foramen is a small mylohyoid groove (sulcus), which indicates the course taken by the mylohyoid nerve and vessels.
-> These structures arise from the inferior alveolar nerve and vessels, just before they enter the mandibular foramen.
-> The internal surface of the mandible is divided into two areas by the mylohyoid line, which commences posterior to the third molar tooth. -> Just superior to the anterior end of the mylohyoid line are two small, sharp mental spines (genial tubercles), which serve as attachments for the genioglssus muscles.

The Zygomatic Bones 

-> The prominences of the cheeks (L. mala), the anterolateral rims and much of the infraorbital margins of the orbits, are formed by the zygomatic bones (malar bones, cheekbones).
-> They articulate with the frontal, maxilla, sphenoid, and temporal bones.
-> The frontal process of the zygomatic bone passes superiorly, where it forms the lateral border of the orbit (eye socket) and articulates with the frontal bone at the lateral edge of the supraorbital margin.
-> The zygomatic bones articulate medially with the greater wings of the sphenoid bone. The site of their articulation may be observed on the lateral wall of the orbit.
-> On the anterolateral aspect of the zygomatic bone near the infraorbital margin is a small zygomaticofacial foramen for the nerve and vessels of the same name.
-> The posterior surface of the zygomatic bone near the base of its frontal process is pierced by a small zygomaticotemporal foramen for the nerve of the same name.
-> The zygomaticofacial and zygomaticotemporal nerves, leaving the orbit through the previously named foramina, enter the zygomatic bone through small zygomaticoorbital foramina that pierces it orbital surface.
-> The temporal process of the zygomatic bone unites with the zygomatic process of the temporal bone to form the zygomatic arch.
-> This arch can be easily palpated on the side of the head, posterior to the zygomatic prominence (malar eminence) at the inferior boundary of the temporal fossa (temple).
-> The zygomatic arches form one of the useful landmarks for determining the location of the pterion. These arches are especially prominent in emaciated persons.
-> A horizontal plane passing medially from the zygomatic arch separates the temporal fossa superiorly from the infratemporal fossa inferiorly.

Other Bones

There are several other, very important bones in the skull, including the palatine bone, ethmoid bone, vomer, inferior concha and the ossicles of the ear (malleus, incus and stapes). These, however, are covered to greater detail where they are relevant in the head (e.g., ethmoid bone with the orbit and nasal cavity).

Endochondral ossification

• A cartilage model exists
• Through intramembraneous ossification in the perichondrium a collar of bone forms around the middle part of the cartilage model
• The perichondrium change to a periostium
• The bone collar cuts off the nutrient and oxygen supply to the chondrocytes in the cartilage model
• The chondrocytes then increase in size and resorb the surrounding cartilage matrix until only thin vertical septae of matrix are left over
• These thin plates then calcify after which the chondrocytes die
• The osteoclasts make holes in the bone collar through which blood vessels can now enter the cavities left behind by the chondrocytes
• With the blood vessels osteoprogenitor cells enter the tissue
• They position themselves on the calcified cartilage septae, change into osteoblasts and start to deposit bone to form trabeculae
• In the mean time the periosteum is depositing bone on the outside of the bone collar making it thicker and thicker
• The trabeculae,consisting of a core of calcified cartilage with bone deposited on top of it, are eventually resorbed by osteoclasts to form the marrow cavity
• The area where this happens is the primary ossification centre and lies in what is called the diaphysis (shaft)
• This process spreads in two directions towards the two ends of the bone the epiphysis
• In the two ends (heads) of the bone a similar process takes place
• A secondary ossification centre develops from where ossification spreads radially
• Here no bone collar forms
• The outer layer of the original cartilage remains behind to form the articulating cartilage
• Between the primary and the secondary ossification centers two epiphyseal cartilage plates remain
• This is where the bone grows in length

• From the epiphyseal cartilage plate towards the diaphysis a number of zones can be identified:

 Resting zone of cartilage

 Hyaline cartilage

 Proliferation zone

 Chondrocytes divide to form columns of cells that mature.

Hypertrophic cartilage zone

 Chondrocytes become larger, accumulate glycogen, resorb the surrounding matrix so that only thin septae of cartilage remain 

Calcification and degeneration zone

The thin septae of cartilage become calcified.

The calsified septae cut off the nutrient supply to the chondrocytes so subsequently they die.

Ossification zone.

Osteoclasts make openings in the bone collar through which blood vessels then invade the spaces left vacant by the chondrocytes that died.

Osteoprogenitor cells come in with the blood and position themselves on the calcified cartilage

septae, change into osteoblasts and start to deposit bone.

 When osteoblasts become trapped in bone they change to osteocytes.

Growth and remodeling of bone

Long bones become longer because of growth at the epiphyseal plates

They become wider because of bone formed by the periosteum

The marrow cavity becomes bigger because of resorbtion by the osteoclasts

Fracture repair

When bone is fractured a blood clot forms

 Macrophages then remove the clot, remaining osteocytes and damaged bone matrix

The periosteum and endosteum produce osteoprogenitor cells that form a cellular tissue in the fracture area

 Intramembranous and endochondral ossification then take place in this area forming trabeculae.

Trabeculae connect the two ends of the broken bone to form a callus

Remodelling then takes place to restore the bone as it was

Joints

The capsule of a joint seals off the articular cavity,  

The capsule has two layers

 fibrous (outer)

synovial (inner)

The synovial layer is lined by squamous or cuboidal epithelial cells,  Under this layer is a layer of loose or dense CT, The lining cells consists of two types:

- A cells

- B cells

They secrete the synovial fluid

They are different stages of the same cell, They are also phagocytic., The articular cartilage has fibres that run perpendicular to the bone and then turn to run parallel to the surface

• Cartilage model is covered with perichondrium that is converted to periosteum

• Diaphysis-central shaft
• Epiphysis-located at either end of the diaphysis
• Growth in length of the bone is provided by the emetaphyseal plate located between the epiphyseal cartilage and the diaphysis

• Blood capillaries and the mesenchymal cells infiltrate the spaces left by the destroyed chondrocytes

• Osteoblasts are derived from the undifferentiated cells; form an osseous matrix in the cartilage
• Bone appears at the site where there was cartilage

      Microscopic structure

• Compact bone is found on the exterior of all bones; canceIlous bone is found in the interior
• Surface of compact bone is covered by periosteum that is attached by Sharpey's fibers
• Blood vessels enter the periosteum via Volkmann's canals and then enter the haversian canals that are formed by the canaliculi and lacunae

•  

• Marrow
  • FiIls spaces of spongy bone
  • Contains blood vessels and blood ceIls in various stages of development
  • Types
• Red bone marrow
  • Formation of red blood ceIls (RBCs) and some white blood cells (WBCs) in this location
  • Predominate type of marrow in newborn
  • Found in spongy bone of adults (sternum, ribs, vertebrae, and proximal epiphyses of long bones)
•  Yellow bone marrow
  • Fatty marrow
  • Generally replaces red bone marrow in the adult, except in areas mentioned above
•  
• Ossification is completed as the proximal epiphysis joins with the diaphysis between the twentieth and twenty-fifth year