Term
| What are the bones of calvarium? |
|
Definition
| sphenoid, occiput, temporals, parietals, ethmoid, frontals |
|
|
Term
| What are the bones of the facial skeleton? |
|
Definition
| zygomas, palatines, maxillae, vomer, lacrimals, nasals, inferior conchae, mandible |
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Term
| What are the regions of the cartilaginous neurocranium? |
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Definition
| petromastoid portion of temporal, body of occiput, body of sphenoid, ethmoid |
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Term
| What are the regions of the membranous neurocranium? |
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Definition
| frontals, parietals, squamous portions of occiput and temporal, greater wings and pterygoid of sphenoid |
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Term
| What regions are the cartilaginous viscerocranium and what arches do they comes from? |
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Definition
1st arch- malleus, incus
2nd arch- stapes, styloid process of temporal bone |
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Term
| What are the regions of the membranous viscerocranium? |
|
Definition
| squamous portion of temporal bone, maxillae, zygomatics, nasal bones, mandible |
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Term
| What are the 4 parts at birth of the occiput? |
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Definition
| basilar, condylar, supraocciput, interparietal |
|
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Term
| What landmarks are found in the basilar, lateral/condylar, and squama of the occiput? |
|
Definition
Basilar- pharyngeal tubercle, SBS, condyles (1/4)
Lateral/condylar- condyles (3/4), hypoglossal canal, groove for lateral sinus
Squama- supraocciput (opisthion) interparietal, inion, superior/inferior nuchal lines, sagittal ridge of falx cerebri and cerebelli, horizontal ridge for tentorium cerebelli and grooves for transverse sinus |
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Term
| What bones articulate with the occiput? |
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Definition
| parietals, temporals, sphenoid, atlas (occipital condyles converge A and I to form diathrosis) |
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Term
| What are the 3 foramina of the occiput and what travels through there? |
|
Definition
Foramen magnum- medulla, ascending spinal accessory nerves, vertebral arteries
Hypoglossal canal- hypoglossal nerve
Jugular foramen- inferior petrosal sinus, glossopharyngeal nerve, vagus nerve, spinal accessory nerve, sigmoid sinus |
|
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Term
| What are the 2 parts of the embryologic sphenoid? |
|
Definition
Prenatal- presphenoid and postsphenoid
Natal (3 parts)- body and less wings, greater wing-pterygoid unit
Endochondral expect for pterygoid plates and anteriolateral parts of greater wings |
|
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Term
| What are the surfaces of the each of the 5 parts of the sphenoid? |
|
Definition
Body
Greater wing- orbital, lateral, infratemporal surfaces
Lesser wing- orbital, anteromedial, lateral surfaces
Anterior body- ethmoid spine, rostrum
Pterygoid processes |
|
|
Term
| What bones does the sphenoid articulate with? |
|
Definition
All bones of cranium- occiput at SBS, temporals, parietals, frontals
6 bones of face- ethmoid, palatines, vomer, zygomae |
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|
Term
| What are the sphenoid foramina and what traverses them? |
|
Definition
Optic foramen- optic nerve, opthalamic artery
Superior orbital fissure- lacrimal nerve, frontal nerve, trochlear nerve, occulomotor nerve, nasociliary nerve, abducens nerve, opthalmic vein, opthalmic nerve
Foramen rotundum- maxillary nerve
Foramen ovale- mandibular nerve
Foramen spinosum- middle meningeal artery |
|
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Term
| What does the ethmoid bone articulate with? |
|
Definition
| Frontals, sphenoid, vomer, septal cartilage, palatines, nasals maxillae, inferior conchae, lacrimal |
|
|
Term
| What are the 3 parts of the ethmoid? |
|
Definition
Horizontal (cribiform plate)- crista galli
Perpendicular plate
Lateral masses- orbital plate, superior/middle conchae |
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Term
| What are the articulations of the vomer? |
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Definition
| sphenoid, ethmoid, septal cartilage, palatines, maxillae |
|
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Term
| Which parts of the temporal bone are membranous and which are endochondral ossification? |
|
Definition
Membranous- squamo-zygomatic portion, tympanic plate
Endochondral- petromastiod portion, styloid process |
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|
Term
| What are the parts of the temporal bone? |
|
Definition
|
|
Term
| What are the foramina of the temporal bone? |
|
Definition
Carotid canal- internal carotid artery, sympathetic plexus
Jugular foramen- between temporal bone and occiput- CN IX, X, XI, sigmoid sinus, inferior petrosal sinus, posterior meningeal artery |
|
|
Term
| What are the temporal bone articulations? |
|
Definition
Occiput- occipitomastoid, petrobasilar
Parietals- parieto-squamous, parieto-mastoid
Sphenoid- spheno-squamous, petro-sphenoid
Zygomae- temporal-zygomatic
Mandible- temporomandibular articulation (TMJ) |
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|
Term
| What are the articulations of the parietal bone? |
|
Definition
| Occipital, frontal, sphenoid, opposite parietal, temporal |
|
|
Term
| What are the parts of the frontal bone? |
|
Definition
| Glabella, ethomoid notch, orbital plate, lateral angle, nasal spine, zygomatic process |
|
|
Term
| What are the articulations of the frontal one? |
|
Definition
| Sphenoid, ethmoid, parietals, nasals, maxillae, zygomae, lacrimal |
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|
Term
| What are the articulations of the sacrum? |
|
Definition
| L5, coccyx, innominates/ilia of SC joint, dural attachment at S2 |
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Term
| What are the 5 components of the primary respiratory mechanism? |
|
Definition
Inherent motility of the brain and spinal cord
Fluctuation of the CSF
Mobility of intracranial and intraspinal membranes
Articular mobility of the cranial bones
Involuntary mobility of the sacrum between ilia |
|
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Term
| What are the movements of the bones in biphasic cycle of motion of hte PRM? |
|
Definition
Inhalation and Exhalation
Midline bones flex and extend
Paired bones internally and externally rotate
CNS shortens (coils) and lengthens (uncoil)
Sacrum couternutates and nutates |
|
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Term
| What increases and decreases the rate/quality of PRM? |
|
Definition
Increased- vigorous exercise, fever, OMT
Decreased- stress, chronic fatigue, chronic infections, depression, chronic poisoning |
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Term
| What are the physiologic and unphysiologic strains? |
|
Definition
Physiologic- flexion/extension, side bending rotation, torsion
Unphysiologic- lateral, vertical, compression |
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|
Term
| What are the goals of cranial treatment? |
|
Definition
normalize structure (both position and motion) to optimize function
increasing circulation by normalizing arterial, venous, and lymphatic channels
normalizing CSF fluctation
correcting or resolving cranial articular strains
releasing membranous tension
counteracting stress-producing factors by normalizing function of the cerebrum, thalamus, hypothalamus, and pituitary body |
|
|
Term
| What are the indications and contraindications of cranial? |
|
Definition
Indications- newborns and children, dental problems, trauma, neuroendocrine immune dysfunction
Contraindications- acute skull fracture, acute cranial bleed, seizure disorder (relative) |
|
|
Term
| What is synarthrosis? What is synchondrosis and syndesmosis? What is diarthrosis? |
|
Definition
Synarthrosis- articulation w/out a joint cavity
Synchondrosis- cartilaginous union (SBS)
Syndesmosis- ligamentous union (petrosphenoid ligament)
Diarthrosis- articulation with a joint cavity (temporomandibular joint) |
|
|
Term
| What are the 5 different types of sutures? |
|
Definition
Serrated- saw tooth, sagittal suture
Squamous- scale like, squamoparietal suture
Harmonic- edge to edge, lacrimoethmoidal suture
Gomphosis- peg and socket, greater wing of sphenoid and body
Combination, irregular |
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Term
| What happens during inhalation and exhalation to the SBS, midline bones, and paired bones? |
|
Definition
Inhalation- SBS rises, midline bones flex (sacrum counternutates), paired bones externally rotate
Exhalation- SBS falls, midline bones extend (sacrum nutates), paired bones internally rotate |
|
|
Term
| What are the midline bones and what are the paired bones? |
|
Definition
Midline- sphenoid, occiput, vomer, ethmoid, sacrum
Paired- parietals, frontals, temporals, zygomae, maxillae, nasals, lacrimals, palatines |
|
|
Term
| What structure is cranial motion based off of? |
|
Definition
Sphenobasilar synchrondrosis- SBS rises (elevates superiorly) is cranial flexion
as SBS falls (depresses inferiorly) is cranial extension |
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|
Term
| What axis does sphenoid sit on? What is its motion? |
|
Definition
Axis- transverse axis A to and on level w/floor of sella turcica
Motion- F/E |
|
|
Term
| What is the axis of the occiput and the motion? |
|
Definition
Axis- transverse axis located above jugular processes of occiput at level of SBS
Motion- F/E |
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Term
| What are the changes in the vault with flexion and extension? |
|
Definition
Flexion- cranial vault widens (palate widens and flattens) AP diameter decreases, S/I diameter decreases, transverse diameter increases
Extension- cranial vault narrows (palate narrows/heightens), AP diameter lengthens, S/I diameter lengthens, transverse diameter shortens |
|
|
Term
| What is the motion and axis of the temporal bone? |
|
Definition
Motion influenced by occiput
Axis- approximately through petrous ridge, converse anterio-medially
Motions- E rotation/I rotation |
|
|
Term
| What is the axis of motion and motion of parietal bone? |
|
Definition
Axis of motion- 2 which converge anteriorly, a point lateral to bregma on coronal border in posterolateral direction through the parietal eminence
Motion- E rotation/I rotation |
|
|
Term
| What is the motion and axis of the frontal bone? |
|
Definition
Axis- from center of each orbital plate through frontal eminence
Motion- E rotation/I rotation |
|
|
Term
| What are the axis of the sacrum? |
|
Definition
| Superior transverse (respiratory axis), middle transverse (postural axis), inferior transverse (hip bone axis) |
|
|
Term
| How do you diagnose cranial strain patterns? |
|
Definition
| History, observation, palpation for symmetry, motion testing |
|
|
Term
| What are the physiologic and unphysiologic strain patterns? |
|
Definition
Physiologic- flexion, extension, torsion, side bending rotation
Non-physiologic- lateral, vertical, sphenobasilar synchrondrosis compression |
|
|
Term
| What is non-strained physiologic motion? |
|
Definition
| SBS rises and falls, sphenoid/occiput rotate in opposite directions around 2 parallel transverse axes (through body of sphenoid, above jugular foramen at level of SBS) |
|
|
Term
| What is the etiology, the axis, and diagnosis of F/E strains? |
|
Definition
Etiology- birth, genetic
Axis- 2 transverse axis
Diagnosis- named for position of SBS |
|
|
Term
| What is the flexion strain pattern in terms of SBS, motion preference, and sacrum? |
|
Definition
SBS is elevated- AP diameter decreased, transverse diameter increased
Motion preference is flexion/external rotation
Sacrum is counternutated (sacral base is posterior, bilateral shallow sacral sulci) |
|
|
Term
| What is the extension strain pattern in terms of SBS, motion preference, and sacrum? |
|
Definition
| SBS is depressed- AP diameter increased, transverse diameter decreased, motion preference is extension/internal rotation, sacrum is nutated (sacral base is A, bilateral deep sacral sulci) |
|
|
Term
| What is the flexion/extension observational diagnosis? |
|
Definition
Flexion- face round, wide side to side, short from above down, orbits wide, eyes protrude, ears protrude, palate wide and flat
Extension- face oval, narrow side to side, long from above down, orbits narrow, eyes retruded, ears close to head, palate narrow and high |
|
|
Term
|
Definition
| Place index finger on pterion, middle finger on squamous portion of temporal, ring finger on mastoid portion of temporal, little finger on lateral angle of occiput, thumbs tough/rest on bregma |
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|
Term
| What happens to your fingers in vault hold w/ F/E? |
|
Definition
Flexion- fingers on greater wings and lateral angles of occiput widen and move inferiorly
Extension- fingers on greater wings/occiput narrow and move superiorly |
|
|
Term
| What can cause a torsion? |
|
Definition
| birth, trauma typically at an angle to 1 quandrant of the head, blow in anterior quadrant (frontal or zygoma) or posterior quadrant (parietal or occipital) |
|
|
Term
| What is the axis, motion, and diagnosis of a torsion? |
|
Definition
Axis 1 AP axis from nasion to opisthion
Motion- sphenoid and occiput rotate at SBS in opposite directions
Diagnosis- names for side of superior greater wing of sphenoid |
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|
Term
| What do your fingers look like in a vault hold with a torsion? |
|
Definition
| Left torsion- in left hand the index finger is superior (or rotates towards you) littler finger is inferior (rotates away form you) right hand is opposite |
|
|
Term
| What causes a side bending/rotation? |
|
Definition
| trauma- blow to L side of temporal and parietal region results in right side bending rotation strain (and vice versa) |
|
|
Term
| What are the axis, motion, and diagnosis of the side bending rotation? |
|
Definition
Two parallel vertical axes (sidebending) one through center of sphenoid, one through foramen magnum , sphenoid/occiput rotate in opposite directions
1 AP axis (rotation)- opisthion to naision, sphenoid and occiput rotate in same direction, rotation is inferior on side of convexity
Diagnosis- named for side of convexity of sphenobasilar synchondrosis |
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|
Term
| What do you fingers look in a vault hold with side bending rotation? |
|
Definition
| LSBR- left index and little fingers spread apart (widen) and move inferior (away from you) and right index finger and little fingers come together and move superior (towards you) |
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|
Term
| What is the etiology, axis, motion, and diagnosis of a lateral strain? |
|
Definition
Etiology- trauma to one side of head A or P to SBS (or birth)
Axis- 2 parallel vertical axes 1 through base of sphenoid and 1 through foramen magnum
Motion- sphenoid/occiput rotate in same direction around 2 parallel vertical axes causing shearing force at SBS
Diagnosis- names for direction of base of sphenoid (L or R) |
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|
Term
| What do you fingers look like in vault hold of a lateral strain? |
|
Definition
| Left lateral- index fingers shift laterally to R (sphenoid base turns L0 and little fingers shift to L (occipital base turns to R) |
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|
Term
| What is the etiology, axis, motion, and diagnosis of vertical strain? |
|
Definition
Secondary to trauma- A cranium force S or I; P cranium force S or I
Axes- 2 parallel transverse axes- 1 through sphenoid, 1 through occiput
Motion- sphenoid/occiput rotate in same direction, 1 moves in flexion and other in extension
Diagnosis- named for direction the P surface of body of sphenoid has shifted (S or I) |
|
|
Term
| What do your fingers look like in vault hold of a vertical strain? |
|
Definition
| Superior- index fingers rotate inferior, little fingers rotate superior |
|
|
Term
| What is the motion of SBS compression? |
|
Definition
limited or absent cranial motion, full flexion, and extension is prevented, can be difficult to diagnose may feel alternating vertical strain pattern
Patients- have headache, low energy level, difficulty concentrating, short attention span, sluggish thinking |
|
|
Term
| What are the goals of BLT? |
|
Definition
Normalize structure (both position and motion) to optimize function
Increasing circulation by normalizing arterial/venous/lymphatic channels, normalizing CSF fluctuations, correcting or resolving cranial articular strains, releasing membranous tension, couteracting stress- producing factors by normalizing function of cerebrum, thalamus, hypothalamus, pituitary body |
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|
Term
| What is the definition of balanced membranous tension? |
|
Definition
| Point of balanced membranous tension is the point in the ROM of an articulation where the membranes are poised b/w normal tension present through the free ROM and the increased tension preceding the strain which occurs as a joint is carried beyond its normal physiologic range |
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|
Term
| What is Exaggeration/Indirect action in BLT? |
|
Definition
Most common
Increase abnormal relationship at joint by taking it slightly in direction that is strained
Typically not used before sutural formation at 5-6 yo
Not used in acute trauma when exaggeration of position may cause intracranial hemorrhage |
|
|
Term
| What is Direct Action in BLT? |
|
Definition
Used in acute trauma
Treatment of children
Used w/overriding sutures
Components are carefully guided back to normal position |
|
|
Term
| What is Disengagement in BLT? |
|
Definition
Used in trauma especially at bevel changes of boney articulations
Separates the opposing surfaces w/in limits of physiologic motion |
|
|
Term
| What is Opposite Physiologic motion in BLT? |
|
Definition
Used when there is very unphysiologic strain, where the physiologic pattern has been severely violated
Take one part toward physiologic pattern (direct) and other away (indirect)
Very seldom used |
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|
Term
|
Definition
| Used to help reshape bones in children but can also be used in adults |
|
|
Term
| What are the forces that assist BLT? |
|
Definition
Respiratory cooperation- inhalation most common but if articulation is held toward external rotation or extension exhalation will be used, crying often employed in treatment of children as respiratory cooperation
Postural cooperation- dorsiflexion of feet, raising of shoulder
Directing the fluid |
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|
Term
| Where is Sutherland's fulcrum? |
|
Definition
| Axis around which the dural membranes move,inbetween the falx cerebri and tentorium cerebelli at the straight sinus |
|
|
Term
| What happens to the reciprocal tension membrane in flexion? |
|
Definition
| The pull on falx cerebri reduces AP diameter, paired bones move externally (pull on petrous portions of temporal one), SBS drawn upward w/ A end of sphenoid moving in inferior direction, resultant pull on dura moves spinal cord upward resulting in counternutation of sacrum |
|
|
Term
| What happens in the flexion of paired parietals in accordance to the reciprocal tension membrane? |
|
Definition
| Midline of parietal bones at sagittal suture descends and lateral aspects as palpated at pterion move laterally (parieto-temporal suture) |
|
|
Term
| What happens in the flexion of paired temporals in accordance to the reciprocal tension membrane? |
|
Definition
| The squamous portion of temporal moves laterally while petrous portion (at mastoid processes) move medially |
|
|
Term
| What happens in the flexion of paired temporals and frontal bone in accordance to the reciprocal tension membrane? |
|
Definition
| Midline of frontal bone at metopic suture (behaving as paired bones) moves inferiorly and posteriorly as lateral aspecit move further latearlly |
|
|
Term
| Where does venous blood from the brain drain into? |
|
Definition
| internal jugular veins (a continuation from sigmoid sinuses) |
|
|
Term
| Where does the inferior sinus run? |
|
Definition
| lies in posterior portion or free margin of falx cerebri and empties into straight sinus |
|
|
Term
| Where does the superior sagittal sinus run? Where does it end? |
|
Definition
Runs from the foramen cecum anteriorly to confluence of sinuses posteriorly and lying w/in the attached margin of the falx cerebri
60% empty into confluence of sinuses in area of R transverse sinus and other 40% end in left transverse sinus or bifurcates to both |
|
|
Term
| What forms the straight sinus? |
|
Definition
| Joining of the great cerebral vein (of Galen) and inferior sagittal sinus, formed at junction of falx cerebri and tentorium cerebelli |
|
|
Term
| Where does the occipital sinus run and where does it empty? |
|
Definition
Runs from foramen magnum to external occipital proturberence formed w/in attached falx cerebelli
Empties into confluence of sinuses |
|
|
Term
| What is the circular sinus formed by and where does it go? |
|
Definition
Made up of 2 cavernous sinuses and their communicating branches
Encircles the hypophysis and empties into superior and inferior petrosal sinuses bilaterally |
|
|
Term
| Where does the basilar plexus lie? |
|
Definition
| over SBJ and joins circular sinus w/internal vertebral venous plexus |
|
|
Term
| Where do the paired transverse sinuses run? |
|
Definition
| laterally from confluence of sinuses at internal occipital protuberance |
|
|
Term
| Where do the paired sigmoid sinuses run? |
|
Definition
| each transverse sinus becomes a sigmoid sinus in area of mastoid portion of the temporal bone, this continues toward the jugular foramen and internal jugular vein |
|
|
Term
| Where do the paired cavernous sinuses lie? What venous flow do they collect? What communicates between them? What do they contain? |
|
Definition
Lie on each side of body of sphenoid
Venous flow from opthalmic vein, superficial middle cerebral vein, sphenoparietal sinus
Intercavernous sinuses communicate between them
Contain- carotid artery, abducent, occulomotor, trochlear, ophthalmic division of trigeminal nerve |
|
|
Term
| Where do the superior petrosal sinuses lie? |
|
Definition
| W/in margins of the tentorium cerebelli and runs along the petrous ridge of the temporal bone from cavernous sinus to transverse sinus |
|
|
Term
| Where do the inferior petrosal sinuses run? What do they connect? |
|
Definition
runs in groove in suture b/w petrous portion of temporal bone and occipital bone
Connects from caverous sinus to internal jugular vein, basilar sinus (plexus) connects the inferior petrosal sinuses and consists of several interfacing veins b/w layers of dura mater |
|
|
Term
| What are the indications of VSD? |
|
Definition
| Treat headaches, sinus congestion, reduce compression at sphenobasilar junction, reduce compression at cranial sutures, augment endocrine function (pituitary body contained w/in sella turcica, diaphragma sella surrounds stalk of pituitary, hormones released into vascular plexus that surrounds pituitary, altered movement of blood flow would affect hormonal circulation), improve overall cerebral function, dura is sensitive to painful stimuli and are innervated by CN V and can respond to distention/congestion |
|
|
Term
| What are the contraindications for VSD? |
|
Definition
Recent trauma w/suspected significant/serious injury to brain, blood vessels, cranium, or other related structures
Certain infections such as meningitis or encephalitis
elevated ICP
Cerebral edema
Recent shunt surgery or neurosurgery
Recent stroke
Brain or other intracranial tumor
Congenital malformations
Other potential conditions not treatable w/OMT |
|
|
Term
| What is the order of VSD? |
|
Definition
Confluence of sinuses (inion)
Occipital sinuses (supraocciput)
Occipital condylar decompression
Transverse sinuses (external occipital protuberance and along superior nuchal lines)
Straight sinus (bregma and inion)
Sagittal sinus (sagittal and metopic sutures) |
|
|
Term
| What is in the optic foramen? What can be caused by nerve entrapment here? |
|
Definition
between two roots of the lesser wings of the sphenoid, contains optic nerve and opthalamic artery
Blindness, diplopia |
|
|
Term
| What is in the foramen rotundum? What can be caused by entrapment here? |
|
Definition
| V2 maxillary nerve, Trigeminal neuralgia- tic doloreux, severe stabbing pain along V2 and/or V3 divisions due to dural restriction over petrous ridge |
|
|
Term
| What is in the foramen ovale? |
|
Definition
|
|
Term
| What is in the foramen spinosum? |
|
Definition
| middle meningeal artery and vein |
|
|
Term
| What is in the jugular foramen? |
|
Definition
| Glossopharyngeal nerve, Vagus nerve, accessory nerve *for visceral dysfunction think vagus! torticollis seen w/CN XI accessory |
|
|
Term
| What condition is caused from CN I entrapment? |
|
Definition
|
|
Term
| What conditions are seen with CN III, IV, VI entrapment? |
|
Definition
| ptosis, diplopia, dilated pupil |
|
|
Term
|
Definition
| misalignment of visual axes, may be congenital or acquired through CN paralysis or neuromuscular disorders, compensated through postural changes |
|
|
Term
| Dysfunction of what nerve causes bell's palsy? |
|
Definition
| CN VII Facial, remember case with stroke affecting only lower half of face |
|
|
Term
| What nerve dysfunction can cause vertigo? And where does it travel? |
|
Definition
| CN VIII Vestibulochoclear, runs through internal acoustic meatus (petrous portion of temporal bone) |
|
|
Term
| Where does the CN XII hypoglossal nerve travel and what dysfunction does nerve entrapment cause? |
|
Definition
exits skull at hypoglossal canals in occipital condyles, lesion causes tongue to debiate to side of lesion/newborn suckling dysfunction
Case of newborn male w/difficult delivery and excessive spitting up |
|
|
Term
|
Definition
| Mechanical compression of 4th ventricle of the brain- as you bring occiput into extension the lateral angles approximate slightly putting tension on the tentorium, cerebellum is rolled downward on roof of pons and medulla while the brachium pontis lefts the pons and medulla up, compressing the 4th ventricle |
|
|
Term
|
Definition
way to affect flow of CSF, the ANS, and structures at floor of 4th ventricle
can alter sleep latency and directly measured muscle sympathetic nerve activity |
|
|
Term
| What are the contraindications for Cv4? |
|
Definition
| acute cerebral hemorrhage, acute head injuries, known or suspected cranial bone fractures, active seizure, increased intracranial pressure |
|
|
Term
| What is the order of articulation for the parietal bone? |
|
Definition
Frontal, parietal, sphenoid, temporal
Parietal is internal to sphenoid and temporal, frontal is internal to sphenoid and parietal (treat frontal before parietals) |
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