The Cranium and Its Sutures: Anatomy, Physiology, Clinical Applications and Annotated Bibliography of Research in the Cranial Field

116 Pages·1987·2.12 MB·English

by  Ernest W. Retzlaff (auth.)

The Cranium
and Its Sutures
Anatomy, Physiology, Clinical Applications
and Annotated Bibliography of Research
in the Cranial Field
Edited by
Ernest W. Retzlaff and Frederic L. Mitchell, Jr.
With a Foreword by Philip E. Greenman
With 30 Figures
Springer-Verlag Berlin Heidelberg New York
London Paris Tokyo
Ernest W. Retzlaff, Ph. D., M. P. H.
Professor of Biomechanics
College of Osteopathic Medicine
Michigan State University
East Lansing, Michigan 48824, USA
Frederic L. Mitchell Jr., D.O., F. A. A. O.
Professor of Family Medicine
College of Osteopathic Medicine
Michigan State University
East Lansing, Michigan 48824, USA
Library of Congress Cataloging in Publication Data
The Cranium and its sutures. Includes index. 1. Craniosacral therapy. 2. Skull. I. Retzlaff,
Ernest W., 1918- . II. Mitchell, Frederic L., 1929- . RZ399.C73C73
1987 617'.514 87-4739
ISBN-13: 978-3-540-17467-7 e-ISBN-13: 978-3-642-71848-9
001: 10.1007/978-3-642-71848-9
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© Springer-Verlag Berlin Heidelberg 1987
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2119/3145-543210
Dedication
This book is dedicated to Patricia Retzlaff, without whom this work
could not have been completed; to the Retzlaff children, Cathryn and
PeterJor their loyal support; and to Carol Mitchel/for her thoughtful
encouragement.
Foreword
The history of medicine is dotted with the episodic appearance of
new discoveries, scientific breakthroughs, and the development of
new schools of medicine, and each has contributed to the evolution
of the art and science of the practice of medicine. The founding of
osteopathic medicine by Andrew Taylor Still was one such event.
The development of the craniosacral concept by William G.Suther
land was another. Both of these giants of osteopathic medicine en
countered the reluctance of their colleagues to accept his contribu
tion. Both were able to overcome this reluctance and saw the
acceptance of his contribution because of the fundamental anatom
ical and physiological truth supporting the concept, and the prag
matic fact that their therapeutic applications were successful. Both
men attracted to them individuals desirous of learning a new diag
nostic and therapeutic procedure. It is fortunate that these individu
als have continued to promulgate the contribution to osteopathic
medicine of their mentors.
The craniosacral concept has slowly and steadily gained recogni
tion and acceptance by an increasing number of osteopathic physi
cians. Many advocates of the field have pursued the diffusion of the
knowledge with a religious fervor. Many skeptics of the field have
refused to acknowledge the possibility of the concept and the clini
cal successes of those skilled in its application. As with most new
contributions to the practice of medicine, the craniosacral concept
started with a clinically observable phenomenon and the clinical
success of its application to patients' problems. With the passage of
time, new therapies are subjected to study and research for better
documentation and understanding. Basic and clinical research of
the craniosacral concept was necessary to support the claims of its
advocates and to answer the questions of its critics.
In 1972 the Department of Biomechanics was formed within the
College of Osteopathic Medicine at Michigan State University. Its
basic mission was to pursue basic and clinical research into the role
of the musculoskeletal system in health and disease. Because of the
perceived need for additional research into the craniosacral con
cept, faculty time and other resources were committed to pursue re
search in the area. This book contains reports of many of the re
search activities that have been pursued through this initiative.
VIII Foreword
While much of the work is impressive inits own right, it clearly dem
onstrates the need to further pursue both basic and clinical research
in the field. Results to date are but a foundation for further progress.
Clearly, we have a better understanding of the anatomy of sutures of
the skull and of the physiology of the craniosacral rhythm. We know
more about the incidence of altered cranial function in certain pat
ient conditions. To date no clinical efficacy trials have been per
formed. Much work still needs to be done.
Appreciation must be extended to those who have supported the
work reported here, particularly the Cranial Academy and the De
partment of Biomechanics at Michigan State University, and all oth
ers who have contributed to the effort. Many have contributed time
and effort to the work presented in this volume and particular recog
nition is given to Dr. Retzlaff as editor for the effort made in compil
ing the material. This book is recommended to both advocates and
skeptics of the craniosacral concept as not only interesting reading
of the current state of the research knowledge in the field, but also as
a springboard for the pursuit of further understanding and valida
tion of the concept.
Philip E.Greenman, D.O., F.A.A.O.
Associate Dean
Michigan State University
College of Osteopathic Medicine
Table of Contents
Embryological Development of the Cranium
Ernest W Retzlaff . . . . . . . . . . . . . . . 1
Anatomy and Physiology of Craniosacral Mechanisms
Ernest W Retzlaff . . . . . . . . . . . . . . . . . 5
Clinical Significance of Cranial Suture Mobility
Frederic L. Mitchell, Jr. . . . . . . . . . . . . . . . . . . .. 13
Learning Difficulties of Children Viewed in the Light
of the Osteopathic Concept
Viola M. Frymann . . . . . . . . . . . . . . . . . . . . . . . .. 27
TMJ Syndrome: An Integrative Approach
Christopher J. Hussar and John D. Curtis .. ... 48
History of Cranial Osteopathy - A Personal Perspective
Paul E. Kimberly . . . . . . . . . . . . . . . . . . . . . . . . .. 59
Annotated Bibliography of Research in the Cranial Field
Ernest W Retzlaff . . . . . . . . . . . . . . . . . . . . . . . .. 68
The Future of Cranial Related Research
Frederic L. Mitchell, Jr. and MichaelA. Seffinger . . . . . . . .. 90
Illustrations
Ernest W Retzlaff . . . . . . . . . . . . . . . . . . . . . . . .. 95
List of Contributors
Curtis, John D., D.D.S.
Private Practice, Specialist in T. M.J. Problems
Charlotte, Michigan 48813, USA
Frymann, Viola M., D.O., F.A.A. O.
Director
Osteopathic Center for Children
8030 Gerard Avenue, La Jolla, California 92037, USA
Greenman, Philip E., D.O., F.A.A. O.
Associate Dean
College of Osteopathic Medicine, Michigan State University
East Lansing, Michigan 48824, USA
Hussar, Christopher J., D. D. S., D. O.
Department of Biomechanics
College of Osteopathic Medicine, Michigan State University
East Lansing, Michigan 48824, USA
Kimberly, Paul E., D.O., F.A.A. 0., D. Ost. Med. Ed. (Hon.)
Clinical Professor of Biomechanics
College of Osteopathic Medicine, Michigan State University
East Lansing, Michigan 48824, USA
(Present address: 10901 Johnson Boulevard, AptJ-609, Seminole,
Florida 33542, USA)
Mitchell, Frederic L., Jr. D.O., F.A.A. O.
Professor of Family Medicine
College of Osteopathic Medicine, Michigan State University
East Lansing, Michigan 48824, USA
w.,
Retzlaff, Ernest Ph.D., M.P.H.
Professor of Biomechanics
College of Osteopathic Medicine, Michigan State University
East Lansing, Michigan 48824, USA
Seffinger, MichaelA., B.A., Student
Graduate Assistant
College of Osteopathic Medicine, Department of Biomechanics,
Michigan State University
East Lansing, Michigan 48824, USA
Acknowledgement
The authors of this publication wish to express sincere appreciation
to Philip E. Greenman, D.O., F. A. A. O. who suggested this study
and who has also given the project his support since its inception in
1972.
Special thanks is extended to Thomas P. Biggert and Jane Walsh
for their excellent histological work for this study. The electron mi
crographs were prepared by Robert Keno. In addition, recognition
is extended to the numerous Michigan State University and College
of Osteopathic Medicine students who contributed to the work on
this project. Many of their names are included in the section on the
bibliography as co-authors of the various publications.
Appreciation is extended to Jon Anthony and Jon Vredevoogd of
the Genesis Foundation for the use of the Apple lIe computer
which was used in the preparation of part of the manuscript. My
wife, Patricia J. Retzlaff, contributed her services in the final prepa
ration of the manuscript. Without her aid the book would not have
been possible. In addition, Sharon Husch and Thomas Biggert, each
in their own way, assisted in the manuscript preparation. Michael
Seffinger's editorial assistance was invaluable in preparing the final
manuscript.
The cooperation and encouragement of Robert Soutas-Little,
Ph. D., Chairman of the Department of Biomechanics is deeply ap
preciated.
The authors are grateful for the funds from the American Osteo
pathic Association, the Sutherland Teaching Foundation, and
Michigan State University College of Osteopathic General Re
search Support 11-4015. The Cranial Academy has given generous
financial support for the past several years which has made it possi
ble for us to continue this study.
The authors are most appreciative of the reprints of published
cranial studies which were sent in response to a request published in
the Cranial News Letter. Even though we attempted to include all
pertinent publications, please forgive us if there are omissions.
Finally, the editors would like to thank Stephen E. Blood, D.O.,
F.A.A.O., Chairman of the Research Committee and the members
of the Cranial Academy for their patience and encouragement while
this was underway.
Embryological Development of the Cranium
Ernest W. Retzlaff
The cranial bones are developed in the mesenchymal tissue surrounding the head
end of the notochord. This developmental process consists of a condensation and
thickening of the mesenchyme into masses which are the first distinguishable crani
al elements. This condensation process begins by the end of the first month. A por
tion of the forming cranial bones are preformed in cartilage while the others form
directly from membranous tissue. Most of the cranial vault and a portion of the
base of the skull arise as membranous bone.
For purposes of discussion, it is useful to describe the two types of origins sepa
rately, but it should be appreciated that they occur simultaneously and that they
complement each other in the formation of the completed cranium.
It is helpful in understanding the development of the primate skull to recognize
that it consists of neural and visceral (branchial) components. The neural portion
consists of the brain case and the capsular enclosure of the special sense organs.
The visceral portion is derived from the embryonic counterparts of the branchial
arches, which, in fishes and tailed amphibia, support the oral and pharyngeal re
gions. These visceral components function in respiration and mastication. The for
mation of the primate palate is an interesting innovation which permits the infant to
suck and the adult to chew while respiration continues.
The earliest evidence of skull formation occurs during the 5th and 6th weeks
when a mass of mesenchyme located at the cephalic end of the notochord forms the
early cartilaginous base of the neurocranium. This base consists of the precursors of
the occipital bone surrounding the foramen magnum, the sphenoid base beneath
the hypophyseal region, and the ethmoid base which is located under the telence
phalon and extends to the nasal area. The cartilaginous occipital area displays
several ossification centers. In addition, there are intramembranous areas which
provide part of the occipital bone. The sphenoid bone also arises both as cartilagi
nous bone and membranous bone. Ossification of the sphenoid begins as early as
the 19th week, but the various parts of this complex bone are not fully ossified or
fused even at birth. The ethmoid bone develops as several parts, begins to ossify by
the 11th week, and is completed by the time of birth. It is of particular interest that
the ethmoid cartilages do not become fused until the olfactory nerve fibers develop
and pass between them. The adult structure for this nerve passage is the perforated
cribriform plate.
The temporal bones are formed mainly from the region of the capsule of the in
ner ear which is a part of the primitive chondrocranium. Also, there is a portion
formed as membranous bone. The styloid process arises from part of the second gill
arch systems. This process has two ossification centers. One center is evident before