Sutherland's Legacy in The New Millennium
Sutherland's Legacy in The New Millennium
Sutherland's Legacy in The New Millennium
REVIEW ARTICLE
ABSTRACT
The concept of cranial osteopathy was introduced by
W. G. Sutherland, DO, and became the foundation for
setting the rules for use of skull palpation and many other
techniques in the many types of dysfunctional patterns
that craniosacral therapy treats. Sutherlands theories
enabled modern osteopathy to develop and improve. The
mechanism of primary respiration as well as the motion of
neurocranial and viscerocranial sutures are phenomena
intrinsic to the field and can be found in every living
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Figure 1. The external surface of the skull base. The sphenobasilar synchondrosis (ie, the joint between the base of the occiput
and the body of the sphenoid bone) is the pivotal location in the body that sustains the cranial model that was developed by
Dr W. G. Sutherland, the father of osteopathy in the cranial field.1
1 Incisor forum
2 Maxillary bone
3 Zygomatic process of the maxilla
4 Greater forum palatine
5 Lower orbital fissure
6 Zygomatic bone
7 Temporozygomatic suture
8 Pterygoid process
9 Great wing of the sphenoid
10 Suture sphenosquamosal
11 Oval forum
12 Spinous forum
13 Lacerated forum
14 Pyramid of the temporal
15 External acoustic meatus
16 Carotid canal
17 Jugular forum
18 Foramen magnum
19 Mastoid notch
20 Inferior nuchal line
21 Nuchal plane
22 Superior nuchal line
23 External occipital crest
24 Inion
25 Lambdoid suture
26 Mastoid forum
27 Occipitomastoid suture
28 Mastoid process
29 Occipital condyle
30 Stylus mastoid forum
Reproduced with permission from Anastasi G, Balboni G, Motta P. Trattato di Anatomia Umana. 4th ed. Milan, Italy: Edi.Ermes; 2014.
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Figure 2. Skull of a newborn in the lateral view. The cranial sutures carry out a fundamental role in the cerebral growth of a
child, adapting themselves to the volume increase of the central nervous system.12 The picture shows a skull of a child and its
sutures in the developing.
1 Anterior fontanel
2 Sphenoid fontanel
3 Cartilage of the septum
4 Mental forum
5 Sheath of styloid process
6 Stylus mastoid forum
7 Mastoid forum
8 Mastoid suture
9 Mastoid fontanel
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18
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Figure 3. Representation of the venous sinuses of the dura mater in a sagittal section of the skull. The venous system of the skull
is an important subject from the point of view of the osteopath, according to the teachings of Sutherland.1 The innermost layer
can easily absorb mechanical energy, both from the outside (eg, through trauma) and the inside (eg, through liquid pressures).22
1 Veins of the dura mater
2 Superior sagittal sinus
3 Left middle cerebral vein
4 Left sinus sphenoparietal
5 Intercavernous sinus
6 Left inferior petrosal sinus
7 Left superior petrosal sinus
8 Left sigmoid sinus
9 Occipital sinus
10 Confluence of sinuses
11 Left transverse sinus
12 Straight sinus
13 Great cerebral vein (of Galen)
14 Inferior sagittal sinus
15 Superior sagittal sinus
16 Falx cerebri
Reproduced with permission from Anastasi G, Balboni G, Motta P. Trattato di Anatomia Umana. 4th ed. Milan, Italy: Edi.Ermes; 2014.
Figure 4. Front section of the skull. The image shows the continuity of the tissues that form the various layers of the skull,
from the outside inward and vice versa. As periosteal tissues expand in response to the developing brain, the bones of the
cranium move apart, straining the sutures and simultaneously creating space for and signaling for the growth of new bone.23
The bone also transitions from the single layered structure observed in early childhood to the trilayer bone present in adults,
which is composed of a cortical table on both the ecto- and endocranial surface, separated by a porous trabecular layer.23
1 Frontal and parietal branches of the
superficial temporal artery
2 Frontal and parietal branches of the
superficial temporal vein
3 Fascia galea
4 Vault the skull
5 Dura mater (2 layers)
6 Telencephalic cortex
7 Arachnoid
8 Space subaracnoidal
9 Pia mater
10 Cerebral artery
11 Superior cerebral vein
12 White matter
13 Falx cerebri
14 Inferior sagittal sinus
15 Epidural space
16 Aracnoidal granulation
17 Superior sagittal sinus
18 Skin
19 Pericranium
20 Emissary vein
Reproduced with permission from Anastasi G, Balboni G, Motta P. Trattato di Anatomia Umana. 4th ed. Milan, Italy: Edi.Ermes; 2014.
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The authors would like to thank their families, who are always by their sides, and are
always provide them strength. They also want to thank their friend Fabiola Marelli, DO,
and director of the School CRESO. Finally, they want to thank their friend Fabio
Castellini, DO.
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