Head and Neck Part-I Anatomy, University of Tripoli (2024-2025) PDF

Head and Neck Part I: Bone , muscles and fossae. Anatomy Department / University Of Tripoli. d la Mi ed...

Head and Neck Part I: Bone , muscles and fossae. Anatomy Department / University Of Tripoli. d la Mi ed al Kh. Dr By Dr Ahmed Mohammed Sulaiman Professor Of Anatomy and Embryology. M.B.B.CH , Msc , DHE , FRCS.A, PhD. Dr. Khalid Milad Mohamed PhD, anatomy and embryology , M.B.B.CH, MRCS,PHD (2024-2025)  Contents of The Head: 1- Bones (skull, hyoid , vertebrae ) 2- muscle of head and neck 3- scalp, face ,parotid region 4- cavities (ear, nose , orbit , oral, larynx, pharyngeal and cranial cavity) Boundaries of the face: above:- hair line or eyebrow. d below: base of mandible & chin Sides :- the auricles on each side la Boundaries of the scalp: Mi anterior: supra-orbital margin (skin of eyebrow). posterior: superior (or highest ) nuchal line and external occipital protuberance. sides (lateral):- superior temporal line ed Boundaries of the neck: above:- base (lower border) of mandible, mastoid process & superior nuchal line. al below:-suprasternal natch, clavicle & acromion→ anteriorly line extends from acromion to C7 → Posteriorly. NB: upper limit of the neck anteriorly is the myelohyoid muscle. Kh. Dr Dr. Ahmad Mohammad Sulaiman. 2 Dr. Khalid Milad Mohammad. Why students feel that anatomy of Head and Neck is more dif cult than other regions?. - Head and neck are anatomically Small but complex area of the body, it contains long list of important structures compressed into a small area of the body. - Quite large number of these structures are important clinically Reid's base line:- d imaginary line from lower margin of orbit la pass through upper margin of the external acoustie meatus (anatomical position). Mi It is used as a base line in CT scan image * General topography of the H&N:- ed Hard palate:- at the level of C1. al Mandible:- at level of С2, Сз. Hyoid bone :- at level of C3 above the larynx. Kh Pharynx and larynx :- ends at C6. Esophagus and Trachea: - starts at C6 CCA :- ends at C3-C4. Dr Dr. Ahmad Mohammad Sulaiman. 3 Dr. Khalid Milad Mohammad. fi  Bones of the head and Neck ( Skull, mandible, hyoid ,and cervical vertebrae ) I. Skull : Protects the brain, and meninges and divided into: 1. Basi-cranium (Brain box)(Brain case): which include :(8 bones) Paired bone: parietal and temporal bones. Single bone: frontal, occipital, ethmoidal and sphenoid bones. Calvaria (skull cap) composed of 6 bones (2parietal, 2 temporal, frontal and occipital). Basicranium = calvarium + sphenoid and ethmoid bone d 2. Viscero-cranium (Facial Skeleton): which include:( 14 bones) la Paired: Maxillae, Zygomatic, Nasal , Lacrimal, Palatine and Inferior conchae. Single: Vomer and Mandible. Mi Examination of the External Features of the skull : 1. Norma Frontalis or anterior view. 2. Norma Verticalis or superior view. ed 3. Norma Occipitalis or posterior view. 4. Norma Lateralis or lateral view. 5. Norma Basilis or inferior view. (anterior , intermediate and lateral parts). al 6. Interior of skull (cranial cavity). Kh. Dr Dr. Ahmad Mohammad Sulaiman. 4 Dr. Khalid Milad Mohammad.  Normal Verticalis or superior view: 1. Sagittal suture between the two parietal bones. 2. Coronal suture between frontal bone in front and the parietal bones behind. 3. Lambdoid suture between the parietal bones anterior and occipital bone posterior. 4. Vertex : Is the highest point of the skull on sagittal suture. 5. Bregma: meeting of coronal and sagittal sutures. (site of anterior fontanelle in fetal skull) d 6. Lambda :meeting of sagittal and lambdoid sutures (site of posterior fontanelle in fetal skull) la 7. The emissary foramen : seen on each site of midline. 8. Superior and inferior temporal lines. Mi ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 5 Dr. Khalid Milad Mohammad.  Norma occipitalis : 1. The lambdoid suture 2. Asterion: Meeting point of lambdoid, parietomastoid and occipitomastoid sutures. 3. External occipital protuberance: Palpable at the back of the neck, it gives attachment to trapezius, and its most prominent point is called inion. 4. The superior nuchal line, Inferior nuchal line, and highest nuchal line. 5. The external occipital crest. d 6. Mastoid emissary foramen la Mi ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 6 Dr. Khalid Milad Mohammad.  Norma Frontalis : 1. Orbital openings. 2. Nasal opening. 3. The superciliary arch. curved elevation in frontal bone , just above medial part of the upper margin of the orbit. 4. The glabella: Medial elevation connecting the right and left superciliary arches. 5. The nasion : meeting point of the frontonasal and internasal sutures at the root of the nose 6. The maxilla. d 7. The zygomatic bone. la 8. The infraorbital and zygomaticofacial foramen NB: occasionally the two haves of frontal bone fail to fuse, leading to formation of Mi metopic suture, which fuses at about 6 years. ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 7 Dr. Khalid Milad Mohammad.  Norma Lateralis: 1. The temporal lines ( as in Norma Verticalis) 2. Temporal fossa. 3. Zygomatic arch. 4. External Acoustic Meatus. 5. Suprameatal triangle. 6. Mastoid process. d 7. Styloid process. 8. Stylomastoid foramen. la 9. Asterion; meeting of parietomastoid, occipitomastoid and lambdoid sutures, and it is the site of mastoid fontanelle in fetal skull. Mi 10. Pterion: H shaped junction where the frontal, parietal, greater wing of sphenoid and squamous part of temporal bones are in close proximity. The bone in this area is very thin, and it overlies the anterior branch of middle meningeal artery. Trauma to this area may lead to the development of extradural hematoma. ed It is the site of sphenoid fontanelle in the fetal skull. It corresponds to a line 2.5cm above the zygomatic arch and 2.5cm posterior to the lateral orbital margin. al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 8 Dr. Khalid Milad Mohammad.  Norma Basalis: 1. Anterior part 1. Hard palate. 2. Alveolar arch of maxilla 2. Intermediate part: [Midline area, and lateral area.] The midline area: 1. Vomer. 2. basilar part of occipital bone with pharyngeal tubercle. Lateral area: Sphenoid bone : Pterygoid process of sphenoid bone (P. Plates) Infratemporal surface d of greater wing of sphenoid ( infratemporal crest, spine of sphenoid, foramen spinosum, f. ovale, f.innominatum), sulcus tubae ( groove of sphenoid bone between the greater wing of Petrous part of la temporal bone, mandibular fossa. Inferior surface of petrous part of temporal bone: carotid canal, foramen lacerum 3. Posterior part of norma basalis: Mi Midline area : F. magnum,external occipital crest. Lateral part: Occipital bone: Condylar part of occipital bone, squamous part of occipital bone, Jugular foramen, occipital condyles ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 9 Dr. Khalid Milad Mohammad.  The interior of cranium: 1. Features of anterior cranial Fossa. 2. Features of middle cranial Fossa. 3. Features of Posterior cranial Fossa. Features Of anterior cranial fossa: Frontal crest, cribriform plate of the ethmoid bone, the crista galli, the foramen cecum, orbital surface of frontal bone, body of sphenoid bone, anterior clinoid process. d Features of middle cranial fossa: la located at lower level than anterior cranial fossa Sulcus chismaticus, optic canal, body of sphenoid bone, carotid sulcus, superior orbital ssure. rotundum, F. ovale, F. spinosum, F. lacerum, petrous part of temporal bone. Mi Features of posterior cranial fossa: Very large and deeper than other two, clavus, F. Magnum, internal occipital crest, hypoglossal canal, jugular tubercle, internal acoustic meatus. ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 10 Dr. Khalid Milad Mohammad. fi  Openings of skull : - Anterior cranial fossa contains: cripriform plate and foramen cecum. - Middle cranial fossa contains : foramen rotundum , oval and spinosum (inside greuter wing), optic canal (inside lesser wing) , superior orbital ssure (between lesser and greater wings)and foramen lacerum (between sphenoid and petrous part of tempora). d - Posterior cranial fossa contains : foramen magnum and hypoglassal la canal (inside occipital bone), internal acoustic meatus (inside petraus part of temporal), and Jugular foramen (between petrous part of temparal and condylar part of Mi occipital. - other foramina as : greater and lesser palatine (inside palatine bone) ed Structure pass through: al 1. Foramen caecum:- emissary vein (but usually closed). 2. cripriform plate:- olfactory nerves Kh NB: small foramen lateral to cripriform plate, through which anterior ethmoidal nerve & vessels Pass from orbit into cranial cavity, then down into nasal cavity. 3. optie canal :- optic nerve, ophthalmic artery.. 4. superior orbital ssure:- Lacrimal, Frontal & Nasociliary nerves (LEN) 5 occulomotor , Dr trochlear and abducent (3,4, 6 cranial N.) Superior and inferior vein 5. Foramen rotundum:- maxillary division of trigeminal nerve (5th CN). 6. Foramen ovale :- Mandibular division of midalle miningeal wein, accessory meningeal artery & lesser super cial petrosal nerve. 7. Foramen spinosum:- middle meningeal artery & nervous spinosus (meningeal branch of mandibular nerve). 8. Internal acoustic meatus :-facial nerve (7th CN), vestibulocochlear nerve (8th CN) and internal auditory vessels. 9. Jugular foramen:- Glessopharyngeal (9th), vagus (10th) and acessory nerve (11th ), internal Jugular vein and inferior petrosal sinus. Dr. Ahmad Mohammad Sulaiman. 11 Dr. Khalid Milad Mohammad. fi fi fi  NB:- Foramen ovale → MALE :- Mandibular N., Acessory Meningeal A, Lesser petrosal N. And Emissary vein 10. Hypoglossal canal: - hypoglossal N. (CN XIl), emissary vein, meningeal branch of ascending pharyngeal artery. 11. Condylar canal: emissary vein from sigmoid sinus. 12. Stylomastoid Foramen:- Facial nerve and stylamastoid artery. 13. Greater palatine F:- greater palatine, Nerve and vessels. d 14. Lesser palatine F:- Lesser palatine nerve and vessels. la 15. Incisive foramen:- terminal branches of greater palatine and nasopalatine nerves. 16. supraorbital Foramen:- supraorbital nerve and vessels. Mi 17. Infraorbital F. And canal:- infraorbital nerve and vessels. 18. Mental Foramen:- mental nerve and vessels. 19. inferior orbital ssure:- connecting vein between inf, ophthalmic vein infraorbital vessels and pterygoid plexus, zugamatic br. of maxillary N. ed 20. pteggomazillary ssure:- maxillary artery , post. superior alveolar N. 21. Zygomatico-orbital :- zygomatisa-orbital N. and vessels. al 22. Zygomatico - facial F:- Z.facial N. & vessels. 23-24.mastoid & parietal foramina:- emissary veins. Kh 25- mandibular F. & canal: - inferior alveolar N. and vessels. 26 - Carotid canal:- ICA & sympathetic plexus around it. 27- pterygoid (vidian) canal:- N. & vessels to Pterygoid canal.. 29. External auditory meatus:- nothing. Dr 30- F. lacerum:- usually closed nerve and artery to pterygaid canal (vidian) emissary vein, ascending pharyngeal artery NB:- Foramen lacerum anteromedial to pterygoid canal 28- Foramen magnum:- 3 nerves: 3 - vessels: 3- others : spinal part of vertebral vessels meninges (dura, accessory N. (R&L) + Symp.plexus. arachnoid & Pia) medulla oblongata. spinal arteries membrana tectoria cerebellar tonsils. (ant. & posterior). ligament: vertebral plexus of Apical ligament. veins. Dr. Ahmad Mohammad Sulaiman. 12 Dr. Khalid Milad Mohammad. fi fi  d la Mi ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 13 Dr. Khalid Milad Mohammad.  Individual bones of skull 1. sphenoid bone: unpaired, composed of body, 2 wings : greater and Lesser 2 peterygoid plates ( large lateral and small Middle plate) sella turcica, and 2 clinoid (anterior & posterior) and sinus 2. Ethmoidal bone : composed of crista galli , perpendicular plate, superior & middle concha (inferior concha is a separate bone), orbital plates, and ethmoidal air sinuses (anterior, middle & posterior. It contains capriform plate. 3. Temporal bone: composed of squamous part, mastoid part, tympanic part, petrous part, zygomatic process, styloid process, mustaid process, and mandibular fossa. d Carotid canal inside petrous part of temporal bone. la 4. Frontal bone: composed of frontal eminence, frontal crest, supra orbital notches, supraorbital margin, superciliary arches , glabella & frontal ail sinus inside. also Zygomatic process Mi 5. Maxilla : composed of body, frontal process, zygamatic process, palatine process (hard palate), maxillary tuberosity, also canine & incisive fossa with canine eminence in between the two fossae, anterior nasal spine., alveolar process. ed 6. Zygomatic bone: composed of body, temporal process , temporal border, maxillary border, orbital border 7. Parietal bone: composed of parietal emenice, superior and inferior temporal lines, Vertex. al 8. Occipital bone:- composed of body, internal &external occipital protuberances, internal & external occipital crests, grooves for superior sagittal & transverse sinuses, superior & Kh inferior nuchal lines, 9. Palatine bone:- composed of perpendicular &e horizontal plate, posterior nasal spi. Dr Dr. Ahmad Mohammad Sulaiman. 14 Dr. Khalid Milad Mohammad.  Applied Related to Skull : 1.Importance of fontanelle: A). Allow the head to deform during its passage through the birth canal B). Help to determine the degree of hydration by palpation of the fontanels, for example if its depressed indicates that the baby is dehydrated, When plugged it indicates rise in ICP. C). Sample of CSF can be taken from anterior fontanels. D). Through anterior fontanelle, superior sagittal sinus can be entered for iv uids and ultrasound can be done 2. Trauma to Pterion area: d It corresponds to a line 2.5cm above the zygomatic arch and 2.5cm posterior to the lateral orbital margin. The bone is very thin, and it overlies the anterior branch of middle meningeal artery. Trauma to la this area may lead to serious consequences as extradural hematoma 3. Jugular Foramen Syndrome: Mi Injury to 9,10,11 cranial nerves as a result of neuro broma or extension of intracranial meningioma through the foramen or thrombosis of the superior part of internal jugular vein. 4. Fracture of the skull : ed A) Maxillofacial fracture : may result in extensive swelling of face, mobility of underlying bone on palpation, double vision, damage to infraorbital nerve lead to anesthesia of skin of cheek, nose bleeding may occur, crepitation and malocclusion of the teeth, Classi ed by Le forte as type I,II,III al B) Nasal fracture: Are the most common facial fractures, may be associated with injuries to nasal septum. Kh C) Fracture of anterior cranial fossa: lead to rhinorrhoea = leakage of CSF from nose due to damage to cribriform plate. D) Fracture of middle cranial fossa: Most common a cross petrous part of temporal bone, internal. acoustic meatus, foramen lacerum.Usually resulting to facial nerve palsy, damage to vestibulocholear nerve and damage to arachnoids around them, resulting in CS escape through the ear (otorrhea). Dr E) Fracture of posterior cranial fossa: blood may escape into neck deep to postvertebral muscles and moves down, and hematoma in posterior triangle close to mastoid process ( Battle sign) 5. Fracture base of the skull: manifested as rhinorrhoea, otorhoea, periorbital hematoma (racoon eye), mastoid hematoma (Battle sign) and scal nerve palsy. Applied Related to cervical vertebra and hyoid bone: 1. Palpable spinous processes of C7 provide important landmark during physical examination. 2. Death with the fractures of the hyoid bone suggests that strangulation is the cause of death. 3. Fracture of axis vertebra is more dangerous than fracture of Atlas. Dr. Ahmad Mohammad Sulaiman. 15 Dr. Khalid Milad Mohammad. fi fi fi fl  d la Mi ed al Kh. Dr Battle sign. Facial palsy Dr. Ahmad Mohammad Sulaiman. 16 Dr. Khalid Milad Mohammad.  II. MANDIBLE BONE: - Mandible is the skeleton of the jaw which is formed of body and two rami. 1 The body : - It is horse-shoe shaped which is convex forwards. - It has two surfaces and two borders:- Two Borders: upper border : carries the teeth & called alveolar margin Lower border: (Base) shows two depressions, one on either side of the middle. - Line extending upwards in the inner surface of the body called epigastric fossa. Two surfaces: Outer surfaces: had body ridges: symphysis menti, mental foramen, oblique line. d Inner surface: had two genial tubercle , Mylohyoid line & groove for the lingual nerve. la 2. The ramus: - It has, two borders:- Anterior & posterior. two surfaces: Outer & inner surfaces. Mi two ends:upper & lower ends. * Muscles attached to the mandible :- Muscles inserted into mandible: Muscles originated from mandible: ed 1- Buccinator: from the oblique line below 1. Masseter : into the outer surface of ramus. the 3 molar teeth. al 2- Temporalis: into coronaid process. 2-Mylohyoid: from the Mylohyoid line. 3- Lateral pterygoid: into pterygoid fovea in 3 - Genioglossus: from superior genial the neck of mandible. tubercle. Kh 4- Medial pterygoid: into inner surface of 4 -Geniohyoid : from inferior genial tubercle. ramus above the angle. 5 - Anterior belly of digastric: from digastric 5- platysma: into the base of mandible. fossa. 6- Superior constrictor muscle of the pharynx.. Dr Determine the age of the mandible:- Infant mandible: - The angle is obtuse 170°. - Mental foramen near lower border. Adult mandible: - The angle is markedly diminished. - Mental foramen midway between upper and lower borders. Old age mandible: - The angle is obtuse again - Mental F. is close to upper border Dr. Ahmad Mohammad Sulaiman. 17 Dr. Khalid Milad Mohammad.  d la Mi ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 18 Dr. Khalid Milad Mohammad.  III. Hyoid bone: U-shaped bone , an important landmark in the midline of the front of the neck, at the level of C3, consists of body and pair of greater and lesser horns, it does not articulate with other bones, it suspended. Attachment : 1. to styloid process by stylohyoid muscles. 2. to mandible by mylohyoid and geniohyoid muscles. 3. to tongue by hyoglossus muscles. 4. to pharynx by middle constrictors. 5. to thyroid cartilage by thyrohyoid muscles. d 6. to sternum by sternohyoid muscles. la 7. to scapula by omohyoid muscles. 8. Intermediate tendon of digastric muscle, is xed to greater horn by a brous pulley. Mi ed al Kh. Dr Dr. Ahmad Mohammad Sulaiman. 19 Dr. Khalid Milad Mohammad. fi fi  IV. Cervical vertebra: Typical cervical vertebra: are 7 , rst, second and 7th are atypical, 3-6 are typical. All have foramen transversarium in each transverse process, which transmits second part of vertebral artery in c1-6 ( not in 7th). C3-6: are typical cervical vertebra has body, bi d spine, foramen transversarium d la Mi ed Non typical cervical vertebra al 1.Atlas : Ring shaped, no body or spine, has large lateral masses joined anteriorly by a short anterior arch( gives attachment to anterior longitudinal Kh ligament ,) and posteriorly by a longer posterior arch( attachment to ligamenta ava), superior surface of posterior arch shows groove for third part o vertebral artery. Has Kidney shaped superior articular facet, which form atlanto-occipital. joint with occipital condyles. Dr Form three joints with C2 (RT , LTand median ) atlantoaxial joints. A transverse ligament of atlas divides the vertebral canal into a small anterior part contains dense of axis and posterior part contains spinal cord, spinal arteries ,and spinal part of accessory nerve. Transverse processes are long ( so atlas is the widest of c vertebra), can be felt midpoint between the mastoid process and angle of the mandible ( occipital ar., IJV, spinal accessory n are anterior. Dr. Ahmad Mohammad Sulaiman. 20 Dr. Khalid Milad Mohammad. fl fi fi  d 2.Axis : la Identi ed by presence of projection from body the dense ( body of atlas), apex of dense gives attachment to apical ligament and its sides Mi ed al Kh gives attachment to alar ligament. 3. C7: Has a prominent spine , which is not bi d, its foramen transversarium. contains only vertebral venous plexus (no V. artery). Dr NB: C6 its transverse process has a large anterior tubercle which can be felt and CCA can be palpated against it. Dr. Ahmad Mohammad Sulaiman. 21 Dr. Khalid Milad Mohammad. fi fi  muscles of head and neck region: d la Mi ed al Kh * Classi cation:-. 1.Muscle of scalp :accipito-frontalis (expression muscle) Dr 2. Ms of face:- A) Ms of expression;- - ear group……. (3) - Nasal group…. (4) - orbital group… (5) - oral group(12) B) Ms of mastication:- - masseter. - medial pterygoid. - lateral pterygoid. - temporalis Dr. Ahmad Mohammad Sulaiman. 22 Dr. Khalid Milad Mohammad. fi 3- Ms of Neck: A) suprahyoid ms:- - mylahyoid. - Digastric - stylohyoid. - geniohyoid B) infrahyoid ms:- - Thyrohyoid. - sterns thyroid. - sterno hyoid. - omohyoid. c) super cial ms:- -sternomastoidi d - Trapezius. - platysma (expression ms) la Mi D) deep muscles := -scalene muscles (deep lateral) (3) - suboccipital ms (deep posterio) (4) - prevertebral muscles (4) 4- other muscles:- Ms of orbit, palate, tongue, ear, Larynx and pharynx. ed Prevertebral ms of neck are: Suboccipital groop of ms are al 1. Longus coil 1. Rectus capitis posterior minor 2. Longus capitis 2. Rectus capitis posterior major Kh 3. Rectus capitis lateralis 3.obliqus capitis superior 4. Rectus capitis anterior 4. Obliqus capitis inferior. Dr Dr. Ahmad Mohammad Sulaiman. 23 Dr. Khalid Milad Mohammad. fi  TEMPEOMANDIBULAR JOINT(TMJ) * ARTICULATION :- Between: above: articular tubercle & mandibular fossa of temperal bone. below:- head (condylar process) of mandible - Articular Disc: - oval plate of brocartilage - divides the joint into upper & lower cavities with separate synovial Membrane - has upper surface concavo-convex (from before backward) and lower surface concave (to t the condyle) - attached to capsule of joint, and in front attached to lateral pterygoid & head d of mandible. la - posteriorly the disc is divided into turo lamina; upper broelastic attached to mandibular fossa. lower lamina nonelastic attach to neck of mandible Mi between the 2 lamina loose CT & BiV & sensending - Unlike most of other synovial joints the articular surface is covered by brocartilage (instead of hyaline). ed TYPE : - synovial condyloid Joint. (some consider it ellipsoid) (modi ed hing). -NB:- On opening the mouth the mandibular head rotates around al a horizontal axis in a hinge-like movement in lower compartment at the same time gliding movement occurs in upper compartment. Kh CAPSULE & S.M: - capsule attached to margins of articular surface and lined by synovial membrane. - Capsule attached medially & laterally to mandibular fossa.. LIGAMENTS :- Dr 1.lateral T.M ligament 2. spheno-mandibular lig. 3 stylo-mandibular lig. runs digonally runs medial to the joint,from from styloid process to backwards. from the spine of sphenoid bone to angle of mandible, lies margin of the articular tubercle to the lingual of mandibular posterior and medial to the neck of the faramen. (it represent a TMJ. (it is athickening of mandible. (it is Reminant of 1st pharyngeal deep fascia). thickened capsule) arch ). Dr. Ahmad Mohammad Sulaiman. 24 Dr. Khalid Milad Mohammad. fi fi fi fi fi NerVE SUPPLY:- - supplied by branches of mandibular N. (masseteric & auriculotemporal.) MOVEMENT OF TMS :- protraction:- mainly by lateral pterygoid assisted by medial pteryyaid & masseter. Retraction (retrucstion. translation):-normal position is restored by passive recoil of the stretched joint structures, aided by posterior bers Elevation (closing): is powerful &s generated by Temporalis, masseter and medial pterygoid. Depression: --hinge like movement in lower compartment done by gravity, digastric, Mylohyoid, geniohyoid , supra and infra hyoid muscles d - gliding movement in upper compartment by Lateral pterygaid. la - side to side movement: by medial and lateral pterygaids. APPLIED:= Dislocation of TMJ occurs only forward, when the head of mandible slides past articular Mi tubercle into the infratemporal fossa, resulting in mandible locked in a protruded position. Relations of TMJ; ed Anterior:- posterior:- lateral :- Medial:- mandibular notch tympanic plate of -parotid gland, skin maxillary vessels, al masseteric nerve. temparal bone and and fascia. auriculotemporal and vessels. glenoid part of nerve. parotid gland. Kh NB:- chewing &gliding movement of TMJ is done by temporalis of same side, pterygoid of opposite side, and masseter.. Dr Dr. Ahmad Mohammad Sulaiman. 25 Dr. Khalid Milad Mohammad. fi  Fossae of head and neck 1. Temporal fossa: A Space below the inferior temporal line and above the zygomatic arch and infratemporal crest of greater wing of sphenoid bone. Temporal and infratemporal fossa Their boundaries are formed by bone and soft tissues. The temporal fossa superior to the infratemporal fossa, they communicate with each other through the gap between the zygomatic arch and the more medial surface of the skull. d Boundaries: la Superior: Inferior temporal line Inferior: infratemporal crest of greater wing of sphenoid. medial wall( oor): part of the skull include pterion. Mi Anterior wall : zygomatic process of the frontal bone, zygomatic bone, and the maxilla. Lateral wall (roof): Temporalis fascia, which attached to superior temporal line aboveand zygomatic arch below. ed Contents:(2N A. And M) 1.Temporalis. 2. Zygomaticotemporal n. branches of the maxillary nerve. 3.Deep temporal nerves. al 4.Deep temporal arteries. 5.Middle temporal artery Kh. Dr Dr. Ahmad Mohammad Sulaiman. 26 Dr. Khalid Milad Mohammad. fl  Infratemporal fossa: The infratemporal fossa is a wedge-shaped space below the infratemporal crest, beneath the base of the skull, deep to the masseter muscle and the ramus of the mandible, between it and pharynx ( lateral pharyngeal space). Boundaries: Lateral wall: Ramus of the mandible, and its coronoid process Medial W: Lateral surface of lateral pterygoid plate, pterygomaxillay ssure, tensor palati and superior constrictor muscles of pharynx. Anterior wall : Posterior surface of maxilla, inferior orbital ssure. d Posterior wall : Styloid process, with carotid sheath behind it, mastoid process, tympanic plate la Superiorly (roof): Inferior surface of the greater wing of sphenoid, with foramen oval and spinosum Inferiorly wall: Attachment of medial pterygoid muscle to the mandible near its angle. Contents of infratemporal fossa: Mi 1. Deep part of parotid gland. 2. Medial and lateral pterygoid muscles. 3. Insertion of temporalis to coronoid process. 4. Maxillary artery and its branches. ed 5. The pterygoid venous plexus 6. the Mandibular nerve 7. Inferior alveolar nerve. al 8. lingual nerve 9. Buccal nerve. Kh 10. The otic ganglion. 11. The chorda tympani. 12. Posterior superior alveolar nerve.. Dr Dr. Ahmad Mohammad Sulaiman. 27 Dr. Khalid Milad Mohammad.      fi fi  Pterygopalatine fossa: Small pyramidal space behind and below the apex of orbital cavity. Function as cross road for neurovascular structures travelling between the middle cranial fossa, orbit, nasal and oral cavities Boundaries: Superior: Sphenoid bone. Anterior: Posterior surface of maxilla. Posterior :Pterygoid process of sphenoid bone. Medial : Perpendicular plate of palatine bone. Lateral : communicates with the infratemporal fossa through pterygomaxillary ssure. d Inferior: None, opens into retropharyngeal space. la Communications: 1.With the middle cranial fossa ,superiorly through the foramen rotundum, transmits maxillary nerve. Mi 2.With the orbit anteriorly through the inferior orbital ssure, transmits, infraorbital N. , zygomatic N., orbital branch maxillary n.. 3.Laterally with infratemporal fossa through pterygomaxillary ssure , transmit ed maxillary artery. 4. Medially into lateral wall of nasal cavity, through Sphenopalatine foramen, al transmits terminal branches of nasopalatine nerve. 5. Inferior free communication, into retropharyngeal space. Kh 6.With palate through palatine canal (grater and lesser palatine foramen). 7.With base of skull through pterygoid canal transmits nerve of pterygoid canal... Contents: Dr 1.Branches of 3rd part of maxillary a. 2.Maxillary nerve, and its branches. 3.Pterygopalatine ganglion. Dr. Ahmad Mohammad Sulaiman. 28 Dr. Khalid Milad Mohammad. fi fi fi