(3) Temporal and infratemporal region.pdf

Head and Neck Temporal and Infratemporal regions Muscles of mastication Mandibular nerve , Maxillary Nerve , Maxillary artery , Pterygo-palatine Ganglion and temporomandibular region Dr. Mohamed El Fiky Professor of Anatomy and embryology Temporal and Infratemporal regions iggg e fiIiitimaz_g MUSCLE...

Head and Neck Temporal and Infratemporal regions Muscles of mastication Mandibular nerve , Maxillary Nerve , Maxillary artery , Pterygo-palatine Ganglion and temporomandibular region Dr. Mohamed El Fiky Professor of Anatomy and embryology Temporal and Infratemporal regions iggg e fiIiitimaz_g MUSCLES OF MASTICATION g MUSCLES OF MUSTICATION : 4 MUSCLES 1- TEMPORALIS 2- MASSTERTER LATERAL PTERYGOID 4- MEDIAL PTERYGLOID  ALL muscles of mastication insreted into the mandibule care  All muscles of mustication arise from 1st branchial arch er cted  All muscles of mustication take nerve supply from mabdibular nerve e  All muscles of matication protrude the mandibule except temporalis retaract the mandibule  All muscles of mastication elviate the mandibule except lateral pterygoid depress the mandibule. 0 Temporalis Muscle Temporal Fascia Temporal Fascia Superficial Layer Deep Layer MOHAMED EL FIKY 1- Temporalis Origin : 1- inf. Temporal line 2-Bone of temporal fossa 3- temporal fascia Inserted into: attacidcoverying The Tip, The Anterior Border And Medial Surface of Coronoid Process Temporalis Muscle Nerve Supply of Temporalis Muscle e Deep Temporal Nerves Deep Temporal Nerves Action : 1- elevation of the mandible 2- Retraction of the mandible I MOHAMED EL FIKY Relations of Temporalis Muscle 1- Superficial Relations : 5- Superficial temporal vessels 6- Auriculo-temporal Nerve 7- Zygomatic arch 8- Masseter muscle MOHAMED EL FIKY 2- Deep Relations Maxillary artery and Pterygoid plexus of veins Buccal nerve and artery Deep temporal vessels and nerve Temporal fossa Temporalis Lateral Pterygoid muscle Medial Pterygoid muscle Buccinator MOHAMED EL FIKY 2- Deep Relations Temporalis Lateral Pterygoid Buccinator MOHAMED EL FIKY 2- Masseter Origin, Insertion, Action and Nerve Supply Origin : Lower border and inner surface of zygomatic arch Insertion : Lateral surface of ramus of mandible Action : Elevation of the mandible Protraction of the mandible Zygomatico-temporal Suture Deep Head Superficial Head Protraction MasseterInsertion of Deep Head Insertion of Superficial Head MOHAMED EL FIKY Nerve to Masseter 3- Lateral Pterygoid I insertedinbonecapsuleof thejointcartilage J Origin : by 2 heads Upper head from infratemporal crest of greater wing of the sphenoid * Lower head : from lateral surface sided of lateral ptregoid plate Insertion : expressionI Fovea in front head of the mandible ( ptregoid fovea ) Action : Protraction Protraction of the mandible Depression of the mandible Side to side movement Nerve supply : Anterior division of the mandibular nerve Lateral Pterygoid MOHAMED EL FIK Sphenomandibular ligament MOHAMED EL FIKY 4- Medial Pterygoid Origin : by 2 heads 1- superficial head : from maxillary tuberosity.abovelastmolar 2- deep head from : medial surface of lateral ptregoid plate. Insertion : see Medial surface of remus of the mandible Nerve supply : trunk of the mandibular nerve Action : Prtruction of the mandible Elevation of the mandible Side to side movement Nerve to Medial Pterygoid sidetoside movementofmandible lateralpterygoid medialpterygoid Protraction Deep Head Superficial Head MOHAMED EL FIKY Trigeminal Nerve The fifth cranial verve or the trigeminal nerve, emerges from the side of the pons and has a large sensory root and a small motor root. The roots cross the apex of the petrous temporal bone beneath the superior petrosal sinus, to enter the middle cranial fossa. Chief sensory nerve for the face and head has sensations of pain, e temperature and touch. gophthalmic maxillary Motor action on muscles of mastication. dibular Branches of the Trigeminal Nerve tens Three main branches The ophthalmic branch – sensory – lacrimal glands, conjunctiva, forehead, eyelids, anterior aspect of scalp and the mucous membrane of the nose The maxillary branch – sensory – cheeks, upper gums, upper teeth e aned lower eyelids The mandibular branch sensory and motor – teeth and gums of the lower jaw, pinnas lower lip and tongue – muscles of mastication see e ak e sensory motor Mandibular branch midbrain i Pons maxillary facialnerve 4 f I tests.be muscle ion fine nervetomedialpterygoid e gloid t.it temporates IN ÉÉ ffff ftp.sorpalati tensortympanimuscle a buccalnerve t.IT fd Lf mylohyoid anteriorbelly ofdigastric mentalforamen trigeminalnervearisfromponsform sensory root motorroot tcharity a trigeminal ganglion Thesensoryrootfordilatationcalled itwillgive 3branch ophthalmic maxillary mandibular themotorroot descent inmandibulardivisionsothemandibular ismixednerve JRTRN ttfd temporal dibdarnervefitwi.tldescentintoforamenoval thenervenowpresent ininfra fossa deeptolateralpterygoid thenthenervedividedinto 2division anteriorposterior themandibular nervetrunkgivemotorbranch tosupply medialpterygoid muscle I1h willgive2branchtoGet thereis anothernerve enterthecranialcavityaga thenameofthebranch iscallednervetomedialpterygoid of aidthis2branchpassingthrowoticganglion uscles fromtrunkand throw theforamenspinosumthenerveiscalled nervusspinosus sensory division fromanterior Theanteriordivion give 3motordivision to 3 muscle lateralpterygoid temporales massete ote buccalbranch and anothersensory branchcalled buccalnerve Theposteriordivisiongive auriculatemporalnerve arisby 2rootwitha sensorybranchtosupplytheorcaland antardtipland thepostganglionicfiberreachtheparotidglandforthe parasympathetictransport temple temporalnerve throwauriculo fromtheposteriorbranchreachthetonguecalled lingualnervethatsupply ofthetongue thelingual nerverelatedtothethirdmolar adherent sothisareaiscalleddangerousareaoflingualnervedangerousdue tooperation inthelastmolarthelingualnervemaycuting it willgiveanotherbranch inthemandible thereisforamen calledmandibularforamen andthere is canalinsid thebonecalled mandibularcanal andthiscanalopeninmentalforamen sobranchfromposteriordivision descentandenterthemandibularforamenandthenerve passinginsidethemandibularcanalandcomeoutan calledmental nerve thisbranchcalled inferioralveolar themotorfiberpassinginthisbranchbut at themandibularforamenbranchingouttosupply 2muscleandthisbranch is callednerveto mylohyoid supplythemylohyoidmuscleandanteriorbellyofdigastric there is 8muscletakenervesupplyfrom mandibularnerve 7 lateralpterygoid 2 temporates3 massete 4 medialpterygoid 5 tensorpalatimuscle 6 tensortympanimuscle 7 mylohyoid 8 anteriorbellyofdigastri cretion my thefacialnervegivebranchcalled chorda tympaninerve willjointhelingualnerve chorda tympaninerve contain 2typesoffibers test fiberrunningwithlingualnerve parasympathetic fiberdescentandrelayin ganglionandgive 2 gland sublingualgland submandibulargland the anterior of the tongue thegeneral sensation from Itv itself thesensation mean touch paintemperature andtest sensationfrom chordatympaninerve anterior 33 thetongue formof 3part Posterior 3 root anterior33 takegeneral sensation fromtrigeminal lingual nerve test fromfacial chorda tympaninerve glossopharyngeal nerve generalandtestfrom posterior root generaland testfrom vagusnerve 9 extract anyteethfromthemandiblewhichnerve mustbe block g chordatympaninerve arisefrom inferioralveolarnerve facialnerve Mandibular Nerve This is the largest of the three divisions of the trigeminal nerve also known as n. mandibularis; inferior maxillary nerve. It has both sensory and motor fibers and supplies the teeth a and gums of the mandible, the skin of the temporal region, the auricula, the lower lip, the lower part of the face, and the muscles of mastication; it also supplies the mucous membrane see It is the nerve of the first brachial arch and supplies all of the anterior two-thirds of the tongue III structures derived from the mandibular or first brachial arch. Course and Relations of the Mandibular Nerve fear Mandibular nerve begins in the middle cranial fossa through a large torna o s sensory root and small motor root. The sensory root arises from the lateral part of the trigeminal ganglion and leaves the cranial cavity through Foramen Ovale. The motor lies deep to the trigeminal ganglion and to the sensory root. It also passes through the foramen ovale to join the sensory root just teetered below the foramen thus forming the main trunk which passes Weed through the infratemporal fossa. Fee After a short course, the main trunk divides into a small anterior division and a large posterior division. Small Motor Root Large Sensory Root Anterior Division Tensor Palati Posterior Division Lateral Pterygoid Middle Meningeal Artery Branches Of The Mandibular Nerve Main Trunk Meningeal Branch Nerve to medial pterygoid andsupply tensorpalati muscle nervus spinosus tensortympanimuscle From The Anterior Trunk Buccal Nerve Massetric Nerve Deep Temporal Nerves Nerve To Lateral Pterygoid Branches Of The Mandibular Nerve From The Posterior Trunk Auriculotemporal Nerve sensory Lingual Nerve sensory dangerous area in lower3rd molar Inferior Alveolar Nerve sensorybutcontainmotor branchto supply 2 muscle Anterior bellyofdigastricmuscle Mylohoid muscle Chorda tympani Branches of mandibular nerve NERVE TO MEDIAL PTERYGOID It arises close to the otic ganglion and supplies the medial pterygoid from its deep surface. This nerve gives a motor root to the otic ganglion which does not relay. It supplies the tensor palati, and the tensor tympani muscles. MENINGEAL BRANCH (Nervus Spinosus ). It enters the skull through Foramen Spinosum with the middle meningeal artery. It supplies dura mater of the middle cranial fossa. BUCCAL NERVE It is the only SENSORY branch of the anterior division of the mandibular nerve. It passes between the two heads of the lateral pterygoid, runs downwards and forwards and 27ST sep 0 for supplies the skin and mucous membrane related to the buccinator. I e It also supplies the labial aspect of gums of molar and premolar teeth. MASSETRIC NERVE Massetric nerve emerges at the upper border of the lateral pterygoid just in ere ted_s front of the TMJ, passes laterally through the mandibular notch in company with the massetric vessels, and enters the deep surface of the masseter. 2 Fee It also supplies to the TMJ. DEEP TEMPORAL NERVES Deep Temporal Nerves are two in number, the anterior and the posterior see nerves. They pass between the skull and the lateral pterygoid, and enters the deep te surface of the temporalis. The anterior nerve is often a branch of the buccal nerve and posterior nerve te may arise in common with the massetric nerve. NERVE TO LATERAL PTERYGOID Nerve to lateral pterygoid enters the deep surface of the muscle. It may be an independent branch or may arise in common with the in buccal nerve. AURICULOTEMPORAL NERVE ar Auriculotemporal nerve arises by two roots which run backwards, encircles the middle meningeal artery and unite to form a single trunk. The nerve continues backwards between the neck of the mandible and the sphenomandibular ligament, above the maxillary artery. f Behind the neck of the mandible, it turns upwards and ascends on the temple behind the superficial temporal veins. LINGUAL NERVE Lingual nerve is one of the terminal branches of the posterior division of the mandibular nerve. z It is sensory to the anterior 2/3rd of the tongue and to the floor of the mouth. Course and Relations of the Lingual Nerve It begins 1cm below the skull runs between the lateral and the medial pterygoids and F about 2cm below the skull it is joined by the Chorda Tympani nerve. Emerging at the lower border of the lateral pterygoid, the nerve runs downwards and IEEE forwards between the ramus of the mandible and the medial pterygoid. Next it lies in direct contact with the mandible, medial to the third molar between the origins of the superior constrictor and the mylohyoid muscles. It leaves the gums, runs over the hyoglossus deep to the mylohyoid and round the e submandibular duct dividing into terminal branches. Posterior Division Anterior Division Lateral Pterygoid Muscle Superior Constrictor of Pharynx Lingual nerve Last molar tooth Medial Pterygoid Muscle Styloglossus Muscle Chorda tympani nerve INFERIOR ALVEOLAR NERVE Inferior Alveolar Nerve is the largest terminal branch of the posterior division of the mandibular nerve. It runs vertically downwards lateral to the medial pterygoid and to the sphenomandibular ligament. e For It enters the mandibular foramen and runs in the mandibular canal accompanied by the inferior alveolar artery. The MYLOHYOID BRANCH contains all motor fibers of the posterior division. It arises just before the inferior alveolar nerve enters the mandibular foramen, pierces the sphenomandibular ligament with the mylohyoid artery and supplies the mylohyoid muscle and the anterior belly of the digastric. While running in the mandibular canal the inferior alveolar nerve gives branches supplying the lower teeth and the gums. The MENTAL NERVE emerges at the mental foramen and supplies the skin of the chin, skin and the mucous membrane of the lower lip. e Its incisive branch supplies the labial aspect of the gums of canine and incisor teeth. Distribution of Inferior Alveolar Nerve Inferior alveolar nerve Branch to molar and Premolar teeth Incisive branch Mental nerve Nerve to Myelohyoid Inferior alveolar nerve Inside the mandibular canal Maxillary nerve ganginal The Maxillary Nerve Origin : It is a branch of trigeminal nerve Pterygo-palatine Fossa Course Foramen Rotundum it arise from trigeminal gaglion and then it inter the lateral wall of the cavernous sinus and then leave the 0 skull through the foramen rotundum to inter the ptregoplatine fossa then it inter the orbit through the inferior orbital fissure and continue as infraorbital nerve Maxillary Nerve as e Pterygo-maxillary Fissure Foss a Inferior Orbital Fissure Infra-orbital Groove Infra-orbital Canal Infra-orbital Foramen midbrain branch it pons mttor Maxillary I favernoussinus ymeningeal or i iiE iiiiii iii iqii iit.fi iiiiiiiii'iii nerves ficial it P im maxillia ptregopiatinefossa thereisforamen calledforamen rotundum thereis fossabetween maxillaandpterygoid called ptregoplatine fossa there is fissure called inferiororbitalfissure openinorb themaxillary ispuresensory the nerve will runninginthewall ofcavernoussinus then themaxillary nervedescentthrowforamenrotundumnow it'spresent inptregoplatinefossa thenthemaxillary nerve enter theinferiororbitfissurein orbitandcalled infra rbitalnerve thencomeoutthrowthe infraorbitalforamen branch meningealbranch supplythecoverof thebrain in ptregoplatine thereis ptregoplatineganglion it will give ganglionicbranch 3 superioralveolarsupply themaxillary nervesupplytheteeth alveolar anteriorsuperioralveolar middlesuperioralveolar posteriorsuperioralveolar branchentertheorbitcalled zygomatic branch give zygomaticnerve will 2branch zygomatictemporal zygomaticfaical Theinfraorbitalnerve give anteriorsuperioralveolarandmiddlesuperioralveolarand divide into gelid nasalbranch and palpebral branch r andlabialbranch themaxi arynerueg.ve branch and descenttothepalate called greaterpalatal there are glandin theorbitcalled lacrimalgland thesecretion oftheglandis parasympathetic thereis for tears a branchfrom ophthalmic thereare communicationbetweenzygomatictemporaland lacrimalnerve there is branchfromficialnervecalled greaterpetrosal running inptregoidcanalandrelay in ptregoplatineganglion and postganglionic enterthemaxillarynerveenterzygomatic nerve enterzygomatictemporal entercommunicationenterlacrimalgland responsible forparasympathetic ofthelacrimalgland is ficialnerve ptregoplatineganglion lacrimation greaterpetrosalandficail motor ganglionresponsible forlacrimation ptregoplatineganglion greaterpetrosal Maxillary nerve if The Maxillary Nerve Branches and Distribution Zygomatico-facial Nerve Zygomatico-temporal Nerve Loop to Lacrimal Nerve 4- Zygomatic Nerve Palpebral Nasal Labial 1- Meningeal Branch 2- Two Sensory Ganglionic Branches Anterior Superior Alveolar 3- Posterior Superior Alveolar Nerve 5- Infra-orbital Nerve Middle Superior Alveolar Maxillary Artery Origin: Is the larger of the two terminal branches of the external carotid artery. Arises behind the neck of the Ieee mandible within the, substance of The parotid gland. e c Course and relations: for descriptive purpose the artery is divided into three parts by the are lateral pterygoid muscle. (1) The first part: runs horizontally first between the neck of the mandible and the sphenomandibular ligament. and then along thel ower border of the lateral ptrygoid. (2) The second part: runs upwards and Fee forwards either superficial or deep to the lower head of the lateral pterygoid. (3) The third part: passes between the two heads of the lateral pterygoid and through the pterygomaxillary fissure to enter the pterygopalatine fossa. f I Maxillary Artery Lateral Pterygoid Medial Pterygoid Muscle Maxillary Artery External Carotid Artery Sphenomandibular Ligament Branches of Maxillary Artery Branches of the first part: (five branches) mediffidday sumsthe 1 (1) Middle meningeal artery: enters the cranial cavity through the foramen spinosum, smaller (2) Accessory meningeal artery: ascends into the Cranial cavity through the foramen ovale. E tothothrough a foramen (cartilage or bone) in the floor of (3) Deep auricular artery : passes external acoustic meatus. It supplies the skin of the external acoustic meatus and the outer surface of the tympanic membrane. totheear (4) Anterior tympanic artery: passes through the petrotympanic fissure to the middle ear. It supplies the inner surface of the tympanic membrane. tomandible teethofthelowerjaw (5) Inferior alveolar artery: enters the mandibular foramen to runs in the mandibular canal with the inferior alveolar nerve. It supplies the lower teeth. Branches of Maxillary Artery zedo.tt (1) Deep temporal arteries: accompany the deep temporal nerves and supply Branches of the second part: (four muscular branches). the temporalis muscle. medialpterygoid 2 lateralpterygoid 3 (2) Pterygoid branches: to the pterygoid muscles. (3) Masseteric artery: accompanies the nerve to masseter and supplies the masseter muscle. (4) Buccal artery: accompanies the buccal nerve and supplies the buccinator muscle. Branches of Maxillary Artery Branches of the third part: (six branches). theepisiaiiis (1) Posterior superior alveolar artery: accompanies the posterior ttiiiiirsinlittlesare theartery.th little'sarea Superior alveolar nerve to supply the molar and premolar teeth. atsharing in shpenopalatine 1greaterpalatine 2 (2) Greater palatine artery: goingtonasalseptum 3 S's.tn Descends through the greater palatine canal with the greater palatine nerve. n facialarters Comes out through the greater palatine foramen and runs forwards in a groove on the oral surface of the hard palate. Its terminal part ascends through the incisive canal to reach the nose where it ends by anastomosing with the sphenopalatine artery at the antero-inferior part of the nasal septum (Little’s area). areainnasalsupt.am wher arteryjoiningwitheachother In the greater palatine canal it gives lesser palatine branches which pass through the lesser palatine foramina to supply the soft palate and tonsils. (3) Shpenopalatine artery: goingtonasalseptum Reaches the nose by passing through, the sphenopalatine foramen. Crosses the roof of the nose and descends on the nasal septum with the long sphenopalatine nerve, Terminates by anastomosing with the greater palatine and the septal branch of the superior labial artery at the antero- inferior part of the nasal septum (Little's area). Supplies the nasal septum. (4) Artery of pterygoid canal: passes through the pterygoid canal to supply the nasopharynx. (5) Pharyngeal branch: passes through the palatovaginal canal to supply the nasopharynx. continuousofmaxillary artery (6) Infraorbital artery: follows the same course and gives branches, which corresponds to the maxillary nerve in the infraorbitalgroove, canal and foramen. Type and Articular Surfaces joint temporomandibular Tmj Type: Condylar variety of synovial joint. Vessel It Articular Eminence 11.1.1 I Mandibular Fossa Articular surfaces: articulationbetweentheheadofthemandible eminence (A) From above: (1) articularandthe tubercle (eminence); and (2) mandibular fossa. (B) From below: head of mandible. Capsule: Is attached to the margins of the articular surfaces. (A) Above: to the articular tubercle and the circumference.of mandibular fossa. (B) Below: to the neck of the mandible. Head of The Mandible Synovial membrane: Lines the capsule and the neck of the mandible. cartilagecalledarticularcartilage there are inside Tmj insertedinthe bonecartilage capsule lateralpterygoid ifthereis inflammation inTmjwillaffectthelateralpterygoidmuscle Articular disc Tmj inside * Is an oval plate of fibrous tissue that divides the joint into upper and lower compartments. * Its upper surface is concavoconvex to fit the articular tubercle and the mandibular fossa. * Its lower surface is concave to fit into the head of the mandible. * Is attached by its circumference to the inner surface of the capsule. Synovial Saddle Variety Intra-articular Disc Condylar Saddle Variety Accessory Ligaments of TMJ 1- Lateral Temporomandibular 2- The Sphenomandibular Ligament 3- The Stylomandibular Ligament 4- Pterygomandibular Ligament important forstability of the joint 2- The Sphenomandibular Ligament 3- The Stylomandibular Ligament 1- Lateral Temporomandibular 4- Pterygomandibular Ligament Superior constrictor Buccinator Pterygomandibular ligament Blood Supply of TMJ Superficial Temporal Artery Maxillary Artery Nerve Supply of TMJ Auriculotemporal Nerve divisionofthemandibular branchfromposterior From Nerves To Muscles of Mastication Movements 1- Position at Rest allthepictureisrelated to the of mastication muscles 1- slight interval between upper and lower teeth 2- Lower teeth lie slightly behind the level of the upper teeth. 2- Occlusal Position Movements 3- Protraction of The Mandible By Lateral and Medial Pterygoid Muscles And masseter 4- Retraction of The Mandible By Posterior Fibers of Temporalis, Digastric and Geniohyoid Muscles Movements 5- Depression of The Mandible (Opening of the Mouth) By Lateral Pterygoid, Platysma, Digastric, Mylohyoid and Geniohyoid Muscles 6- Elevation of The Mandible (Closure of the Mouth) By Temporalis, Masseter and Medial Pterygoid Movements 7- Side to Side Movement of The Mandible (Grinding) (Chewing) By Lateral and Medial Pterygoid Muscles Dislocation trauma heheaddislocatedinfrontoftheeminence by or excessive openof themouth thepatientcan't closeoralcavity thedislocation isvery dangerous because it is compressthebloo i I 2finger in mandiblethendeppress downthenback Anterior Dislocation of The Mandible noga Dislocation of Temporomandibular Joint Thank You