36 Anatomy Temple InfraTemporal Fossa TMJ PDF

Temple, Infratemporal Fossa & TMJ Class MED Year 2, Semester 1 Lecturer DR. VIJAYALAKSHMI S B Date 24-11-2024 1  Learning Outcomes Describe the osteology and movement of the TMJ Identify the muscles of mastication Define the boun...

Temple, Infratemporal Fossa & TMJ Class MED Year 2, Semester 1 Lecturer DR. VIJAYALAKSHMI S B Date 24-11-2024 1  Learning Outcomes Describe the osteology and movement of the TMJ Identify the muscles of mastication Define the boundaries of the temporal fossa and describe its contents Describe the Infratemporal fossa, V3 (mandibular nerve) and maxillary artery Describe the pterygopalatine fossa and V2 (maxillary nerve) Identify mylohyoid and its attachments Describe the submandibular gland and duct Describe the blood supply and lymphatic drainage of the submandibular region The divisions of the trigeminal nerve are segregate to exit the skull through separate foramen  Trigeminal nerve (V)  3 Divisions 1. Ophthalmic (V1) ▪ Sensory ▪ Superior orbital fissure 2. Maxillary nerve (V2) ▪ Sensory ▪ Foramen rotundum ▪ Pterygopalatine fossa 3. Mandibular division (V3) ▪ Sensory ▪ Motor (1st Branchial arch) ▪ Foramen ovale Ophthalmic (V1) Maxillary (V2) Mandibular (V3) ▪ Infratemporal fossa Standing Room Only Superior Orbital Fissure (V1) Foramen Rotundum (V2) Foramen Ovale (V3) Temporal- Infratemporal - Pterygopalatine Temporal fossa Pterygopalatine Fossa – deeper Medial to ITF and anterior to pterygoid process Infratemporal fossa medial and caudal to zygomatic arch Fossae from lateral to medial Temporal Fossa Boundaries of Temporal fossa Posteriorly and superiorly – superior and inferior temporal lines Anteriorly – Frontal and zygomatic bones Laterally – Zygomatic arch Inferiorly – Infratemporal crest  Contents of Temporal Fossa Superficial Temporalis Temporal Artery  Temporalis Temporalis is a large muscle of mastication It is Fan shaped It attaches below the inferior temporal line Floor of temporal fossa and coronoid process of the mandible Elevates (closes the mouth) and retracts mandible Supplied by deep temporal nerves (mandibular nerve) & vessels Infratemporal fossa - Boundaries Frontal Parietal Temporal Sphenoid Z Maxilla Lat. Pterygoid Plate Lateral – condyle and ramus of the mandible Medial – lateral pterygoid plate; tensor veli palatini, levator veli palatini, superior pharyngeal constrictor muscles Anterior – posterior border of the maxillary sinus Posterior – carotid sheath Roof – greater wing of the sphenoid bone Floor – medial pterygoid muscle  Infratemporal fossa contents Lateral Pterygoid muscle Medial Pterygoid muscle Sphenomandibular ligament Mandibular division of the trigeminal nerve and its branches – Auriculotemporal, Inferior alveolar, N. to Mylohyoid, Lingual nerves Lesser petrosal nerve Chorda tympani Otic ganglion Maxillary artery Pterygoid venous plexus  Lateral Pterygoid Arises from the lateral aspect of the lateral pterygoid plate, Greater wing of sphenoid Inserts into the neck of mandible, the articular disc in the TMJ and the capsule of the joint Action: Protrusion and side-to-side movements of the mandible The lateral pterygoid opens the mouth and protrudes the mandible  Medial Pterygoid Originates from the medial aspect of the lateral pterygoid plate, Tuberosity of the maxilla Inserts onto the medial side of the mandibular ramus Actions: Elevation (closes the mouth), side-to-side movements and protrusion of the mandible  Masseter Originates from the zygomatic arch Inserts onto the lateral side of the mandibular ramus V3 Masseteric nerve Masseteric artery (branch of maxillary) Elevation (closes the mouth), retraction of the mandible  The trigeminal nerve 3 parts Ophthalmic, Maxillary, Mandibular Mandibular nerve (Motor & sensory) Motor to 2 big ones – Masseter and Temporalis 2 Pterygoids – Lateral and medial 2 Floor of the mouth Mylohyoid Anterior belly of digastric 2 small ones – Tensor tympani and tensor veli palatini  Mandibular nerve (Motor) Mylohyoid nerve Auriculotemporal Inferior Alveolar Lingual MAIL Anterior division Posterior division All motor except for the buccal branch, All sensory except for branch to (sensory to inside of the cheek) mylohyoid 1) Auriculotemporal Nerve 1) Skin over the Temple 2) Parasympathetic to parotid gland (IX nerve) 2) Inferior Alveolar Nerve 1) Lower Teeth and associated gingivae 2) Mental Nerve 3) Lingual Nerve 1) Anterior 2/3 of the tongue – General Sensation 4) Buccal Nerve 1) Skin over the cheek + 2nd/3rd Molar Teeth 5) Motor Nerves  Maxillary artery Maxillary artery – in the infratemporal fossa Supplies much of the nasal cavity and the roof of the oral cavity, muscles of mastication Middle meningeal artery goes through foramen spinosum Middle meningeal artery bleed - EDH  Pterygoid plexus (veins) Drains areas supplied by the maxillary artery Connected by emissary veins to the cavernous sinus *Facial infection can spread to the cavernous sinus Otic ganglion Infratemporal fossa  Pterygopalatine Fossa Pterygopalatine fossa Pterygomaxillary fissure Deeper and medial to the infratemporal fossa Anterior to the pterygoid process of sphenoid  Pterygopalatine Fossa - Boundaries Medial wall: Palatine bone – perpendicular plate Roof: sphenoid Anterior: Maxilla Posterior: sphenoid Inferior: Palatine bone – pyramidal process Lateral: pterygomaxillary fissure Pterygopalatine Fossa - connections PTERYGOPALATINE FOSSA Maxillary nerve Vb  Pterygopalatine Ganglion The Hay fever Ganglion !  Pterygopalatine Ganglion The Hay fever Ganglion ! Greater petrosal nerve branch of facial nerve carries preganglionic parasympathetic fibers. Deep petrosal nerve is sympathetic nerve that arises from sympathetic plexus on the internal carotid artery. It conveys postsynaptic fibers from nerve cell bodies in the superior cervical sympathetic ganglion. MAXILLARY ARTERY – The artery of the Infratemporal and Pterygopalatine fossae Pterygopalatine fossa branches SPHENOPALATINE ARTERY, INFRAORBITAL ARTERY Temporomandibular joint – Atypical synovial * The temporomandibular joint is the only movable joint in the skull Articular eminence Mandibular fossa Condyle Temporomandibular joint, or TMJ Osteology of the mandible Mandibular notch Coronoid process Condyle Body Neck Ramus Angle  More mandible landmarks Condyle articulates with the skull Coronoid process attachment for temporalis muscle Ramus attachment for masseter and medial pterygoid muscles Mandibular foramen transmits the inferior dental neurovascular bundle Alveolar process = tooth- bearing area Mental foramen transmits the mental nerve Temporomandibular Joint - Mandible  Temporomandibular Joint – extracapsular ligaments Sphenomandibular ligament From the spine of the sphenoid to the lingula of the mandible Stylomandibular ligament Styloid process From the styloid process to the mandible Temporomandibular joint –* movements  Submandibular region Submental triangle Ant belly of Digastric Submandibular triangle Mandible Mylohyoid Hyoid bone Stylohyoid Sternocleidomastoid Posterior triangle Mylohyoid Mylohyoid Line  Submandibular gland 2 parts – superficial and deep Grooved by facial artery Inferior surface – Cervical branch of VII – Marginal mandibular branch of VII Nodes on/in gland Curls round posterior border of mylohyoid Passes forward between mylohyoid and hyoglossus The submandibular duct goes upward and ends on either side of the frenulum, beneath the tongue The duct is lateral and then medial to the lingual nerve  Frenulum Sublingual caruncle Crest of the sublingual fold Sublingual glands under sublingual fold Ducts open onto the crest of the sublingual fold 42 The submandibular gland medial view Lingual nerve Sublingual Submandibular gland gland Submandibular duct ( Whartons duct) 43  The Submandibular glands are the second largest major salivary glands (exocrine glands) Saliva lubricates the food bolus, contains amylase, helps keep your teeth clean. 44  The Submandibular ganglion Hangs from lingual nerve lateral to hyoglossus Contains Parasympathetic to the submandibular & sublingual gland Sympathetic 45 Submandibular gland innervation 46 Submandibular region – Blood supply  Submandibular Gland pathology Duct blocked /Stones Tumours of the gland Adenoma (benign) Adenocarcinoma (malignant) Lymph node pathology (Enlarged in infection, metastases Bimanual palpation for floor of the mouth examination 48  Lymphatic drainage – Know how to examine cervical lymph nodes 49  References Gray’s Anatomy for Students Acknowledgement Practice questions Google images http://teachmeanatomy.info/