Head and Neck Osteology PDF

BDS 217 - HEAD and NECK ANATOMY Topic 2: HEAD and NECK OSTEOLOGY Danielle Badro, PhD Associate Professor - College of Healthcare Technologies [email protected] GLOSSARY OF TERMS Condyle...

BDS 217 - HEAD and NECK ANATOMY Topic 2: HEAD and NECK OSTEOLOGY Danielle Badro, PhD Associate Professor - College of Healthcare Technologies [email protected] GLOSSARY OF TERMS Condyle : A rounded knob that articulates with another bone. Foramina : Foramen – a hole through a bone, usually round. Hiatus : Aperture (opening or open space). Meatus : Opening, canal. Norma basalis : Inferior view. Norma frontalis : Anterior (ventral) view. Norma lateralis : Lateral view. Norma occipitalis: Posterior (dorsal) view. Norma verticalis : Superior view. Process : Any bone prominence. Sometimes called arch. Pterygoid : Usually refers to a structure that looks like a wing. Ramus : Branch. Scaphoid : Rowboat-like. 2 GLOSSARY OF TERMS (cont.) – Actions of Muscles Abduction : Movement of a part of the body away from the midline. Adduction : Movement of a part of the body toward the midline. Protraction : Movement that brings part of the body forward. Retraction : Movement that brings part of the body backward. Abduction Adduction Protraction Retraction 3  A. Functions of the Skull Also called cranium. Protects the brain. Protects the 5 organs of special sense: o Olfaction o Vision o Taste o Vestibular function o Auditory function 4  B. General Anatomy of the Skull 28 individual bones make up the skull: o 11 are paired o 6 are single o Wormian (sutural) bones are also found in the skull: - Small - Irregularly shaped - Found along sutures that occur naturally 5  1 2 1 1 2 2 1 2 2 2 2 1 2 2 1 means unpaired bone (only one such bone exists) 2 means the bone is paired (this 1 bone is present twice) Lateral view (norma lateralis) and anterior view (norma frontalis) of the skull. 6 Anterior view (norma frontalis) of the skull. 7 Bones of the right orbit. Anterior view. Bones of the right orbit. Lateral view. 8 Posterior views (norma occipitalis) of the skull. 9 Lateral view of the skull. 10 B. General Anatomy of the Skull B.1- Divisions of the Skull Regional divisions of Developmental the skull divisions of the skull Cranium Viscerocranium (Facial skeleton) Neurocranium Mandible (skull without the The portion of the skull related to the The portion of the skull that protects the (lower jaw) digestive and respiratory systems mandible) brain and the 5 organs of special senses Cranial base Facial skeleton Cranial vault Cranial cavity Acoustic skeleton Inferior portion of Bones that make up Upper portion of the Interior of the skull Ear ossicles the skull (see slide the face skull. Forms by 12). Formed by intramembranous endochondral ossification. ossification. Anterior cranial fossa Contains the frontal lobe of the brain Middle cranial fossa Contains the temporal lobe of the brain Posterior fossa Contains the cerebellum 11  The base of the skull is also called cartilaginous neurocranium, chondrocranium or cranial base. It is composed of the following bones: o Ethmoid (not visible in the figure). o Sphenoid o Occipital o Temporal (part of it) o Frontal (part of it) o Inferior nasal concha o Palatine o Auditory ossicles Inferior view of the base of the skull. 12  The basal aspect of the skull. Inferior view. 13 Memorize the items marked inside the green brackets.  B. General Anatomy of the Skull B.2- Articulations Memorize the items inside the green frames. 14 B. General Anatomy of the Skull B.3- Sutures At birth, the flat bones of the skull are separated from each other by narrow seams of connective tissue, the sutures. At points where more than two bones meet, sutures are wide and are called fontanelles. Sutures and fontanelles allow the bones of the skull to overlap (molding) during birth and allow the skull to enlarge as the brain is growing in volume. Although cranial capacity is reached at the age of 5-7 years, some sutures do not undergo ossification until adulthood. 15  Sutures of the skull are: Coronal Frontonasal Frontozygomatic Intermaxillary (see next slide) Lambdoid Metopic Occipitomastoid Petro-occipital Petrosquamous Petrotympanic Sagittal Sphenofrontal Spheno-occipital Zygomaticomaxillary suture Sphenoparietal Squamosal (squamous) Squemotympanic Temporozygomatic Transverse palatine (see next slide) Zygomaticomaxillary Memorize the items marked in green. 16  Sutures of the skull are: Coronal Frontonasal Frontozygomatic (see previous slide) Intermaxillary Lambdoid Metopic Occipitomastoid Petro-occipital Petrosquamous Petrotympanic Sagittal Sphenofrontal (see previous slide) Spheno-occipital Sphenoparietal (see previous slide) Squamosal (squamous) (see previous slide) Squemotympanic Temporozygomatic (see previous slide) Transverse palatine Zygomaticomaxillary (see previous slide) Memorize the items underlined in green and the figure. 17  B. General Anatomy of the Skull B.4- Foramina (sing. foramen) and Fissures (see slide 19) Hypoglossal canal Occipital Hypoglossal n. Inferior view Memorize the items inside the green bracket. of the cranial base. B. General Anatomy of the Skull B.4- Foramina (sing. foramen) and Fissures 19  Superior view of the cranial base. Memorize the items underlined in green. 20  Right orbit. Lateral view. The lateral side of the orbit was removed. 21 Do not memorize the items underlined in red. Memorize the items marked in green. 22  C. Detailed Bone Anatomy of the Skull Glossary Foramen: An opening (usually round) through a tissue (usually bone), that allows nerve fibers and blood vessels to pass through. Process: Any bony outgrowth. Protuberance: A bony outgrowth or protruding part. Tubercle: A small, rounded process. Anterior view (norma frontalis) of the skull. 23  Mid-sagittal view of the adult human skull. Memorize the items 24 underlined in green.  Incisive fossa (located anteriorly to the incisive foramen) Inferior view of the base of the skull. Detailed structure of the occipital bone. Do not memorize the items 25 inside the red brackets. C. Detailed Bone Anatomy of the Skull C.1- Frontal Bone 26 27  Unpaired - there is one frontal bone. Divided into three parts: squamous portion, orbital portion, and nasal portion. Articulates with the nasal bones and the frontal process of the maxilla to form the root of the nose. Left lateral view of the human skull. Note: The glabella is a bony point Frontal process of the maxilla present on the frontal bone between two superciliary arches. Do not memorize the items marked in a red bracket. Anterior view of the human skull. 28 C. Detailed Bone Anatomy of the Skull C.2- Temporal Bone 29  Develops from three centers that fuse to form a single bone: o squamous part (temporal squama), bears the mandibular (glenoid) fossa and the zygomatic process. Fossa is inferior and medial to the process and articulates the mandibular condyle, forming the temporomandibular joint (TMJ) o petrous part (petrous bone) contains the auditory and vestibular apparatus o tympanic part forms large portions of the external auditory canal The external acoustic meatus is located behind the fossa of the TMJ. This proximity explains blunt force jaw trauma causing damage to the auditory canal. Left lateral view of the human skull. Temporal bone is paired (2 temporal bones). Help form the base and lateral walls of the skull. Left lateral view of the temporal bone. Inferior view of the temporal bone. 30  The temporal bone contains three processes: zygomatic, styloid, and mastoid. Three bones of the skull contain a zygomatic process: o Temporal o Maxillary o Frontal The mastoid process of the temporal bone is located behind the ear and serves as a point of attachment for many muscles of the head and neck. Inferior view of the base of the skull. 31 C. Detailed Bone Anatomy of the Skull C.3- Sphenoid Bone 32  Forms most of the middle portion of the cranial base. Most structurally complex bone in the human body. Lateral view of the skull. Sphenoid Inferior view of the base of the skull. Superior and interior view of the bone in light green color. base of the skull. 33  The sphenoid bone has several openings to allow the entry and exit of several nerves and blood vessels to move in and out of the cranial cavity. These include the: o Optic canal o Superior orbital fissure o Foramen rotundum o Foramen lacerum o Foramen spinosum o Foramen ovale Inferior view of the base of the skull. 34  The sphenoid bone contains the 2 pterygoid processes that allow the medial and lateral (right-to-left) movement of the mandible. Each pterygoid process has a: o Lateral pterygoid plate o Medial pterygoid plate Inferior view of the base of the skull. Do not memorize items Human skull. Sagittal view. inside the red bracket. 35  Inferior view Superior view Anterior view Posterior view 36 Do not memorize items underlined in red. C. Detailed Bone Anatomy of the Skull C.4- Lacrimal Bone and Nasal Bone 37  Both bones are paired. They articulate with multiple bones, including the frontal process of the maxilla. Lateral view. Midsagittal view. Do not memorize the items highlighted in red. 38 Right orbit. Anterior view. Right orbit. Lateral view. 39 C. Detailed Bone Anatomy of the Skull C.5- Zygomatic Bone (Zygoma) 40  This bone forms the prominence of the cheeks. It articulates with multiple bones, including the zygomatic process of the maxillary bone to form the orbit. Inferior view Memorize the items inside the green bracket. of the cranial base. 41  The zygomatic bone has three processes: o Temporal process o Frontal process o Maxillary process The zygomatic arch forms from the temporal process of the zygomatic bone and the zygomatic process of the temporal bone. It is vital in the mastication system, as it attaches the masseter muscle, which is the major jaw adductor in mammals. Anterior view of the skull. 42 C. Detailed Bone Anatomy of the Skull C.6- Ethmoid Bone 43 The ethmoid bone is shown in pink in a left lateral view, anterior and frontal (coronal) section of the skull. 44  Unpaired. Separates the nasal cavity from the brain. Connects with the maxilla through the hiatus semilunaris (semilunar hiatus, part of the maxilla). 45 Memorize the items marked in green.  Right nasal cavity, left lateral view; nasal septum has been removed. The middle, superior, and highest (supreme) nasal conchae are projections of the ethmoid bone, whereas the inferior nasal concha is a separate bone unto itself. Bones of the right orbit. Anterior view. Bones of the right orbit. Lateral view. 46 C. Detailed Bone Anatomy of the Skull C.7- Vomer 47 Inferior view of the base of the skull. 48 Frontal (Coronal) sections. 49  The vomer bone is shaped like a “plough”. It is unpaired. It forms the posterior inferior part of the nasal septum. It articulates with the: o Perpendicular plate of the ethmoid o Maxilla o Palatine o Sphenoid o Septal cartilage of the nose o Posterior border of the vomer does not articulate with any other bone Paramedian (situated adjacent to the midline) section, left lateral view. 50 Parasagittal and midsagittal views. 51 C. Detailed Bone Anatomy of the Skull C.8- Inferior Nasal Concha 52 Right nasal cavity, left lateral view; nasal septum has been removed. 53  It is a curved bone that forms part of the lateral wall of the nasal cavity. It is a paired bone. It articulates with the: o Perpendicular plate of the palatine o Lacrimal o Ethmoid Midsagittal view. Anterior view. 54 C. Detailed Bone Anatomy of the Skull C.9- Palatine Bone There are 2 palatine bones, each is L-shaped. It forms part of the nasal cavity and the hard palate. Contains three parts: perpendicular plate, horizontal plate, and pyramidal process. The lateral wall of the bone articulates with the maxilla to form the palatine canal. 55  Oblique posterior view of the hard palate region. 56 Right nasal cavity, left lateral view; Paramedian (situated adjacent to the midline) nasal septum has been removed. section, lateral view of the left side. 57  Do not memorize items underlined in red. Parasagittal section viewed from the left side of the nasal septum Lateral wall of the right nasal cavity. Midline section viewed from the left with the nasal conchae removed. 58 The Hard Palate The hard palate comprises about two-thirds of the total palate surface area. Its underlying bony structure consists of the palatine processes of the maxilla and the horizontal plates of the palatine bones. Inferior views of the hard palate. 59 Superior views of the hard palate. 60  Left lateral view of the nasal cavity. Inferior view of the hard palate. 61 C. Detailed Bone Anatomy of the Skull C.10- Maxilla (pl. maxillae) It is a paired bone (two maxilla bones). Forms most of the skeleton of the face and upper jaw. Contains the maxillary paranasal sinus (see slide 67). Articulates with the following bones: o Frontal o Sphenoid o Nasal o Vomer o Ethmoid o Inferior nasal concha o Palatine o Lacrimal Lateral view. o Zygomatic o Septal and nasal cartilages o Opposite maxilla 62 63  The maxilla is divided into five parts: o Body o Zygomatic process o Palatine process o Frontal process o Alveolar process All parts form by intramembranous ossification. 64 Body of the maxilla It is the major part of the bone. Shaped like a pyramid. Gives rise to four different “regions: o Orbit o Nasal cavity o Infratemporal fossa o Face Frontal view. 65 Zygomatic process Extends laterally to articulate with the maxillary process of the zygomatic bone. Palatine process Extends medially to form the majority of the hard palate. Articulates with: o the palatine process of the opposite side o the horizontal plate of the palatine bone Its anterior portion contains the incisive foramen Inferior view 66 of the cranial base. Frontal process Extends posteriorly to articulate with the following bones: o Nasal o Frontal o Ethmoid o Lacrimal 67 Alveolar process It is the part of the maxilla that supports all the maxillary teeth. Extends inferiorly from the maxilla. Each maxilla contains: o 5 primary teeth o 8 permanent teeth Alveolar bone is resorbed when a tooth is lost. Coronal section. Anterior view. 68  Median palatine suture Transverse palatine suture 69 C. Detailed Bone Anatomy of the Skull C.11- The mandible There is one mandible. It forms the lower jaw. It is described as horseshoe shaped. All muscles of mastication attach to the mandible. It is divided into the following parts: o Body o Ramus o Coronoid process o Condylar process o Alveolar process Forms by intramembranous ossification and endochondral ossification; they Lateral surface of body of mandible ossify around Meckel’s cartilage. 70 Body of mandible The mental foramen lies on the anterior part of the lateral surface of the body. The external oblique line lies on the lateral side. The mylohyoid line lies on the medial side. It helps divide the sublingual from the submandibular fossa. The posterior border of the mylohyoid line provides for attachment of the pterygomandibular raphe (see slide 72). The superior and inferior genial tubercles (also called mental spines) and the digastric fossa lie at the midline on the medial side (see slide 73). Lateral surface of body of mandible 71  72 Memorize the underlined only. Superior (2 in total) and inferior (2 in total) genial tubercles are also called superior and inferior mental spines. 73  The mandible is connected to the viscerocranium at the temporomandibular joint, whose convex surface is the condyle (head) of the mandible. This “head of the mandible” is situated atop the vertical (ascending) ramus of the mandible. The ramus joins with the body of the mandible at the mandibular angle. The 5 primary and 8 permanent teeth are set in the alveolar processes along the upper border of the mandibular body. This part of the mandible is subject to typical age- related changes as a result of dental development. The mental branch of the trigeminal nerve exits Anterior view. through the mental foramen to enter its bony canal. 74  The superior part of the ramus divides into a coronoid process anteriorly and a condylar process posteriorly. The mandibular notch is located between these two processes. The coronoid process is the anteriormost superior extension of each ramus. It is a site for muscular attachments. The condylar process bears the head of the mandible, which articulates with the mandibular fossa of the temporal bone. The pterygoid fovea is a depression on the medial side of the condylar process; it gives attachment to portions of the lateral pterygoid muscle. Oblique left lateral view. 75  The mandibular foramen is located on the medial side of the ramus – it transmits the inferior alveolar nerve, which supplies sensory innervation to the mandibular teeth. Its terminal branch emerges from the mental foramen. The two mandibular foramina are interconnected by the mandibular canal. Posterior view. 76  The masseter muscles attaches to the lateral side of the ramus (see slide 78). The medial pterygoid muscle and sphenomandibular ligament attach to the medial side of the ramus. The temporalis muscle attaches to the coronoid process. 77  Masseter m. is on the lateral side of the ramus of mandible. Sphenomandibular l. and medial pterygoid m. are on the medial side of the ramus. Memorize the underlined 78 Highlights about mandibular processes Alveolar process of mandible 79 The Temporomandibular Joint (TMJ) The temporomandibular joint (TMJ) is the articulation between the squamous portion of the temporal bone and the condyle of the mandible. The TMJ comprises 2 types of synovial joints - hinge and sliding - and consists of the following: a- Squamous portion of the temporal bone b- Condyle of the mandible (Mandibular condyles) c- Articular disc d- Bilaminar zone (posterior attachment complex) e- Capsule f- Ligaments (serve as boundaries) TMJ dysfunction affects approximately 25% of the population and may be severe in a small subgroup. o Causes include arthritis, trauma, infection, bruxism, and disc displacement o More common in females 80  Left lateral view of the temporomandibular joint. In this figure, memorize the items inside the green bracket. 81  a- Squamous portion of the temporal bone The TMJ articulation is located on the squamous portion of the temporal bone (see next slide). The articulation has an avascular articular surface composed of fibrous connective tissue instead of hyaline cartilage. The main load-bearing areas are on the lateral aspect of the squamous portion, condyle, and articular disc. o The dense fibrous connective tissue is thickest in the load-bearing areas. Relations of the squamous portion of the temporal bone: o Anterior - articular eminence becoming the articular tubercle. o Intermediate - glenoid (mandibular) fossa. o Posterior - tympanic plate tapering to the postglenoid tubercle. 82 Do not memorize items in the red bracket.  Develops from three centers that fuse to form a single bone: o squamous part (temporal squama), bears the mandibular (glenoid) fossa and the zygomatic process. Fossa is inferior and medial to the process and articulates the mandibular condyle, forming the temporomandibular joint (TMJ) o petrous part (petrous bone) contains the auditory and vestibular apparatus o tympanic part forms large portions of the external auditory canal The external acoustic meatus is located behind the fossa of the TMJ. This proximity explains blunt force jaw trauma causing damage to the auditory canal. Left lateral view of the human skull. Temporal bone is paired (2 temporal bones). Help form the base and lateral walls of the skull. Left lateral view of the temporal bone. Inferior view of the temporal bone. 83 a- Squamous portion of the temporal bone (Cont’) The articular eminence is the strong bony prominence on the base of the zygomatic process. The articular tubercle is located on the lateral part of the articular eminence. o It provides attachment for the capsule and lateral temporomandibular ligament. The glenoid fossa is the depression into which the condyle is located. The postglenoid tubercle is an inferior extension of the squamous portion of the temporal bone. o It makes the posterior aspect of the glenoid fossa. o Provides attachment for the capsule and retrodiscal pad. 84 b- Mandibular condyles (of the mandible) Articulate with the articular disc. Shaped like footballs: o Mediolateral - 20mm o Anteroposterior - 10mm Articular surface is avascular fibrous connective tissue instead of hyaline cartilage. The main load-bearing areas are on the lateral aspect. 85 c- Articular disc An articular disc (or disk) is an oval-shaped cartilaginous (a type of connective) tissue interposed between two articulating bones. Located between the squamous portion of the temporal bone and the condyle. It is avascular and aneural in its central part but is vascular and innervated in the peripheral areas, where load-bearing is minimal. The main load-bearing areas are located on the lateral aspect; this is an area of potential perforation. 86 c- Articular disc (Cont’) It is divided into 3 bands: o Anterior - thick band, lies just anterior to the condyle with the mouth closed. o Intermediate - thinnest band, located along the articular eminence with the mouth closed. o Posterior - thick band, located superior to the capsule with the mouth closed. Additional attachments: o Medial/lateral - medial and lateral ligaments anchor the disc to the condyle. o Anterior - disc is attached to the capsule and the superior head of the lateral pterygoid, but not the condyle, allowing the disc to rotate over the condyle in an anteroposterior direction. o Posterior - disc is contiguous with the bilaminar zone. 87 c- Articular disc (Cont’) The articular disc divides the TMJ into superior and inferior compartments. The internal surface of both compartments contain endothelial cells that produce synovial fluid, making the TMJ a synovial joint. Synovial fluid acts as: o A lubricant o An instrument for providing the metabolic requirements to the articular surfaces of the TMJ Superior compartment: o It is located between the squamous portion of the temporal bone and the articular disc o Volume = 1.2 mL o Provides for the translational movement of the TMJ Inferior compartment: o It is located between the articular disc and the condyle o Volume = 0.9 mL o Provides for the rotational movement of the TMJ 88  d- Bilaminar zone (Posterior attachment complex) A bilaminar structure located posterior to the articular disc. Highly distortable, especially on opening the mouth. Composed of: o Superior lamina - contains elastic fibers and anchors the superior aspect of the posterior portion of the disc to the capsule and bone at the postglenoid tubercle and tympanic plate. o Retrodiscal pad - the highly vascular and neural portion of the TMJ, made of collagen, elastic fibers, fat, nerves, and blood vessels. o Inferior lamina - contains mainly collagen fibers and anchors the inferior aspect of the posterior portion of the disc to the condyle. Do not memorize items in the red bracket 89 and do not memorize figure. e- Capsule Completely encloses the articular surface of the temporal bone and the condyle. Composed of fibrous connective tissue. Toughened along the medial and lateral aspects by ligaments. Lined by a highly vascular synovial membrane. Has various sensory receptors including nociceptors. Attachments: o Superior - along the rim of the temporal articular surfaces. o Inferior - along the condylar neck. o Medial - blends along the medial collateral ligament. o Lateral - blends along the lateral collateral ligament. o Anterior - blends with the superior head of the lateral pterygoid muscle. o Posterior - along the retrodiscal pad. 90 f- Ligaments Four types of ligaments: f.1- Collateral ligaments f.2- Temporomandibular (lateral) ligament f.3- Stylomandibular ligament f.4- Sphenomandibular ligament 91 f.1- Collateral ligaments Composed of 2 ligaments: medial collateral and lateral collateral. o Medial collateral: connects the medial aspect of the articular disc to the medial pole of the condyle. o Lateral collateral: connects the lateral aspect of the articular disc to the lateral pole of the condyle. Frequently called the discal ligaments. Composed of collagenous connective tissue; thus, they do not stretch. 92 f.2- Temporomandibular (Lateral) ligament The thickened ligament on the lateral aspect of the capsule. Prevents lateral and posterior displacement of the condyle. Composed of 2 separate bands: o Outer oblique part - largest portion; attached to the articular tubercle; travels posteroinferiorly to attach immediately inferior to the condyle; this limits the opening of the mandible. o Inner horizontal part - smaller band attached to the articular tubercle running horizontally to attach to the lateral part of the condyle and disc; this limits posterior movement of the articular disc and the condyle. 93 f.3- Stylomandibular ligament Composed of a thickening of deep cervical fascia. Extends from the styloid process to the posterior margin of the angle of the ramus of the mandible. Helps limit anterior protrusion of the mandible. 94 f.4- Sphenomandibular ligament Remnant of Meckel’s cartilage. Extends from the spine of the sphenoid to the lingula of the mandible. May help act as a pivot on the mandible by maintaining the same amount of tension during both opening and closing of the mouth. 95 Head of the mandible of the right TMJ. Frontal view (a) Left TMJ with ligamentous apparatus. Lateral view. The and dorsal view (b). TMJ extends dorsally up to the petrotympanic fissure. It is The joint capsule of the mandibular head is considerably secured by three ligaments. This lateral view shows the smaller than the socket and is cylindrical. This cylinder strongest ligament, the lateral ligament, which lies on the shape increases head mobility given that it allows capsule and with which it is connected as well as the rotation around a vertical axis. weaker stylomandibular ligament. 96 Mandibular fossa of the TMJ on the outer skull base. Inferior view. 97  Right TMJ with ligamentous apparatus. Medial view. Opened, left TMJ. Lateral view. From the medial view, the sphenomandibular ligament is Sagittal section through joint. visible. 98 TMJ motions. View from the left lateral side. The schematic on the right depicts the course of the axis. Muscle, capsule, and disc build a functionally combined musculo-disco-capsulo system that works closely together during the opening and closing of the mouth. In idle position with the mouth closed, the mandibular head rests in the mandibular fossa of the temporal bone. 99 TMJ motions. View from the left lateral side. The schematic on the right depicts the course of the axis. Mouth opening up to 15°. The mandibular heads stay in the mandibular fossa up to this degree of abduction. 100 TMJ motions. View from the left lateral side. The schematic on the right depicts the course of the axis. Mouth opening more than 15°. The mandibular heads shift to the front of the articular eminence; as a result, the joint axis that runs diagonally through the mandibular heads shifts ventrally. The articular disk is pulled forward by the superior head of the lateral pterygoid m. The inferior head of the lateral pterygoid m. inserts onto the neck of the condylar process of the mandible. 101  Arterial supply of the TMJ: superficial temporal, deep auricular, and anterior tympanic arteries. Veinous drainage of the TMJ: superficial temporal and maxillary vein. Sensory innervation of the TMJ: auriculotemporal, masseteric, and posterior deep temporal nerves. 102 The Pterygopalatine Fossa This fossa is a crossroads between the middle cranial fossa, orbit, and nasal cavity. It is traversed by many nerves and vessels that supply these regions. Close-up view of the left pterygopalatine fossa. Lateral view. 103 Structures adjacent to the right pterygopalatine fossa. 104  D- The Neck The neck is the area between the base of the skull and inferior border of the mandible and the superior thoracic aperture. Not included for AUIB Exam 105