Lecture 6 - TEMPORAL, INFRATEMPORAL AND PTERYGOPALATINE REGIONS.pdf

Dr. Kiran C. Pater College of Osteopathic Medicine Nicholas Lutfi, MD, MS, DPM TEMPORAL REGION Temporal Region l BOUNDARIES: l The temporal region is situated at the side of the head. l Superiorly = superior temporal line l Anteriorly = frontal process of the zygomatic bone l Inferiorly = zygomat...

Dr. Kiran C. Pater College of Osteopathic Medicine Nicholas Lutfi, MD, MS, DPM TEMPORAL REGION Temporal Region l BOUNDARIES: l The temporal region is situated at the side of the head. l Superiorly = superior temporal line l Anteriorly = frontal process of the zygomatic bone l Inferiorly = zygomatic arch l CONTENTS: l Temporalis muscle l Deep temporal nerve (V3) l Deep temporal artery (maxillary a.) l Auriculotemporal nerve l Superficial temporal artery (ECA) TEMPORAL REGION BOUNDARIES CONTENTS INFRATEMPORAL FOSSA Infratemporal Fossa l CONTENTS: l The infratemporal region is a space located below the temporal region and behind the maxilla. l BOUNDARIES: l Superior = infratemporal surface of the sphenoid bone l Anterior = posterior surface of the maxilla and inferior orbital fissure l Medial = lateral pterygoid muscle and pterygomaxillary fissure l Lateral = ramus and coronoid process of the mandible l Lower border of the l l l l temporalis muscle Lateral pterygoid muscle Medial pterygoid muscle Pterygoid venous plexus Maxillary a. and branches: l l l Inferior alveolar a. Middle meningeal a. Branches to the external auditory meatus and tympanic membrane l Branches to muscles of mastication l Maxillary nerve l Mandibular nerve l Otic ganglion (functionally associated with the glossopharyngeal nerve and it innervates the parotid gland for salivation) INFRATEMPORAL FOSSA: Inferior View FORAMEN OVALE FORAMEN SPINOSUM ANGLE OF THE MANDIBLE CONDYLE OF THE MANDIBLE MANDIBULAR FOSSA FORAMEN LACERUM STYLOMASTOID FORAMEN OCCIPITAL CONDYLE JUGULAR FOSSA CAROTID CANAL Infratemporal Fossa l The infratemporal fossa communicates with: l Temporal fossa beneath the zygomatic arch l Orbit, by way of the inferior orbital fissure l Middle cranial fossa via the foramen ovale and foramen spinosum l Mandibular canal via the mandibular foramen. The mandibular canal provides access to the roots of the mandibular teeth and mental foramen) PTERYGOPALATINE FOSSA Pterygopalatine Fossa l It is the area inferior to the apex of the orbit between the pterygoid process of the sphenoid bone posteriorly, and the posterior aspect of the maxilla, anteriorly. l BOUNDARIES: l Superior: body of the sphenoid bone l Anterior: posterior surface of the maxilla l Posterior: lateral pterygoid plate l Medial: perpendicular plate of the palatine bone l OPENINGS: l Anterior: inferior orbital fissure l Inferior: greater palatine canal l Posterior: l Foramen rotundum l Pterygoid canal to the foramen lacerum l Palatovaginal canal to the choanae l Medial: sphenopalatine foramen to the nasal cavity l Lateral: pterygomaxillary fissure to the infratemporal fossa Pterygopalatine Fossa l The pterygopalatine fossa is a major distributing center for the branches of the maxillary nerve and the maxillary artery. l It is located between, and has communications with the: l Infratemporal fossa via the pterygomaxillary fissure l Nasal cavity via the sphenopalatine foramen l Orbit via the inferior orbital fissure l Middle cranial fossa via the foramen rotundum l Pharynx via the choanae l Oral cavity via the greater palatine foramen DIRECTION PASSAGE CONNECTION Posteriorly Foramen rotundum Middle cranial fossa Posteriorly Pterygoid canal Middle cranial fossa Posteriorly Palatovaginal canal (pharyngeal) Nasal cavity, nasopharynx Anteriorly Inferior orbital fissure Orbit Medially Sphenopalatine foramen Nasal cavity Pterygopalatine Fossa-Contents 1. Maxillary nerve 2. Maxillary artery 3. Pterygopalatine (Sphenopalatine) ganglion Maxillary Nerve l It is the second division (V2) of the trigeminal nerve (CN V). l It leaves the skull through the foramen rotundum reaching the pterygopalatine fossa. l It then goes through the infraorbital fissure where it changes names to infraorbital nerve. l The infraorbital nerve exits through the infraorbital foramen to become sensory to the face. The infraorbital nerve is hence a continuation of the maxillary nerve. It is an end nerve. l BRANCHES: l Meningeal branch l Communicating branches to the pterygopalatine ganglion l Superior alveolar Nerves: l Posterior l Middle l Anterior l Zygomatic nerve Maxillary Artery l BRANCHES: l It is a terminal branch of the ECA. l It passes superficial to the lateral pterygoid muscle and then disappears in the infratemporal fossa. l The maxillary artery is divided into three parts by the lateral pterygoid muscle. I l INFRATEMPORAL FOSSA: l Inferior alveolar l Branches to muscles of mastication l Branches to the external auditory meatus and tympanic membrane l PTERYGOPALATINE FOSSA: l Posterior superior alveolar = maxillary sinus and molar and premolar teeth l Infraorbital = with the infraorbital nerve (inferior orbital fissure) l Pharyngeal branch = mucous membrane of the nasopharynx l Sphenopalatine = mucous membrane of nasal cavity and septum. End artery of the maxillary. Pterygoid Venous Plexus l MAXILLARY VEIN: l It is a venous network that surrounds the lateral pterygoid muscle. l It is located partly between the temporalis and lateral pterygoid muscles and partly between the two pterygoid muscles. l It communicates with the facial vein via the deep facial vein. l It is a short vein that drains the maxillary venous plexus. l It joins the superficial temporal vein in the parotid gland to form the retromandibular vein. Pterygopalatine (Sphenopalatine) Ganglion l Lies below the maxillary nerve in front of the pterygoid canal and behind the middle nasal concha. l It may be blocked through the mandibular notch.