Temp,infratemp,pterygo. fossa-part 4-2022.pdf

Human Biology 2 Head & Neck Anatomy Pterygopalatine Fossa- Part 4 2022-2023 Dr.Basheer Muhammed Jafar Salman Lecturer- Oral Surgery B.D.S, M.Sc, MFDS RCS ( Edinburgh ) 1 Email: [email protected] References and further reading • Martin Atkinson (2013): Anatomy For Dental Students. Fourth Ed...

Human Biology 2 Head & Neck Anatomy Pterygopalatine Fossa- Part 4 2022-2023 Dr.Basheer Muhammed Jafar Salman Lecturer- Oral Surgery B.D.S, M.Sc, MFDS RCS ( Edinburgh ) 1 Email: [email protected] References and further reading • Martin Atkinson (2013): Anatomy For Dental Students. Fourth Edition, Oxford University Press. • Snell RS (2012): Clinical Anatomy by Regions. 8th Edition, Lippincott Williams & Wilkins. Baltimore. Frank H. Netter (2018): Atlas of Human Anatomy. 7th edition by Elsevier. Stanley F. Malamed (2020): Handbook of Local Anesthesia7th edition by Elsevier. http://www.nysora.com/peripheral_nerve_blocks/head_and_n eck_block/3062-oral_maxillofacial_regional_anesthesia.html • • • 2 The Pterygopalatine fossa Objectives: 1- Discuss branches & area supplied by the maxillary nerve. 2- Understand the function and branches of pterygopalatine ganglion 3- Understaand branches & area part of the supplied by the 3rd Maxillary artery 3 Pterygopalatine Fossa - Contents Maxillary nerve Maxillary n. Pterygopalatine ganglion Maxillary artery – 3rd part Pterygopalatine ganglion Maxillary artery 4 Branches of the maxillary nerve They are classified into: 1- Branches that come directly from the maxillary nerve: 1 Ganglionic branches 2 Posterior superior alveolar nerve 3 Zygomatic nerve 4 Infraorbital nerve Zygomatic n. 2- Branches that are associated with the pterygopalatine ganglion: Infra-orbital n. Greater palatine nerve Lesser palatine nerves Nasal nerves Nasopalatine nerve Pharyngeal nerve Orbital branches Ganglionic branches hemopalatine Foramen 5 Pterygopalatine ganglion. Posterior superior alveolar nerve Branches of the maxillary nerve 1- Ganglionic branches: They are two in number, connecting the maxillary nerve with pterygopalatine ganglion. Ganglionic branches Pterygopalatine ganglion. 6 Branches of the maxillary nerve 2- Posterior superior alveolar nerve: fillings crowns Root www.pyp winaiterere that anything 1- It passes through the pterygomaxillary fissure into the infratemporal fossa. canaltreatments ranchofthemaxillary Pterygomaxillary fissure nervegiveto pterygopalatinefossa 2- It runs on the posterior surface of the maxilla and divide into smaller branches which enter the maxilla through posterior superior alveolar foramina. 3- It provides sensory innervation for the buccal gingiva of the upper molar teeth as well as the alveoli, periodontal ligaments and pulpal tissues of the maxillary third, second and first molars (with the Iexception of the mesiobuccal root of the first molarin in 28% of patients). It also supplies the mucous membrane of the maxillary sinus. 7 Maxillary sinus Posterior superior alveolar nerve theupperfirst molarhas and Pyotr2B molar It will supplythepulpof upper buccal sum upperposteriorteeth the oftheuppermolarthemaxillarysinus andperiodontium Posterior superior alveolar foramen s t extraction preparation wi anesthetist thebone thePup andtheBuccalgum of withtheexeption z crown 3 Its III dfillings dentalprocesuretotheupper s any Upper molars molar m rootofthe1st thepalatalgum Branches of the maxillary nerve wzgpyggqjg.it Itwillleavethepterygopalatine orbitalfissure interior 3- Zygomatic nerve: bypassingthrough It passes through the inferior orbital fissure, then it divides into: 1- Zygomaticofacial nerve. Passes through the zygomaticofacial foramen to supply the skin over the prominence of the cheek. fossa y Lacrimal gland fibers seabird Lacrimal n. Inf. Orbital fissure gyyyyg.y.gg Zygomatic n. Zygomaticotemporal n. s 2- Zygomaticotemporal nerve. Passes through zygomaticotemporal foramen into the temporal fossa to supply the skin of this region. Note: Zygomatic n. contains postganglionic parasympathetic fibers from the pterygopalatine ganglion and within the orbit these fibers will be given to the lacrimal nerve to reach the lacrimal gland. parasympatuchi tearswhichare Zygomaticofacial n. parasympbatheh ganglion Iterygopalatineganglion 8 infraorbital foramin Branches of the maxillary nerve 4- Infraorbital nerve: y 1- It runs through inferior orbital fissure into the orbit. 2- Then it runs across the floor of the orbit in the infraorbital groove then infraorbital canal and finally emerges into the face through infraorbital foramen. Howmanynervecan pass orbital fissuer through theInferior Zygomaticnerve Infraorbitalnerve vessels Inferiorophthalmicvein Inf. Orbital fissure Infraorbital n. Ant. sup. Alve. n. 3- It supplies the skin of the lower eyelid, side of the nose, and upper lip. Note: In the orbit, infraorbital nerve gives 2 branches: Middle superior alveolar nerve. Anterior superior alveolar nerve. Middle sup. Alveolar n. 9 infraorbital 9 Branches of the maxillary nerve Middle Superior Alveolar Nerve: 1- It is a branch from the infraorbital nerve during its course within the infraorbital canal. 2- It provides sensory innervation to the maxillary premolars and mesiobuccal root of upper first molar (pulp), also it supplies the buccal gum, bone, periodontal tissue of the premolar region. Infaorbital and anterior middle and Both superioraleolarnervetare branches Branchfromtheinfraorbitalnerve ranchfrom themaxillarynerve Infraorbital n. Ant. sup. Alve. n. Anterior Superior Alveolar Nerve: 1- It is a branch from the infraorbital nerve during its course within the infraorbital canal. 2- It provides sensory innervation to the maxillary central, lateral incisors, and canine (pulp) also it supplies the labial gingiva, bone, and periodontal tissue of these teeth. 10 of theinfraorbitalnerve Middle sup. Alveolar n. Pterygopalatine ganglion I sometimestheycallit heyfever ganglion 1- It is a parasympathetic ganglion, situated below the maxillary nerve in the pterygopalatine fossa. 2- It is connected to the maxillary nerve by two ganglionic branches. Pteregopalatine Thergy Lacrima Maxillary nerve Lacrimal gland 3- It is concerned with supplying the lacrimal gland and glands of the mucous membrane of the nose, nasopharynx, paranasal sinuses, palate, and upper lip. 4- It is thought as the hay fever ganglion as it responsible for the symptomes of running nose and eyes. Pterygopalatine ganglion sneeze iMining ithtears nasalsinuseslinedby para thathas membrane mulouse 11 that hassecretion glandswhich pterygopalatine lomasfrom the ganglion Pterygopalatine ganglion 5- Three types of fibers enter into the ganglion: parasympathetic, sympathetic and sensory fibers. Greater petrosal n. Deep petrosal n. 6- Only the parasympathetic fibers synapse in the ganglion. Ganglionic branches 7- Preganglionic parasympathetic fibers (secretomotor) come through greater petrosal nerve (branch from the facial nerve) 8- Sympathetic fibers come from deep petrosal nerve from plexus around internal carotid artery. 9- The greater petrosal and deep petrosal nerve join within pterygoid canal to become nerve known as nerve of pterygoid canal or vidian nerve. 10- Sensory fibers come from ganglionic braches of maxillary nerve. 12 Pterygoid canal Vidian n. Internal carotid artery Pterygopalatine ganglion Branches of the pterygopalatine ganglion hardpalate posteriorfeetypaatagam SMOTE 1- Greater palatine nerve: If doingextraitionforthe the molar maxilla L posteriorsuperior molarsandpremolars alveolarnerve thebonepulp for andbuccalgum 1- It runs through the greater palatine canal. s palatine greater nerve thepalatal frgum exitfrom 2- Emerges through the greater palatine foramen in the hard palate. 3- In the hard palate, it runs forwards between the midline of the palate and the palatal gum of the posterior teeth. Nasal branches 4- It supplies sensory innervation to the palatal soft tissues, glands and bone as far anterior as the first premolar. the molar to last Note: Within the greater palatine canal, it gives rise to nasal branches to supply the mucous membrane of the lateral wall of the nose. 13 If doingextractionfor the1storemolar c middlesuperior It isoarsedbetween midline ofthe the and gingivalmargin s greaterpalatine nerve Greater palatine n. palate the supplythemucosa bonetnd Greater palatine F. Greater palatine canal g bone nerve pulpand buccalsum b Paff Branches of the pterygopalatine ganglion softpalate a nerves: 2- Lesser palatine runsthroughthegreaterpalatinecanal passthrough lesserpalatine They run through the greater palatine canal, emerges through the lesser palatine foramina in the hard palate. It supplies the mucous membrane of the soft palate. foramen supply sensation and glandssecretions Greater palatine canal Lesser palatine n. 14 Lesser palatine F. Soft palate Branches of the pterygopalatine ganglion men 3- Nasal Nerves: Spheno palatine fogra fora men - Enters the nasal cavity through sphenopalatine foramen. - It supplies the membrane of the nose. mucous Nasal nerves 15 a lati nos e Sph ne ofthemaxillary extraction Branches of the pterygopalatine ganglion spherepalatineforamen It will supplythe 4- Nasopalatine nerve : 1- Enters the nasal cavity through sphenopalatine foramen. 2- Then runs across the nasal septum, and through the incisive canal it will reach the oral cavity. 3- It supplies small area of nasal septum and provide sensation to the palatal mucosa in the region of the premaxilla (canines through central incisors). ofthe palatalgum centralincisor fagging lateralincisor superior anterior among nerve centralincisors Lateralincisors canines nasotalatin nerve Nasopalatine n. n Nasal septum Sphenopalatine foramen 16 Incisive canal Nasopalatine n. Branches of the pterygopalatine ganglion 5- Pharyngeal nerve: Supplies the mucous membrane of the nasopharynx. All 6 branchesofthe Pterygopalatineganglion will supplyInaisetretomotorfibersfor anygland thatsuppingthesestructures Pharyngeal branch Nasopharynx 6- Orbital nerve: Supplies periosteum of the orbit 17 Maxillary artery- 3rd part 1- Enters the pterygopalatine fossa through the pterygomaxillary fissure. Infrerior orbital fissure 2- It gives branches that correspond to branches of the maxillary nerve. Infraorbital a. Pterygomaxillary fissure 3- Passes into the orbit through the inferior orbital fissure as the infraorbital artery and emerges with the infraorbital nerve on the face. v through infraorbitalforamen 18 Maxillary a. Maxillary artery- 3rd part Branches: Sphenopalatine a. Pharyngeal a. 1- Palatine arteries (greater & lesser palatine branches) Supplying hard and soft palate. Artery of Pterygoid canal 2- Posterior superior alveolar artery moffman Supplies upper posterior teeth, buccal gingiva, and maxillary sinus. 3-Sphenopalatine artery Supplies the nasal cavity. 4- Pharyngeal artery Suplies nasopharynx. 5- Artery of the pterygoid canal Supplies nasopharynx and tympanic cavity. Note: Infraorbital artery gives a branch called anterior superior alveolar artery to supply anterior teeth. Then emerges through infraorbital foramen to supply lower eyelid, 19 side of the nose, and upper lip. Post. Sup. Alveolar a. G Falatined V palatine a. C palate Pterygopalatine Fossa – Venous Drainage Veins correspond to branches of maxillary artery. The main site of drainage is into the pterygoid venous plexus in the infratemporal fossa. Pterygoid venous plexus 20 a Review Questions Q1- Fill in the blanks: 1- Anterior division of the mandibular nerve is mainly ------------------------, with only one --------------------- branch. 2- Chorda tympani nerve is a branch of the ----------------- nerve given off in the tympanic cavity and join -----------nerve in the infratemporal fossa. 3- Otic ganglion is concerned primarily with supplying ------------------------------------ . 4- Pterygopalatine fossa communicates posteriorly with -------------------------- through ------------------------ opening. 5- The preganglionic sympathetic fibers of pterygopalatine ganglion come through ------------------------------- nerve. 6- The palatal mucosa & palatal glands from third molar as far as the canine tooth is supplied by --------------- nerve. 7- The skin of the lower eyelid, side of the nose, and upper lip is supplied by --------------------------------------- nerve. 8- Pterygopalatine fossa communicates anteriorly with ----------------------- through ---------------------------- opening. 9- The Preganglionic sensory fibers of pterygopalatine ganglion come through ------------------------------------- nerve. 1021 --------------- nerve supplies small area of nasal septum & palatal mucosa of the incisor region of the hard palate. Review Questions Q2- Correlate the following nerves with their main branches or ganglia. Nerve 1- Supraorbital nerve 2- lesser petrosal nerve 3- Long buccal nerve 4- Lingual nerve 5- Nerve to tensor tympani muscles 6-Greater palatine nerve 7- nervous spinosus nerve 8- Incisive Nerve 9- Infraorbital nerve 10- Mental nerve 11- Posterior superior alveolar nerve 22 12- Mylohyoid nerve Branch of frontal nerve / a branch of the ophthalmic division of the trigeminal nerve ( V ) Review Questions Q3- Match the following branches of the maxillary artery with the corresponding part. Branch First part Deep temporal artery Sphenopalatine artery Inferior alveolar artery Palatine artery Anterior tympanic artery Buccal branch Pharyngeal artery Middle meningeal artery Posterior superior alveolar artery Deep auricular artery 23 Second part Third part Review Questions Q4- Write ( T ) in front of the true statement and ( F ) in front of the false one. 1- The infratemporal fossa communicates with the pterygopalatine fossa through the inferior orbital fissure. 2 - Temporal fascia is a strong sheet of fibrous tissue, it is considered as the lateral extension of temporalis muscle. 3 - Nervous spinosus nerve is sensory in nature, it is branch from the main trunk of the mandibular nerve. 4- Inferior alveolar nerve is a branch from the anterior division of the mandibular nerve. 5- The upper head of lateral pterygoid muscle arises from maxillary tuberosity. 6- Chorda tympani nerve emerges on the base of the skull by passing through foramen ovale. 7- The infratemporal fossa communicates with the orbit through the superior orbital fissure. 8- Temporal fascia is a strong sheet of fibrous tissue that attaches to superior temporal line superiorly, and zygomatic arch inferiorly. 9- Long buccal nerve is motor in nature, it is branch from the posterior division of the mandibular nerve. 10- The lingual nerve is a branch from the mandibular nerve that convey taste sensation from the anterior 2/3 of the tongue. 11- The lower head of lateral pterygoid muscle arises from lateral surface of the lateral pterygoid plate. 12- Chorda tympani nerve carries general sensation for the anterior 2/3 of the tongue. 13- Pterygopalatine fossa communicates posteriorly with middle cranial fossa through foramen rotundum. 14- The Preganglionic sympathetic fibers of pterygopalatine ganglion come through deep petrosal nerve. 15- To extract tooth #18, you have to anesthetize posterior superior alveolar nerve and greater palatine nerve. 16- The skin of the lower eyelid, side of the nose, and upper lip is supplied by mental nerve. 17- Pterygopalatine fossa communicates anteriorly with foramen lacerum through pterygoid canal. 18- The Preganglionic sensory fibers of pterygopalatine ganglion come through auriculotemporal nerve. 19- nasopalatine nerve supplies small area of nasal septum and the palatal mucosa of the incisor region of the hard palate. 24 20- Inferior alveolar artery is a branch from the second part of maxillary artery. 25