Temporal, infratemporal and pterygopalatine fossae

With questions & answers

Write an account of the course and distribution of the mandibular division of the trigeminal nerve

Briefly state its central connections

Give an account of the maxillary division of the trigeminal nerve and its branches

MS Part I –past questions

Describe the course, distribution and clinical anatomy of the maxillary artery.

Add a note on its development

MS Part I –past questions

Write an account of the attachments, relations and actions of the lateral pterygoid muscle

MS Part I –past questions

Infratemporal fossa

A. Communicates with pterygopalatine fossa through pterygomaxillary fissure

B. Contains the otic ganglionC. Contains the temporalis muscleD. Has the lateral pterygoid muscle as a medial boundayE. Contains the maxillary nerve A, B, D

Multiple Choice Questions

Auriculotemporal nerveA. Is branch of the maxillary nerveB. Recieves secretomotor fibres from the otic ganglionC. Embraces the origin of the middle menigeal arteryD. Innervates the tympanic memebraneE. supplies temporomandibular joint

B, C, D, E

Multiple Choice Questions

Maxillary nerveA. passes through the pterygopalatine fossaB. innervates the teeth of upper jawC. supplies the skin of templeD. leaves the cranial cavity through foramen rotundumE. supplies muscles of mastication

A, B, C, D

Multiple Choice Questions

Lateral pterygoid muscleA. Is supplied by a branch of the mandibular nerveB. Is inserted into the articular disc of TM jointC. Elevates the mandibleD. Arises from the medial pterygoid plateE. Has a venous plexus surrounding it A, B, E

Multiple Choice Questions

Temporal, infratemporal and pterygopalatine fossae

Prof Deepthi NanayakkaraDepartment of Basic SciencesFaculty of dental sciencesUniversity of Peradeniya

Contents

Temporal, infratemporal and pterygopalatine fossae and their contents

Muscles of mastication Mandibular nerve and its branches Maxillary nerve and its branches Maxillary artery and its branches Pterygopalatine and otic ganglia and their

connections Chorda tympani

Temporal Fossa

Boundaries Upper – superior and inferior temporal lines Lateral - Temporal fascia Anterior – Frontal process of zygomatic bone Zygomatic process of frontal bone Maxilla Inferior – zygomatic arch laterally infratemporal crest of greater wing of sphenoid - medially Medially - pterion

Temporal Fossa

Contents

Temporalis Deep temporal nerves Auriculo-temporal nerve Superficial temporal artery Zygomaticotemporal nerve

Origin: Temporal fossa, temporal fasciaInsertion: Coronoid process and temporal crest of the mandibular ramus

Blood supply: Anterior and posterior deep temporal arteriesNerve supply: Anterior and posterior deep temporal nerves

Action: Elevation and retraction of the mandible

Contents- Temporalis

Anterior division of mandibular nerve

Upper border of lateral pterygoid muscle

Deep surface of temporalis

Contents- Deep temporal nerves

Contents- Auriculo-temporal nerve

Posterior division of mandibular nerve

Upper border of parotid gland, behind TMJ

Crosses zygomatic arch behind STA and front of auricle

Supply

Skin of auricle

Ext aud meatus

Scalp over temple

Contents- superficial temporal artery

Branch of ECA Upper border of parotid

gland, behind TMJ

Crosses zygomatic arch behind STA and front of auricle

Anterior and posterior divisions

Deep to zygomatic arch temporal fossa communicates with infratemporal fossa

Space beneath base of skull between wall of pharynx and ramus of mandible

Infratemporal Fossa

Medial - lat pterygoid plate (lat surface) Lateral – ramus and coronoid process Anterior – post surface of maxilla Roof – infratemporal surface of greater wing

of sphenoid Posterior – styloid process and carotid sheath

behind

Infratemporal Fossa - boundaries

Infratemporal Fossa - boundaries

Infratemporal Fossa -contents

Lateral pterygoid

Medial pterygoid

Mandibular division of V

Otic ganglion

Chorda tympani

Maxillary artery

Pterygoid plexus of veins

Maxillary vein

Contents - lateral and medial pterygoids

Lateral pterygoid Origin: Upper head – infratemporal surface of greater wing of sphenoid Lower head – lat. surface of lateral pterygoid plate

Insertion: Upper head - capsule and articular disc of TMJ Lower head - pterygoid fovea of condylar neck Blood supply: Twigs / maxillary artery

Nerve supply: mandibular division of V

Action: Protraction and opening movements of mandible

Medial pterygoid Origin: Medial surface of lateral

pterygoid plate and maxillary tuberosityInsertion: Medial surface of ramus of mandible

Blood supply: Arterial twigs/ maxillary artery

Nerve supply: Nerve to medial pterygoid

Action: Protraction and elevation of the mandible

Contents- mandibular nerve Foramen ovale small motor root

large sensory root unite

divide

Small anterior division

Large posterior division

Branches from main trunk

Meningeal branch (foramen spinosum)

meninges in middle cranial fossa

Nerve to medial pterygoid : medial pterygoid

two branches :

tensor tympani

tensor palati

Branches from anterior division

masseteric : masseter

Nerve to lateral pterygoid :

lateral pterygoid

deep temporal nerves (2) : temporalisMOTOR

Buccal nerve : skin over cheek mucosa lining cheek

SENSORY

Branches from posterior division

Auriculotemporal nerve

Lingual nerve

MOTOR

SENSORY

Inferior alveolar nerve

Nerve to mylohoid

Supplies: mylohoid muscle

anterior belly of digastric

2 roots embrace middle meningeal artery

Behind temporomandibular joint with superficial temporal artery

postganglionic parasympathetic secretomotor fibres from the otic ganglion – to parotid gland

Auriculotemporal nerve

Supply : skin of auricle , external auditory meatus tympanic membrane, parotid gland, TM joint, skin of scalp

Auriculotemporal nerve

Lingual nerve

Emerging at lower border of lat pterygoid

chorda tympaniBetween tensor palati and lat pterygoid

Between lat and medial pterygoids

In direct contact with mandible medial to third molar

Lies over hyoglossus

Lies over genioglossus

General sensory to Anterior 2/3 tongue, floor of mouth

Lingual nerve

Chorda tympaniA branch of facial nerve Petrotympanic fissure

Lingual nerve

Chorda tympani

Infratemporal fossa

i. Preganglionic parasympathetic secretomotor : submandibular and sublingual salivary glands ii. taste fibres from anterior 2/3 of tongue

arises deep to descends on lateral surface lateral pterygoid of medial pterygoid

and sphenomand. ligament

enters mandibularforamen

nerve to mylohyoid mandibular canal mylohoid muscle anterior belly of digastricmental foramen

Inferior alveolar nerve1. teeth of lower jaw and gingivae (incisive nerve)2. skin of chin (mental branch)

Inferior alveolar nerve

Inferior salivatory nucleusof Glossopharyngeal nerve

Otic ganglion

tympanic plexus

tympanic branch

Lesser petrosal nerve

parotid gland

otic ganglion Auriculo temporal nerve

postganglionic

preganglionic

Origin : behind neck of mandible From external carotid artery first part superficial to lower head of lateral pterygoidPterygopalatine second part fossa third part between two heads of

lateral pterygoid through pterygomaxillary fissure

Maxillary artery

Lies around and within the lateral pterygoid muscle

Tributaries correspond to branches of maxillary artery

The plexus is drained by maxillary vein

Pterygoid plexus of veins Maxillary vein

Pterygoid plexus of veins.

Communications

With the inferior ophthalmic vein through inferior orbital fissure

With the cavernous sinus through emissary veins

With the facial vein through deep facial vein

Pterygoid plexus of veins Maxillary vein

Pterygopalatine Fossa

A small space between the back of the maxilla and the front of the pterygoid process of the sphenoid bone

It communicates with the infratemporal fossa via the pterygomaxillary fissure

Pterygopalatine Fossa

posteriorly by the sphenoid bone (root of the the pterygoid process containing the pterygoid canal and the foramen rotundum)

medially by the palatine bone

anteriorly by the posterior wall of the maxilla

superiorly by the body of the sphenoid and the orbital process of the palatine

Pterygopalatine Fossa - boundaries

Location of the openings in the posterior wall Foramen rotundum- connection to the middle cranial

fossa Contents: Maxillary nerve

Pterygoid canal- medial and inferior to rotundum Contains the nerve of the pterygoid canal

(greater superficial petrosal nerve and deep petrosal nerve)

Pharyngeal canal- connection to the nasopharynx Contents: pharyngeal nerve (a branch of V2, coming

off the pterygopalatine ganglion) and pharyngeal artery (a branch of the third part of the maxillary artery)

Pterygopalatine Fossa - connections

Location of the openings in the superior wall

Spheno-palatine foramen- connection to the nasal cavity

Contents: sphenopalatine (also known as nasopalatine) nerve

(a branch of V2 coming off the pterygopalatine ganglion),

sphenopalatine artery (a branch of the third part of the maxillary artery).

Pterygopalatine Fossa - connections

Location of the openings on the anterior wall

Inferior orbital fissure- connection with the orbit Contents:

infraorbital nerve (a branch of V2),

infraorbital artery (a branch of the third part of the maxillary artery)

Pterygopalatine Fossa - openings

Inferiorly pterygopalatine fossa continues into a canal - connection with the the oral cavity

Pterygopalatine canal leads to the greater and lesser palatine foramina

Contents: descending palatine nerve (a branch of V2 coming off the pterygopalatine ganglion), descending palatine artery (a branch of the third part of the maxillary artery)

Pterygopalatine Fossa - connections

Laterally through the pterygo-maxillary fissure - connection with the infratemporal fossa Contents: maxillary artery enters pterygopalatine fossa via

pterygo-maxillary fissure Posterior superior alveolar artery leaves the

maxillary artery in the pterygo-palatine fossa but turns around and comes back out of the fossa via pterygo-maxillary fissure to enter its foramen on the tuberosity of the maxilla

Pterygopalatine Fossa - connections

Maxillary nerve pterygopalatine ganglion maxillary vessels

Pterygopalatine Fossa - contents

Pterygopalatine Fossa - contents

Maxillary Nerve Gives off a meningeal branch

Enters fossa

middle superior al nerve

Lateral wall max sinus

inferior orbital fissure

infraorbital nerve

infraorbital groove

infra orbital canal

skin of face

Premolar teeth

infra orbital foramen

anteior superior al nerve

anteriorl wall max sinus

Upper incisors

Canines

Max sinus

Roof of max sinus

Maxillary Nerve – branches in pterygopalatine fossa

Zygomatic nerve

Infratemporal fossa

1. Molar teeth and adjacent buccal gingivae

2. Maxillary sinus

1. Zygomatico temporal

2. zygomaticofacial

Posterior superior

alveolar nervePterygomaxillary fissure

Posterior surface of maxilla

Two ganglionic branches

Secretomotor fibres Lacrimal nerve Lacrimal gland

Pterygopalatine Fossa - contents

Maxillary Nerve – branches in pterygopalatine fossa

Orbital branches

Palatovaginal canal

1. Orbital wall

2. Sphenoidal/ ethmoidal sinuses

infraorbital fissure

Pharyngeal nerve

Glands of nasopharynx

Maxillary Nerve – branches in pterygopalatine fossa

Sphenopalatine foramen

Nasal nerves (7)

Nasal cavity

Lateral and medial wall

Nasopalatine nerve

Largest of nasal nerves

Medial wall Nasal septum

Incisive canalMucosa, gingiva and glands adjacent to incisor teeth

Maxillary Nerve – branches in pterygopalatine fossa

Passes inferiorlyGreater palatine nerve

Pterygopalatine canal

Roof of oral cavity

Lesser palatine foramen

Mucosa, glands of hard palate adjacent gingivae up to incisor teeth

Greater palatine foramnina

lesser palatine nerve

Soft palate

Post inf nasal nerve

Lateral nasal wall

Pterygopalatine ganglion

Relay station between the superior salivatory nucleus and the lacrimal gland and glands of the nose, palate, nasopharynx and paranasal sinuses

Is suspended from the maxillary nerve by two ganglionic branches

Location: just anterior to opening of pterygoid canal

Pterygopalatine Fossa - contents

i. Greater petrosal nerve

ii. Deep petrosal nerve

Nerve of pterygoid canal

Foramen lacerum: middle cranial fossa

Nerve of pterygoid canal

Pterygopalatine ganglion

Post ganglionic sympathetic vasoconstrictor fibres

Pre ganglionic parasympathetic secretomotor fibres

Pterygopalatine fossa

Greater petrosal nerve

origin : geniculate ganglion of facial nerve in temporal bone

Petrous part of temporal bone

Posterior margin – middle cranial fossaForamen lacerum

Deep petrosal nerve

Greater petrosal nerve

Greater petrosal nerve – extractanial course

Mandibular nerveA. Supplies the temporalis muscleB. Has the buccal nerve as one of its branchesC. Supplies the anterior belly of digastricD. Leaves the cranial cavity as separate motor and sensory rootsE. Divides into its two trunks in the infratemporal fossa

A, B, C, D, E

Parasypathetic secretomotr fibres from pterygopalatine ganglion are distributed to the

A. Parotid glandB. lacrimal glandC. Glands in the mucosa of the maxillary air sinusD. to glands in the palateE. Submandibular gland B,C, D

Auriculotemporal nerveA. Is branch of the maxillary nerveB. Recieves secretomotor fibres from the otic ganglionC. Embraces the origin of the middle menigeal arteryD. Innervates the tympanic memebraneE. supplies temporomandibular joint

B, C, D, E

Maxillary nerveA. passes through the pterygopalatine fossaB. innervates the teeth of upper jawC. supplies the skin of templeD. leaves the cranial cavity through foramen rotundumE. supplies muscles of mastication

A, B, C, D

Lateral pterygoid muscleA. Is supplied by a branch of the mandibular nerveB. Is inserted into the articular disc of TM jointC. Elevates the mandibleD. Arises from the medial pterygoid plateE. Has a venous plexus surrounding it A, B, E

Infratemporal fossa

A. Communicates with pterygopalatine fossa through pterygomaxillary fissure

B. Contains the otic ganglionC. Contains the temporalis muscleD. Has the lateral pterygoid muscle as a medial boundayE. Contains the maxillary nerve A, B, D

Buccal branch of mandibular nerveA. Supplies the mucous membrane on the medial

surface of the buccinatorB. Runs between the two heads of the lateral pterygoidC. Supplies the skin over buccinatorD. Is the only sensory branch of the mandibular nerveE. Is a branch of the anterior division A, B, C, E

Greater petrosal nerveA. is a branch of the facial nerveB. Receives taste fibres from the anterior two

thirds of the tongueC. Passes through the greater palatine canalD.Begins at the geniculate ganglionE. Passes through the posterior cranial fossa

A, D

Pterygopalatine fossa

A. Communicates with the middle cranial fossa via foramen rotundum

B. Contains the pterygopalatine ganglionC. Is bounded medially by the palatine boneD. Communicates with the nasopharynxE. Contains the maxillary nerve A, B,C, D, E

Temporalis muscleA. Is supplied by the deep temporal nervesB. Is attached to the coronoid processC. Depresses the mandibleD. Has posterior fibres that retract the mandibleE. Has fibres originating from temporal fascia A, B, D, E

Pterygopalatine ganglion

A. Supplies the sphincter pupillae muscleB. Supplies secretomotor fibre to the lacrimal glandC. Gives passage to sympathetic fibresD. Distributes secretomotor fibre to glands of nasopharynxE. Receives preganglionic secretomotor fibres from greater

petrosal nerve B,C, D, E

Lateral pterygoid muscleA. Derives from form fisrt arch mesodermB. Is attached to the infratemporal surfaceC. Is attached to the capsule of the TM jointD. Has the maxillary artery running between its two

headsE. Has the buccal nerve on its superficial surface A, B, C, D, E

Maxillary arteryA. Arises behind the neck of mandibleB. Lies in the temporal fossaC. Passes through the pterygomaxillary fissureD. Gives off the middle meningeal arteryE. Passes through the teo heads of lateral pterygoid

muscle A, B, C, D, E

Medial pterygoid muscleA. Derives from form fisrt arch mesodermB. Is attached to the lateral pterygoid plate of sphenoidC. Is attached to the maxillary tuberosityD. Is supplied by a branch of the mandibular nerveE. Has the tensor palati superficial to it

A, B, C, D, E

Write an account of the course and distribution of the mandibular division of the trigeminal nerve

Briefly state its central connections

Give an account of the maxillary division of the trigeminal nerve and its branches

MS Part I –past questions

Describe the course, distribution and clinical anatomy of the maxillary artery.

Add a note on its development

Write an account of the attachments, relations and actions of the lateral pterygoid muscle

Superficial : masseter, ramus of mandible, tendon of temporalis and maxillary artery

Relations

Deep : mandibular nerve, middle meningeal artery sphenomandibular ligament, deep head of medial pterygoid

Emerging from upper border: deep temporal nerves, masseteric nerve

Relations

Passing in the gap between two heads: maxillary artery and the buccal branch

Emerging at the lower border: lingual nerve, inferior alvelolar nerve, middle meningeal artery passes upwards

In and around it : pterygoid plexus of veins