Anatomy The skull and face The temporal region Infratemporal and pterygopalatine fossae

Done by : Dr. Noor B. Najjar

Scalp

Scalp :Skin: thick, hair bearing and contains numerous sebaceous gland.

Connective Tissue: fibro-fatty, highly vascular layer, uniting the skin to underlying aponeurosis of the occiptofrontalis muscle

Aponeurosis ( Epicranial ): thin, tendinous sheet that unites the occipital and frontal bellies of the occiptofrontalis muscle.

Loose subaponeurotic layer: occupy the subaponeurotic space.Connect aponeurosis to the pericranium

Pericranium: Periosteum covering outer surface of the skull bones

Muscles of the scalp Occiptofrontalis muscle

Origion: 2 occipital bellies each arise from highest nuchal line on occipital bone

2 Frontal belly arise from the skin of eyebrow.(from anterior lateral margin of the aponeurosis)

Connected over the cranial vault by the epicranial aponeurosis.

Insertion: the skin of the corresponding eyebrow and into the orbicularis oculi muscle

Nerve supply: Occipital belly by Posterior Auricular branch of Facial nerve,

Frontal belly by temporal branch of Facial nerve.

Action: Moving forward or backward first 3 layers of scalp,

frontal belly raise the eyebrow in expression of surprise or horror.

Epicranial aponeurosis

A sheet of strong connective tissue which covers the vertex of the skull between the occipital and frontal bellies. It is firmly attached to the skin of the scalp by the dense subcutaneous layer

Laterally it fades out above the ears.

Sensory Nerve supply

Supratrochlear Nerve: branch of ophthalmic division of trigeminal

nerve

Supply: The forehead and front of scalp

Supraorbital Nerve: branch of ophthalmic division of trigeminal nerve

Supply: The forehead and front of scalp

Auriculotemporal nerve: branch of mandibular division of trigeminal nerve

Supply: Temple region

Lesser occipital nerve: branch of cervical plexus

Supply: region above and behind the ear

Greater occipital nerve: branch of posterior ramus of second cervical nerve

Supply: Posterior part of scalp

Arterial supply and venous drainage

Supratrochlear and supraorbital arteries / veins Superficial temporal Artery / vein Posterior auricular artery/ vein Occipital artery / vein

They run in the subcutaneous layer, they have very tortuous courses and anastomose freely with each other

Lymph drainage of the skull

Anterior part submandibular lymph nodesLateral Part superficial parotid nodes Back of scalp occipital nodesAbove and behind the ear mastoid nodes

The Face Sensory innervation

Skin of the face is supplied by all branches of trigeminal nerve except area over the mandible and parotid area which is supplied by greater auricular nerve

Trigeminal Nerve divisions

1. Opthalmic nerve

- lacrimal nerve

- Supraorbital nerve

- Supratrochlear nerve

- Infratrochlear nerve

- External nasal nerve

2. Maxillary Nerve

- Infraorbital nerve

- zygomaticofacial nerve

- Zygomaticotemporal nerve

3. Mandibular nerve

- mental nerve

- Buccal nerve

- Auriculotempoarl nerve

Arterial supply of face

From 2 main vessels : facial and superficial temporal arteries Branches of facial artery Branches of temporal arteries

1. submental artery 1.transverse facial artery

2. inferior labial artery

3. superior labial artery

4. lateral nasal artery

Supraorbital and Supratrochlear arteries branches of ophthalmic artery.

Venous Drainage of the face

Facial vein Its formed at the angle of the eye by the union of supraorbital and supratrochlear veins. It is connected to the superior ophthalamic vein directly through the supraorbital vein. Connected to cavernous sinus by superior ophthalamic vein.

Note : This connection is of great importance because it provides path of spread of infection from the face to the cavernous sinus.

Then the facial vein descend behind the facial artery to the lower margin of the body of the mandible. It then crosses superficially to the submandibular gland and is joined by the anterior division retromandibular vein. The facial vein ends by draining into the internal jugular vein.

Facial vein receive tributaries from that correspond to the branches of the facial artery.

Its joined to the pterygoid venous plexus by the deep facial vein and to the cavernous sinus by the superior ophthalmic vein.

The transverse facial vein joins the superficial temporal vein with in the parotid gland.

Lymph drainage of the face

Forehead and anterior part submandibular lymph nodes

Lateral part lymph vessels that end in the

parotid lymph nodes Central part of lower lip and skin of chin submental lymph

nodes

Bones of the face

It is made of :1. frontal bone: area above superior alveolar margin

It contain frontal air sinuses

2. Zygomatic bone: forms lateral orbital margin

3. Maxilla bone: forms inferior orbital margin with zygomatic bone

It is the most important central bone of middle third of the face, contain teeth and maxillary air sinuses

Medial orbital margin is formed by maxillary process of frontal bone and frontal process of the maxilla

4. Nasal bones: forms roots of the nose

5. Mandible bone: forms lower third of the face with its teeth.

Muscles of the face/ superficial muscles

Are derived from the mesoderm of the second pharyngeal arch and receive motor innervation from the facial nerve.

No deep fascia in the face. There are several small muscles associated with the

external ears, these are derived from the second pharyngeal arch and are innervated by the facial nerve. They are virtually functionless in man.

Muscles of facial expression Muscles of eye orbit 1.Orbicularis oculi: the sphincter muscle

palpebral part orbital part

origin: medial palpebral ligament medial palpebral ligament and adjoining bone insertion: lateral palpebral raphe loops return to origin

action: closes eye and dilate lacrimal sac throws skin around orbital into fold to protect the eyeball nerve supply: Facial nerve facial nerve

2. Levator palpebrae superior: the dilator muscle

3. Occiptofrontalis

Muscles of nostrils 1. Dilator Naris 2. Compressor naris

origin: Maxilla frontal process of maxilla

Insertion: Ala of nose aponeurosis of bridge of nose

action: widen nasal aperture compress mobile cartilage

nerve supply: Facial nerve facial nerve

Muscles of lips

Sphincter muscle of the lips

Orbicularis oris

Origin: Near midline on anterior surface of maxilla and mandible and modiolus at angle of mouth

Inserion: Mucous membrane of margin of lips and raphe with buccinator at modiolus

Action: Narrows orifice of mouth, purses lips and puckers lip edges

Nerve: buccal and mandibular branches of the facial nerve

Dilator muscles of the lips1.Levator labii superioris alaque nasi

2.Levator labii superioris

3. Zygomatic minor

4. Zygomatic major

5.Risoris

6.Levator Anguli oris

7. Depressor anguli oris

8. Depressor labii inferiors

9. Mentalis

arise from bones and fascia around the oral aperture and

insert into substance of the lip

Supplied by Facial nerve

Muscles of cheeks

Buccinator Muscle

Origin: From maxilla and mandible adjacent to the molar teeth and from pterygomandibular raphe and pterygoid hamulus behind the last molar teeth

Nerve: Motor innervation is from the buccal branch of the Facial nerve.

Sensory innervation is supplied by the buccal branch of the mandibular part of the trigeminal

Action: Compress the cheeks and lips against the teeth (in blowing and whistling)

Muscles of MasticationDerived from mesoderm of first pharyngeal arch

1. Masseter The masseter muscle is the most powerful muscle of mastication. It is quadrangular in shape.

Made of 3 layers:

- Superficial layer: largest component of the muscle arise by strong aponeurosis from anterior two third of the zygomatic arch and inserted to the lateral surface of lower half of the ramus, including the angle of the mandible.

-Middle layer: from the medial surface of the anterior two third and lower border of posterior one third of the arch; and inserted into the lateral surface of the middle part of the ramus.

-The deep layer : originates from the zygomatic arch of the temporal bone. And inserted to upper part of the mandibular ramus.

These3 layers are distinctive posterior and fuse anteriorly.

Actions: Elevates the mandible, closing the mouth.

Innervation: massetric branch of anterior division of the Mandibular nerve (V3).

Blood supply: Facial artery

2. Temporalis muscleThe temporalis muscle originates from the temporal fossa – a shallow depression on the lateral aspect of the skull. The muscle is covered by tough fascia, this can harvested surgically, and used to repair a perforated tympanic membrane (an operation known as a myringoplasty).

Attachments: Originates from the temporal fossa. It condenses into a tendon, which inserts onto the coronoid process of the mandible.

Actions: Elevates the mandible, closing the mouth.

Also retracts the mandible, pulling the jaw posteriorly.

Innervation: Mandibular nerve (V3)

3. Lateral pterygoid

The lateral pterygoid muscle has a triangular shape, with two heads; superior and inferior. It has horizontally orientated muscle fibres, and thus is the major protractor of the mandible.

Attachments: The superior head originates from the greater wing of the sphenoid. The inferior head originates from the lateral pterygoid plate of the sphenoid. The two heads converge into a tendon, which attaches to the neck of the mandible.

Actions: Acting bilaterally, the lateral pterygoids protract the mandible, pushing the jaw forwards. Unilateral action produces the ‘side to side’ movement of the jaw.

Innervation: Mandibular nerve (V3).

4.Medial Pterygoid

The medial pterygoid muscle has a quadrangular shape, with two heads; deep and superficial. It is located inferiorly to the lateral pterygoid.

Attachments: The superficial head originates from the maxillary tuberisty and neighbouring part of palatine bone. The deep head originates from the lateral pterygoid plate of the sphenoid bone. Both parts attach to the ramus of the mandible, near the angle of mandible.

Actions: Elevates the mandible, closing the mouth

Innervation: Mandibular nerve (V3).

Pterygomandibular space: the gap between the muscle and medial surface of the ramus above the insertion

Pterygomandibular space and anatomy of inferior alveolar block

Pterygomandibular space:

It is a potential space in the head and is paired on each side.

Contents of the Pterygomandibular space: The mandibular division of the trigeminal nerve which divides

into many branches including the Inferior alveolar nerve. The inferior alveolar artery and vein. The sphenomandibular ligament.

Boundaries of each pterygomandibular space are:The posterior border of the buccal space anteriorly.The parotid gland posteriorly.The lateral pterygoid muscle superiorly.The inferior border of the mandible (lingual surface) inferiorly.The medial pterygoid muscle medially (the space is superficial to medial pterygoid).The ascending ramus of the mandible laterally (the space is deep to the ramus of the mandible).

A Temporalis muscle, B Masseter muscle, C Lateral pterygoid muscle, D Medial ptaerygoid muscle, E Superficial temporal space, F Deep temporal space, G Submasseteric space, H Pterygomandibular space, I Approximate location of infratemporal space.

Note: The Only way to anesthetize the mandibular teeth is to anesthetize the main trunk of inferior alveolar nerve when it’s in the pterygomandibular space before it enters the mandibular canal. Because mandibular bone is dense therefore the local anesthetic can’t diffuse through it.

 

Stylohyoid ligament The styloid process ossifies in the dorsal part of the cartilage of the second pharyngeal

arch.

The lesser cornu and upper part of the body of the hyoid bone ossify in the ventral part of this cartilage. The intervening part atrophies but its perichondrium persists as the stylohyoid ligament, a well defined cord of fibrous tissue which runs from the tip of the styloid process to the apex of the lesser cornu of the hyoid bone.

Stylohyoid muscle Origin: The stylohyoid muscle arises from the posterior surface of the styloid process.

It runs downwards and forwards crossing superficial to the external carotid artery before the latter structure enters the parotid gland. A short distance above the hyoid bone the muscle divides into two slips which pass one either side of the intermediate tendon of the digastric muscle to be i Inserted As 2 tendinous slips that pass on either side of the intermediate tendon of digastric.

Innervation: Facial nerve.

Action: Elevate the hyoid.

The muscle is derived from the second pharyngeal arch.

Styloglossus muscle Origin: from the anterior aspect of the lower part of the styloid process and of the neighbouring part of the stylohyoid ligament.

Stylopharyngeus muscle Origin: Arises from the medial surface of the styloid process. It runs almost vertically

downwards, passes between the internal and external carotid arteries, crosses the lower border of the superior constrictor muscle and then continues downwards inside the middle constrictor, beneath the pharyngeal mucous membrane

Insertion: Into the posterior border of the thyroid cartilage and the side wall of the pharynx.

Innervation: The glossopharyngeal nerve.

Styloid apparatus The styloid process is a curved bony spine, of variable length, which projects downwards and somewhat forwards from the inferior surface of the temporal bone and lateral to the internal carotid artery. Its upper part (the base) is fused with the tympanic plate. Its lower part gives attachment to two ligaments and three muscles.

Sphenomandibular ligament This is a well-developed band of fibrous tissue which extends

from the spine of the sphenoid to the lingula of the mandible and the adjacent margin of the mandibular foramen.

As it passes downwards and forwards it is separated from the neck of the mandible by the maxillary vessels while more inferiorly (in the pterygomandibular space) it is separated from the ramus of the mandible by the inferior alveolar nerve and vessels.

Medially relation: to the pharyngeal wall above and to the medial pterygoid muscle below.

The ligament is pierced near to its attachment to the lingula by the mylohyoid nerve and vessels.

Developmentally, the sphenomandibular ligament is a remnant of Meckel's cartilage.

Temporal Region Is situated on the side of the head.

The temporal lobe is one of the four Major lobes of the cerebral cortex in the brain of mammals. The temporal lobe is located beneath the lateral fissure on both cerebral hemispheres of the brain.

The temporal lobes are involved in processing sensory input into derived meanings for the appropriate retention of visual memories, language comprehension.

1.Temporal Fossa Medial: Frontal bone, Parietal bone, Temporal bone, Sphenoid bone, Occipital bone.

Lateral: Temporal fascia.

Anterior: Posterior surface of the frontal process of the zygomatic bone and the posterior surface of the zygomatic process of the frontal bone.

Superior: Pair of temporal lines (superior and inferior temporal lines) that arch across the skull from the zygomatic process of the frontal bone to the supramastoid crest of the temporal bone.

Inferior: Zygomatic arch laterally and by the infratemporal crest of the greater wing of the sphenoid medially.

Content:

It is occupied by the temporalis muscle and its covering fascia, the deep temporal nerves and vessels, the auriclotemporal nerve, and the superficial temporal artery.

Parotid gland The largest of the salivary glands, is mainly serous but contains a few scattered mucous acini.

Location: lies below the external acoustic meatus wedged between the mandibular ramus in front and the mastoid process and sternocleidomastoid muscle behind.

Structure: facial nerve pass through it and divides it into deep and superficial parts/lobes.

1. Glenoid lobe: Superior margin extend upward behind the TMJ into posterior part of mandibular fossa.

2. Facial process: Anterior margin of the gland extend forward superficial to the masseter muscle.

3. Accessory part of the gland: small part of the facial process may be separate from the main gland.

4. Pterygoid process: Deep part of the gland may extend forward between the medial pterygoid muscle and the ramus of the mandible.

Parotid duct: The duct draining the gland begins by the confluence of tributaries within the anterior part of the gland. It emerges from the anterior border of the gland and runs forwards across masseter below the accessory part of the gland. At the front edge of masseter it turns medially, pierces buccinator and opens on the oral surface of the crown of the second upper molar.

Structures within the Parotid gland Three major non-glandular structures traverse the gland. From deep to superficial these are as follows

1. External carotid artery enters the gland through the lower part of its posteromedial surface. Within the gland the artery divides into its two terminal branches - the maxillary artery which leaves the gland through its anteromedial surface and the superficial temporal artery which leaves through the upper part of the superficial surface.

2. Retromandibular vein is formed within the gland, by the union of maxillary and superficial temporal veins. It runs downwards lateral to the external carotid artery and in the lower part of the gland or after emerging from there splits into anterior and posterior divisions. The posterior division joins the posterior auricular vein to form the external jugular vein; the anterior division joins the facial vein.

3. Facial nerve enters the upper part of the posteromedial surface of the gland, runs forwards, superficial to the retromandibular vein, and divides into five branches which leave the anteromedial surface of the gland to supply the muscles of facial expression. Connections between these branches form a network called the parotid plexus. The auriculotemporal nerve, as it passes behind the temporomandibular joint runs through the glenoid lobe of the parotid gland or within its covering fascia.

4. Parotid group of lymph nodes.

Innervation Parasympathetic supply.

The preganglionic fibres begin in the inferior salivatory nucleus in the medulla, leaving the brainstem in the glossopharyngeal nerve and pass through its tympanic branch, the tympanic plexus, and the lesser petrosal nerve to the otic ganglion where they synapse with postganglionic fibres which pass to the gland in the auriculotemporal nerve.

Stimulation of the parasympathetic innervation leads to the production of copious saliva rich in mucus and enzymes.

Sympathetic supply

From the superior cervical ganglion of the sympathetic trunk. Postganglionic neurons travel from the ganglion to the gland in the plexus on the external carotid artery. The preganglionic neurons which relay in the ganglion begin in the upper thoracic segments of the spinal cord.

Stimulation of Sympathetic stimulation results in a reduced secretion of saliva which is low in organic content.

Note : The facial nerve, which passes through the gland, does not supply it.

Blood supply : External carotid artery and the branches given off within the gland.

Venous drainage : External jugular vein.

Lymph drains :

Parotid nodes and thence to the deep

cervical nodes.

Infratemporal fossa

Is an irregularly shaped cavity, situated below and medial to the zygomatic arch. Boundaries defined by:

Anteriorly, by the infratemporal surface of the maxilla and the ridge which descends from its zygomatic process.

Posteriorly, by the articular tubercle of the temporal and the spina angularis of the sphenoid.

Superiorly, by the greater wing of sphenoid below the infratemporal crest, and by the under surface of the temporal squama, containing the  foramen ovale, which transmits the mandibular branch of the trigeminal nerve, and the foramen spinosum, which transmits the middle meningeal artery.

Inferiorly, by the medial pterygoid muscle attaching to the mandible.

Medially, by the lateral pterygoid plate.

Laterally, by the ramus of mandilbe, which contains the mandibular foramen , leading to the mandibular canal through which the inferior alveolar nerve passes. This also contains the lingula, a triangular piece of bone that overlies the mandibular foramen antero-medially. Finally, the mylohyoid groove descends obliquely transmitting the mylohyoid nerve the only motor branch of the posterior division of the trigeminal nerve.

Content:

Its occupied by the lateral and medial pterygoid muscles, branches of the mandibular nerve, the otic ganglion, the chorda tympani, the maxillary artery, and the pterygoid venous plexus.

Note: Temporal Fossa and the Infratemporal fossa communicate with each other deep in the zygomatic arch.

Otic ganglion

Below foramen ovale

It receive preganglionic parasympathetic fibers from the inferior salivatory nucleus via glossopharyngeal nerve and its lesser petrosal branch. These fibers synapses with postganglionic fibers which pass by communicating branch to the auriculotemporal nerve and thence to the parotid gland to which they are secremotor .

A few postganglionic fibers pass to the main trunk of mandibular nerve to be distributed through the inferior alveolar and buccal nerves to the mucosa glands in the lower lip and cheeks.

It receive sympathetic root from the plexuses on the middle meningeal artery, this contain postganglionic fibers from the superior cervical ganglion.

It receive a branch from the nerve to medial pterygoid. These fibers supply the tensor veli palatini and tensor tympani.

Pterygopalatine fossae/ sphenopalatine fossa

 It is a cone-shaped paired depression deep to the infratemporal fossa and posterior to the maxilla on each side of the skull, located between the  pterygoid process  and the maxillary tuberosity, close to the apex of the orbit. It is the indented area medial to the  pterygomaxillary fissure leading into the sphenopalatine foramen. It communicates with the nasal and oral cavities, infratemporal fossa, orbit, pharynx, and middle cranial fossa through eight foramina

It has the following boundaries:

Anterior: Superomedial part of the infratemporal surface of maxilla.

Posterior: Root of the pterygoid process and adjoining anterior surface of the greater wing of sphenoid bone.

Medial: Perpendicular plate of the palatine bone and its orbital and sphenoidal process

Lateral: Pterygomaxillary fissure .

Inferior: Part of the floor is formed by the pyramidal process of the palatine bone.

Direction Passage Connection

Posteriorly foramen rotundum middle cranial fossa

Posteriorly pterygoid canal (Vidian) middle cranial fossa, foramen lacerum

Posteriorly palatovaginal canal (pharyngeal)

nasal cavity/nasopharynx

Anteriorly inferior orbital fissure orbit

Medially sphenopalatine foramen nasal cavity

Laterally pterygomaxillary fissure infratemporal fossa

Inferiorly greater palatine canal (pterygopalatine)

oral cavity,lesser palatine canals

Contents

The pterygopalatine ganglion suspended by nerve roots from the  Maxillary nerve.

The terminal third of the Maxillary artery.

The maxillary nerve (CN V2, the second division of the trigeminal nerve), with which is the nerve of the pterygoid canal, a combination of the greater petrosal nerve (preganglionic parasympathetic) and the deep petroal nerve (postganglionic sympathetic). To obtain block anesthesia of the entire second division of the trigeminal nerve, an intraoral injection can be administered into this area.

1.Pterygopalatine ganglion• This is located deep within the pterygopalatine fossa close to the sphenopalatine foramen.

• It is a relay station for parasympathetic secretomotor fibres derived from the facial nerve and destined for the lacrimal gland and the glands of the mucous membranes of the nose, nasopharynx, paranasal sinuses, palate, and upper lip.

• Most of the fibres are sensory .

• Preganglionic parasympathetic fibres from the superior salivatory nucleus reach the ganglion through the greater petrosal branch of the facial nerve. This branch fuses with the deep petrosal nerve from the carotid sympathetic plexus to form the nerve of the pterygoid canal which enters the pterygopalatine fossa through that canal and unites with the posterior aspect of the ganglion.

• The preganglionic fibres synapse in the ganglion with postganglionic neurons. The latter are distributed to the glands associated with the mucous membrane of the nose, nasopharynx, and palate through the nasal, pharyngeal, and palatine branches respectively of the ganglion and to the lacrimal gland through a complicated pathway comprising the ganglionic branches of the maxillary nerve, the maxillary nerve itself, its zygomatic and zygomaticotemporal branches, the communicating branch to the lacrimal nerve and then via the latter nerve to the gland.

Postganglionic fibres pass to the small glands in the upper lip, upper part of the cheek, and mucous membrane of the maxillary sinus through the maxillary nerve and its infraorbital continuation. Postganglionic fibres to the linings of the sphenoidal, ethmoidal, and frontal sinuses run in the small orbital branches of the pterygopalatine ganglion. The deep petrosal nerve contains postganglionic sympathetic fibres from the superior cervical ganglion. These are mostly vasoconstrictor in function and pass through the ganglion without interruption to be distributed in its branches

Branches of the pterygopalatine ganglion 1.Greater palatine nerve leaves the inferior aspect of the ganglion and descends through the greater palatine canal to emerge through the foramen of the same name on to the oral surface of the hard palate. It then runs forwards in a groove located approximately halfway between the midline of the palate and the palatal surface of the posterior teeth to

Supply: The mucous membrane and associated glands of the palate as far forwards as the lateral incisor region.

The mucous membrane of the posteroinferior quadrant of the lateral wall of the nose.

2. Nasal nerves : Enter the nasal cavity through the sphenopalatine foramen.

Supply :The lateral branches supply the mucous membrane of the posterosuperior quadrant of the lateral nasal wall.

The medial branches supply the roof and most of the septum.

3.Lesser palatine : also descend in the greater palatine canal but emerge on to the oral surface of the bony palate through the lesser palatine foramina.

Supply: the mucous membrane of the soft palate and of an area around the palatine tonsil.

Note: The taste fibres from this region are believed to pass back to the pterygopalatine ganglion and then travel in the nerve of the pterygoid canal and in the greater petrosal nerve to the facial nerve.

4.Nasopalatine nerve runs with the medial nasal branches to the septum. It then turns to run downwards and forwards on the vomer to reach the incisive fossa through which it passes on to the oral surface of the hard palate.

Supply: small part of the septum and the incisor region of the hard palate

5. Pharyngeal nerve leaves the posterior aspect of the pterygopalatine ganglion and passes through the palatovaginal canal.

Supply:The mucous membrane of the nasopharynx.

Maxillary Nerve: Maxillary nerve is the second of the three branches of the trigeminal

nerve. It is purely sensory. Leaves the skull through foreman Rotundum. Recieves sensory innervation from the nose, palate , upper teeth and

lower eye lid.

Branches Its branches may be divided into four groups depending on the location

it branches from.

1. In the cranium

Middle meningeal nerve

in the meninges

2. In the pterygopalatine fossa Infraorbital nerve through Infraorbital canal.

Zygomatic nerve (zygomaticotemporal nerve, zygomaticofacial nerve) through Inferior orbital fissure

The zygomaticotemporal branch :

a. Supplies the skin of the temple.

b. Joins the Lacrimal nerve and supplies the lacrimal gland.

The zygomaticofacial nerve supplies the skin over the prominence of the cheek.

Nasal Branches (nasopalatine) through Sphenopalatine foramen

Superior alveolar nerves (Posterior superior alveolar nerve, Middle superior alveolar nerve, Anterior superior alveolar nerve).

Palatine Nerves (Greater palatine nerve, Lesser palatine nerve, including the nasopalatine nerve.

Pharyngeal nerve

3. In the infraorbital canal Anterior superior alveolar nerve.

Infraorbital nerve

4.On the face Inferior palpebral nerve.

Superior labial nerve.

Lateral nasal nerve

Note: The posterior superior alveolar nerves pass through the pterygomaxillary fissure into the infratemporal fossa.

They then enter the maxilla through the posterior alveolar foramina to supply:

1) The upper molar teeth.

2) The mucous membrane on the buccal surface of the associated alveolar process.

3) The lining of the maxillary sinus.

  Posterior superior alveolar block = injecting a local anesthetic solution adjacent to the nerves as they enter the maxilla.

3.Maxillary artery  

The maxillary artery is the larger of the two terminal branches of the external carotid artery.

It is divided into three major parts:

  FIRST :

The Mandibular part branches:

A. Deep auricular artery.

B. Anterior tympanic artery.

C. Middle meningeal artery.

D. Inferior alveolar artery which gives off its mylohyoid branch just prior to entering the mandibular foramen.

E. Accessory meningeal artery.

SECOND:

The Pterygoid part branches:

A.Masseteric artery.

B.Pterygoid branches

C.Deep temporal arteries (anterior and posterior).

D.Buccal artery

THIRD:The Pterygomaxillary part branches:

A. Sphenopalatine artery (Nasopalatine artery is the terminal branch of the Maxillary artery).

B. Descending palatine artery

C. Infraorbital artery (enters the orbit through inferior orbital fissure).

D. Posterior superior alveolar artery (supplies the upper posterior teeth and adjacent structures).

E. Artery of pterygoid canal (supplies nasopharynx & tympanic cavity).

F. Pharyngeal artery.

G. Middle superior alveolar artery (a branch of the infraorbital artery).

H. Anterior superior alveolar arteries (a branch of the infraorbital artery).

I. Greater palatine artery

NOTE: the palatine, nasal, and pharyngeal branches of the third part of maxillary artery accompany the corresponding branches of the pterygopalatine ganglion.

The posterior superior alveolar artery may give rise to a sizeable buccogingival branch which may anastomose with the infraorbital artery in the infraorbital region.

It is usually accompanied by a vein which is a tributary of the facial vein.

The artery and vein lie immediately adjacent to periosteum, and may be at risk of being punctured in injections to obtain anaesthesia of the maxillary teeth.

The veins accompanying these branches of the maxillary artery emerge from the pterygopalatine fossa through the pterygomaxillary fissure and drain into the pterygoid plexus.

 

The EndThank You