M219 Infratemporal

8/2/2019 M219 Infratemporal

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The Infratemporal Fossa

The infratemporal fossa is an

irregularly shaped cavity, situatedBelow And Medial to theZygomatic Arch. It is bounded by:

Anteriorly (In front),by the

Infratemporal Surface Of The

Maxilla and the ridge whichdescends from its zygomaticprocess.

Posteriorly (behind),by theArticular Tubercle Of TheTemporal Bone and the spinal

Part of the sphenoid Superiorly (above),by the Great

Wing Of The Sphenoid below theinfratemporal crest, and by theunder surface of the Temporal

Squama;.


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Temporal fossa

Infratemporal fossa


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Pterygomandibular fossa

Lateral pterygoid plate

Greater wing of sphenoid


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Inferiorly (below): by the Alveolar Border Of TheMaxilla.

Medially, by the Lateral Pterygoid Plate.

Contents It contains:

1. The lower part of the Temporalis.

2. The Medial and Lateral Pterygoid Muscles.

3. Maxillary Vessels.

4. Mandibular And Maxillary Nerves.



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Foramen ovaleand Foramen Spinosumopen on its roof, and

The Alveolar Canalson its anterior wall.

At its upper and medial part are TwoFissures, which together form a T-shaped fissure, the horizontal limb beingnamed the Inferior Orbital, and the verticalone the Pterygomaxillary.



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Sphenoid bone

Spinosum f.

Ovale f.

Rotundum f.


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Pterygopalatine fossaPterygopalatine fossa

Maxilla

Sphenoid

Alveolar foramen

Rotundum f.

Palatine


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Muscles of Mastication

1. Temporalis2. Masseter

1. Medialpterygoid

2. Lateralpterygoid


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Muscles of Mastication

Masseter


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Temporalis m.

process and anterior

border of mandible

Origin: Temporal fossa

and temporalis fascia

Insertion: Coronoid


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Masseter m.

Deep part

Superficial part

Insertion: Ramus and

angle of mandible

Origin: Zygomatic arch


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Lateral Pterygoid Upper head: Origin

from infratemporal

crest of sphenoid

bone

Lower head: Origin from lateral side of

lateral pterygoid

plate Insertion: Articular

capsule of TMJ and

mandibular neck


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Lateral pterygoid muscle

Lower head

Upper head


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Medial pterygoid m.

Deep head of medial pterygoid

m.Superficial head of MPG m.


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Action of Muscles of Mastication

1.Temporaris: Anterior

and middle fiber:

elevate

Posterior fiber:Retract

2. Masseter: Super

fiber: Elevate

Deep fiber:

t

Temporalis


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Action of Masticatory Muscle

3.Medial

pterygoid:

Elevate

4. Lateral

pterygoid:

Protract

(protrude)


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Maxillary Artery The Larger of the Two Terminal

Branches of the External Carotid,Arisesbehind the Neck Of TheMandible, and is at first imbedded in

the substance of the parotidgland; it passes forward betweenthe ramus of the mandible and thesphenomandibular ligament, andthen runs, either superficial or deepto the Pterygoid, to thepterygopalatine fossa.

It supplies the deep structures of theface, and may be divided intomandibular, pterygoid, andpterygopalatine portions.
http://www.bartleby.com/107/illus510.html


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Branches

Inferior Alveolar:

Anterior Tympanic:Tympanic Membrane.

Middle Meningeal: Isthe largest of thebranches whichsupply the duramater throughForamen Spinosum.
http://www.bartleby.com/107/144.html


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Maxillary Artery

It is the terminal part of the External carotid artery.

The maxillary artery is divided

into four parts

1. Mandibular part

2. Muscular part.

3. Infraorbital part. 4. Sphenopalatine(pterygo-

palatine)


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1.The Mandibular Part Of MaxillaryArtery

There are four branches from this part

1. Deep Auricular And Anterior

Tympanic Arteries

2. Middle Meningeal Artery

3. Accessory Meningeal Artery.

4. Inferior Alveolar Artery


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Maxillary artery

Middle meningeal a.

Auriculotemporal n.

eep temporal a.


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2.The muscular part of maxillary artery

The Branches Are;

1. Deep Temporal Arteries

2. Massetric And Pterygoid

Arteries

3. Buccal artery


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Nerve and artery of temporal fossa

External carotid artery

Maxillary artery

Deep temporal nerveDeep temporal artery

Superficial temporal arter

Mandibular nerve(V3)


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3.Infraorbital part

It give off the Superior Alveolar Arteriesand traverse infraorbital canal to exittheinfraorbital foramen becoming infraorbital

artery

which supply the cheek. Inferior palpebral part.

Superior labial, and External nasal


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4. Spheopalatine part of the

maxillary artery

This part gives off the

branches which supply

1.The nasal cavity

2.The palate of oral cavity


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It is the venous plexus which is located aroundthe pterygoid muscle. Moreover, it hasconnection tothe following veins;

1. The maxillary vein 2. Deep facial vein 3. Inferior ophthalmic vein

4. Cavernous sinus (in the cranial

cavity) Therefore, the infection could invade from

external region to Cranial Cavity


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Pterygoid venous plexus of vein

Maxillary v.

Deep facial v.

Inferior ophthalmic v. Emissary vein connect tocavernoussinus in brain

Cavernous sinus


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Intracranial venous connection

Cavernous sinus

Pterygoid venous plexu


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Maxillary Vein

Is a short trunk which

accompanies the First Part OfThe Maxillary Artery. It isformedby a confluence of theveins of the Pterygoid Plexus,and Unites With The Temporal

Vein To Form The PosteriorFacial Vein.

It joins to Retromandibularvein

Pterygoid plexus: Drains areaof pterygoid muscles & draininto Maxillary Vein
http://www.bartleby.com/107/illus557.html


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The Maxillary Nerve Second division of the

trigeminal, is Pure Sensory

Nerve & Intermediate in Size(Ophthalmic & Mandibular).

It arises from Trigeminalganglia in the Middle Cranialfossa & leaves the skull

through the ForamenRotundum, and enters theorbit through The InferiorOrbital Fissure;

It traverses the infraorbitalgroove and canal in the FloorOf The Orbit, and appearsupon the face at theInfraorbital Foramen.
http://www.bartleby.com/107/200.html


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Maxillary Nerve: Alveolar Branches to supply:

Gums and neighboring parts of the

Mucous Membrane Of The Cheek. Two premolar teeth (Nerves runs in a

canal in the Lateral Wall Of The Maxillary

Sinus). Incisor And Canine Teeth, Mucous

Membrane Of The Anterior Part Of TheInferior Nasal Meatus and the Floor Of

The Nasal Cavity (Nerves runs in a canalin the anterior wall of the maxillary sinus).

5 Th ill (V2)


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5. The maxillary nerve (V2)

It is pure sensory nerve and divided into

three Parts as follows:

1.External (Zygomatic n.): They are zygomaticofacial andzygomaticotemporal nerves2. Intermediate Part: It is infraorbital nerve which gives

off branches.

2.1. Posterior, middle and superior alveolar nerves

which supply alveolar and upper teeth

2.2. Infraorbital nerve which traverses

infraorbital foramen to supply cheekandlower eyelid.


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A.Maxillary n.branches B.Pterygopalatine ganglion

Infraorbital n.

ygomaticofacial n.

Zygomaticotemporal n.

Zygomatic n.

Lesser palatine

Greater palatine

nterior,middle andposterior superior alveolar n.

V2

Pterygopalatinganglion

Palatine n.

Infraorbital n.

Zygomatic n

Nasal n.(sphenopalatine

Sphenopalatine f.

M ill N


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Maxillary Nerve

3. Internal Part (Pterygopalatine OrSphenopalatine N.): It Supplies Nasal CavityAnd Palate. The Branches Are The Following. 3.1. Sphenopalatine Nerve: It Enters The Sphenopalatine Foramen To Supply NasalCavity. Its Terminal Branch Is Incisor Nerve WhichSupplies Upper Incisor. 3.2. Descending Palatine Nerve: AfterDescending It Ramifies To Give These Branches. 3.2.1. Greater Palatine N. WhichSupplies Hard Palate. 3.2.2. Lesser Palatine N. WhichSupplies Soft Palate.


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Maxillary Nerve

The greater petrosal n. (preganlionic

fiber) of CN.VII (facial n.) come tosynapse with this ganglion. Thepostganglionic fibers merged withinternal ramus branches to supply

seromucous glandinpalateand nasalcavity.

There was some postganglionicfiber running with

zygomaticotemporal n. tomeet thelacrimal n.(sensory)of V1. It passalong with this nerve to supplylacrimal glandfor gland secretion.

N l ( h l i


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A.Maxillary n.branches B.Pterygopalatine ganglion

Infraorbital n.

ygomaticofacial n.

Zygomaticotemporal n.

Zygomatic n.

Lesser palatine

Greater palatine

nterior,middle andposterior superior alveolar n.

V2

Pterygopalatin

ganglion

Palatine n.

Infraorbital n.

Zygomatic n

Nasal n.(sphenopalatine

Sphenopalatine f.


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Innervation of lacrimal gland

Pterygopalatine ganglion

Zygomatic n.

Zygomaticotemporal n.Lacrimal n.

Lacrimal gland

Maxillary n.(V2)

Zygomaticofacial n.

Greater petrosal n


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Landmarks / Area of Insertion

Mucobuccal fold above second premolar

Apex of second PremolarThe practitioner must find the Greater

Palatine Foramen And Pass The NeedleThrough The Greater Palatine Canal.This is difficult, and occasionally the canal

is impassable.The other technique described by Malamed is

easier and calls for Advancing TheNeedle Posterior And Superior To TheMaxillary Tuberosity.

There is a Higher Risk Of Puncturing ThePterygoid Venous Plexus Or MaxillaryArtery in the pterygomaxillary fossa. In


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Mandibular Nerve

It is the largest of the three divisions of the fifth,

and is made up of Two Roots: a Large, SensoryRoot and a small motor root. Both unite just after its exit through the Foramen

Ovale., and then Divides Into Two Trunks:

Anterior and Posterior. Supplies The Teeth And Gums Of The Mandible Skin of the temporal region, Auricula, the lower lip,

The lower part of the face, and the Muscles Of Mastication; it also supplies the Mucous Membrane Of The

Anterior Two-thirds Of The Tongue.


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Ophthalmic n.(V1) Maxillary n.(V2)

Mandibular n.(V3)

Trigeminal nerve(V) leaving the skull


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Mandibular(V3) nerve branches


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Branches of Mandibular Nerve

From Main Trunk: Meningeal branch Passes Via foramen

spinosum supply the durra matter &mucous lining of the mastoid cells

Nerve to Medial Pterygoid. Branches of Anterior Division:

All branches of this divisionare motor

nerve exceptbuccal nerve.

Nerve to Masseter & Lateral Pterygoid. Buccal Nerve To skin of Cheek (NO

Supply to Buccinator) .


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M dib l N P i Di i i


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Mandibular N: Posterior DivisionBranches

All branches are sensory nerve except mylohyoidnerve

Auriculotemporal: Gives Sensory Branches toSkin of Auricle ear opening &

Temperomandibular joint. Lingual: Supplies Ant-2/3 of Mucous Membrane

of Tongue & Joined by Chrdae Tympani ( OfFacial N Secteromotor fibers to Submandibular &Sublingual Glands).

Otic Ganglion: Branch of GlossopharyngealCarry Secret motor Fibers to Parotid Gland.


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Posterior division of mandibular nerve

Lingual n.

Inferior alveolar n.

Mylohyoid n.

Auriculotemporal n.

Chorda tympani n.

M MA


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Posterior Division of Mandibular

M HIA

Ch Ty


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Mandibular Nerve Block

It is the procedure for dentist toanesthetize nerve supply of lower

teeth and gum before dental

treatment.

Landmark: Internal and external

oblique ridge, retromolar triangle.

Space: Pterygomandibular space

(locate between medial mandibularramusand medial pterygoid m.)

Nerves block: 1.Inferior alveolarn.,2.Lingual n. and 3.buccal n.


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Mandibular Nerve Block

An injection used to anesthetize the anterior

two-thirds portion of the tongue, the pulptissue of the mandibular teeth, the floor ofthe mouth, the facial periodontium of themandibular first premolar and anterior teeth,

the lingual periodontium of all mandibularteeth, the skin on the chin, and the lower portionof the lip.

Gow-Gates Procedure: Injection delivered atthe neck of the condyle just under theinsertion of the lateral pterygoid muscle

Inferior Alveolar


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Inferior Alveolar

Both Motor & Sensory Teeth of Lower Jaw far as themental foramen, where it divides into two terminal

branches, Incisive And Mental. Moreover, it receive additional branch from

CN.VII(facial n.) which is called Chorda Tympani

Nerve.

The dental branches supply the molar and premolarteeth.

The incisive branch is continued onward within thebone, and supplies the canine and incisor teeth. skinof the chin, and two ascend to the skin and mucousmembrane of the lower lip

Mylohyoid Nerve: Branch of Inferior Alveolar &Supplies Mylohopid Muiscle.

Lesser petrosal n of CN IX


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Lesser petrosal n.of CN.IX

Chorda tympani

Auriculotemporal n.

Lingual n.

Parotid gland

Submandibular gland

Submandibular ganglion

Sublingual gland

M219 Infratemporal

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