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.
The Infratemporal Fossa
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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.
The Infratemporal Fossa
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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.
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Branches
Inferior Alveolar:
Anterior Tympanic:Tympanic Membrane.
Middle Meningeal: Isthe largest of thebranches whichsupply the duramater throughForamen Spinosum.
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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
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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.
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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