HN4 Infratemporal Fossa

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HN4 Infratemporal Fossa
2012-06-05 18:48:49
HN4 Infratemporal Fossa

HN4 Infratemporal Fossa
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  1. 1. What are the general contents of the infratemporal fossa?
    • 1) the inferior part of the temporalis muscle,
    • 2) lateral & medial pterygoids,
    • 3) maxillary artery & brs
    • 4) pterygoid venous plexus,
    • 5) V3 (mandibular division) & brs including the inferior alveolar, lingual, and long buccal nerves
    • 6) chorda tympani,
    • 7) the otic ganglion
  2. 2. Where is the temporal fossa located (with respect to the zygomatic arch)?
    temporal fossa is a depression on the lateral cranial wall (bounded superiorly by the temporal lines) that is superior to the zygomatic arch and serves as an attachment site for the temporalis muscle.
  3. 3. Where is the infratemporal fossa located (with respect to the zygomatic arch and mandible)?
    inferior and medial to the zygomatic arch and deep to the ramus of the mandible
  4. 4. What bone forms the anterior wall of the infratemporal fossa?
    posterior (infratemporal) surface of the maxilla
  5. 5. What bones form the posterior wall of the infratemporal fossa?
    styloid process, mastoid process, and the tympanic part of the temporal bone
  6. 6. What bone forms the medial wall of the infratemporal fossa?
    lateral pterygoid plate of the sphenoid bone.
  7. 7. What bone forms the lateral wall of the infratemporal fossa?
    ramus of the mandible
  8. 8. What bones form the roof of the infratemporal fossa?
    • greater wing of the sphenoid
    • squamous (flat) part of the temporal bone such as the mandibular fossa and articular eminence (a.k.a. “articular tubercle”).
  9. 9. What foramina are found in the roof of the infratemporal fossa?
    foramen ovale, foramen spinosum, and infra-temporal crest
  10. 10. Which cranial fossa is superior to the infratemporal fossa?
    middle cranial fossa
  11. 11. Which nerve and artery course through the mandibular notch?
    – masseteric n & vessels
  12. 12. Which nerve and artery courses through the mandibular foramen and canal?
    inferior alveolar
  13. 13. Which gland sits in a fossa below the mylohyoid line?
  14. 14. Which gland sits in a fossa above the mylohyoid line?
  15. 15. Which muscle attaches to the coronoid process of the mandible?
  16. 16. Which muscle attaches to the pterygoid fovea of the neck of the mandible?
    lateral pterygoid
  17. 17. Which muscle of mastication attaches to the medial surface of the mandibular angle?
    • medial pterygoid
    • (lateral angle = masseter)
  18. 18. Which ligament attaches from the sphenoid bone (spine of the sphenoid) to the lingua (near the mandibular foramen)?
    sphenomandibular ligament
  19. 19. Which muscle attaches to the mylohyoid line?
    mylohyoid muscle
  20. 20. Which nerve runs in the mylohyoid groove?
    mylohyoid nerve
  21. 21. Which branchial arch does the muscles of mastication develop from?
  22. 22. Which nerve also develops (or is associated) with branchial arch 1? What kind of motor fibers must it have?
    V3, BM
  23. 23. Which two muscles of mastication are located outside the infratemporal fossa?
    • temporalis
    • masseter
  24. 24. Which two muscles of mastication are located inside the infratemporal fossa?
    medial & lateral pterygoid
  25. 25. Which nerves innervate the temporalis?
    deep temporal ns
  26. 26. Which nerves innervate the medial & lateral pterygoids?
    ns to medial/lateral pterygoid
  27. 27. Which nerve innervates the masseter?
    n to masseter
  28. 28. Which muscles are the elevators of the mandible?
    temporalis (1), masseter (1), medial pterygoid (2)
  29. 29. Which muscles are the depressors of the mandible?
    – lateral ptergyoid (1), gravity (2), digastric-ant belly (2), mylohyoid (2)
  30. 30. Which muscles act to protrude (or protract) the mandible?
    lateral pterygoid (1), medial pterygoid (2)
  31. 31. Which muscles act to retrude (or retract) the mandible?
    posterior fibers of temporalis
  32. 32. Based on what you know about their attachments, the contraction of which muscle will cause the mandible to deviate laterally?
    – med. & lat. pterygoids (contralateral excursion); temporalis & masseter (ipsilateral excursion)
  33. 33. Through which foramen does the V3 Division enter the infratemporal fossa?
    foramen ovale
  34. 34. What artery courses through this same foramen ovale?
    accessory meningeal a
  35. 35. How many branches of the V3 Division are there (as we have numbered them)?
    • Trunk Branches:
    • 1. meningeal br. (not depicted)
    • 2. m. pterygoid n.
    • Anterior Division Branches:
    • 3. masseteric n.
    • 4. deep temporal ns.
    • 5. lateral pterygoid n.
    • 6. long buccal n.
    • Posterior Division Branches:
    • 7. auriculotemporal n.
    • 8. lingual n.
    • 9. inferior alveolar n.
    • a. mylohyoid n.
  36. 36. The meningeal br of V3 goes through the foramen spinosum to innervate the dura mater. What artery does it follow through this foramen?
    middle meningeal a
  37. 37. Which V3 branches are sensory (SA)? (disregard any other hitchhiking fibers from sources other than the trigeminal nerve)
    • long buccal
    • Posterior Division Branches:
    • 7. auriculotemporal n.
    • 8. lingual n.
    • 9. inferior alveolar n. (after mylohyoid nerve jumps off-> mental n)
  38. 38. Which V3 branches have both SA and branchial motor fibers?
    • deep temporal ns
    • ns to medial & lateral pterygoids
    • masseteric nerve
    • inferior alveolar n (mylohyoid & anterior belly of digastric)
  39. 39. Which V3 branch has VE-para/post fibers hitchhiking on it to get to the parotid gland?
    auriculotemporal n
  40. 40. Which V3 branch gives rise to the mylohyoid nerve?
    inferior alveolar n
  41. 41. Which V3 branch supplies sensory innervation to the skin and internal mucosa of the cheek region?
    long buccal n
  42. 42. Which V3 branch carries special sense (taste) to the anterior 2/3rds of the tongue? What nerve brings these taste fibers to this V3 branch?
    lingual n. via chorda tympani (CN VII)
  43. 43. Which V3 branch innervates the mandibular teeth?
    Inferior alveolar
  44. 44. Where along the lingual nerve does it carry VE-para/pre fibers? Where along the lingual nerve does it carry VE-para/post fibers?
    • when chorda tympani joins it
    • VE-para/post after submandibular ganglion
  45. 45. Based on what you know about fiber types coursing in the lingual nerve (including hitchhiking fibers), what would be the symptoms of a complete lesion of the nerve between point where the chorda tympani joins it and the submandibular ganglion.
    • No salivation from (submandibular and submental glands
    • no SA or SS (taste to anterior 2/3rds)
  46. 46. What is the relationship of the mandibular canal and the roots of the mandibular teeth?
    just inferior
  47. 47. What is “anesthesia”, “paresthesia” and “dysesthesia”?
    • anesthesia (numb tongue)
    • paresthesia (tingling)
    • ysesthesia ( pain and burning)
  48. 48. What is the pterygomandibular space (What are its boundaries?) What does it contain that is important in dentistry?
    • Borders:
    • the medial aspect of the mandibular ramus (laterally)
    • the medial pterygoid muscle (medially)
    • lateral pterygoid (superiorly)
    • Contains:
    • inferior alveolar nerve
    • lingual n. (nerves important in dental anesthesia)
    • The myloyoid n. and inferior half of the sphenomandibular lig. are also in this space.
  49. 49. What are the connections of the pterygoid venous plexus?
    cavernous sinus, facial vein (via the deep fascia vein) and retromandibular vein (via the maxillary veins).
  50. 50. Where is the pterygoid venous plexus located?
    infratemporal fossa.
  51. 51. What is the relationship of the maxillary artery to the neck of the mandible?
    passes posterior to the neck of the mandible to enter the infratemporal fossa.
  52. 52. The maxillary artery is divided into 3 parts: 1st Part, 2nd Part, and 3rd Part. What are the other names of these 3 parts?
    • 1st (retromandibular or mandibular) "superficial" part
    • 2nd (pterygoid) "muscular" part
    • 3rd (pterygopalatine) "deep" part
  53. 53. Which branch of the 1st part courses through foramen spinosum?
    middle meningeal a
  54. 54. Which branch of the 1st part courses through the foramen ovale?
    accessory meningeal a (supply the trigeminal ganglion & dura mater)
  55. 55. Which branch of the 1st part supplies the external auditory meatus?
    deep auricular a. (TMJ)
  56. 56. Which branch of the 1st part supplies the tympanic membrane?
    anterior tympanic a. (TMJ)
  57. 57. Which branch of the 1st part travels in the mandibular canal?
    inferior alveolar a
  58. 58. The branches of the 2nd part all supply what kind of anatomical structure?
  59. 59. The maxillary artery terminates by changing names as it enters which cavity?
    • sphenopalatine a through sphenopalatine foramen to enter the nasal cavity.
    • supplies the lateral nasal wall, nasal septum, and adjacent paranasal sinuses.
  60. 60. Which branch of the 3rd part descends to the hard palate?
    descending palatine
  61. 61. Which branch of he 3rd part supplies the maxillary molar and premolar teeth?
    posterior superior alveolar a
  62. 62. Which branch of the 3rd part supplies the lower eye lid, side of nose, and upper lip area?
  63. 63. How many branches does the maxillary artery have in total?
  64. 64. Which ligament supplies lateral stability to the TMJ?
    lateral ligament
  65. 65. What is unusual about the cartilage of the TMJ given that it is a synovial joint?
    • synovial joint (subtype: modified hinge joint).
    • covered by fibrocartilage (rather than hyaline cartilage as in a typical synovial joint)
  66. 66. What is the movement called when the mandibular head slides forward onto the articular eminence (or “articular tubercle”)? When does this motion occur?
    “translation” (anatomically, it is referred to as “gliding or sliding”). Note the relative position of the articular tubercle and mandibular head in the “mouth open” and “mouth closed” positions. So in opening the mouth (depressing the mandible), rotation occurs first, followed quickly by translation. Then both occur together
  67. 67. For mandibular movement, where is the axis of movement? Is it at the TMJ?
    • reference point for these movements is the chin.
    • two extrinsic ligaments that relate to the TMJ and motions of the mandible: the sphenomandibular ligament and stylomandibular ligament.
    • watch out for sphenomandibular damage with IAN block