sign in sign up
<<
Home , Infratemporal fossa, Pterion

PAROTID AND INFRATEMPORAL REGIONS

OUTLINE

I. TEMPORAL II. III. IV. PTERYGOID VENOUS PLEXUS V. TEMPORO- MANDIBULAR JOINT (TMJ) VI. MUSCLES OF MASTICATION VII. PAROTID REGION

COMPLEX, CLINICALLY IMPORTANT AREA - source of blood supply to nasal cavity, calvarium, oral cavity, middle ; location of muscles of mastication TEMPORAL I. FOSSA - SUPERFIC. area above SUP. TEMPORAL LINE zygomatic TEMP. ART arch AURICULO- TEMPORAL NERVE.

ZYGOMATIC ARCH

BOUNDARIES: CONTAINS SUP. - SUPERIOR TEMPORAL 1) SUPERFICIAL TEMPORAL ARTERY LINE INF. - 2) AURICULO-TEMPORAL NERVE (V3) TEMPORAL FOSSA

TEMPORALIS MUSCLE CONTAINS 1) TEMPORALIS MUSCLE 2) AND NERVES (DEEP TEMPORALIS MUSCLE INSERTS TO TEMPORALIS TO (CORONOID MUSCLE) PROCESS) MEDIAL TO ZYGOMATIC ARCH II. INFRATEMPORAL FOSSA

INFRATEMPORAL FOSSA - ZYGOMATIC area inferior to zygomatic arch ARCH

BOUNDARIES RAMUS OF SUPERIOR - ZYGOMATIC ARCH MANDIBLE LATERAL - MANDIBLE (RAMUS) INFRATEMPORAL FOSSA – remove mandible

GREATER WING OF SUPERIOR SPHENOID BOUNDARY ALSO - GREATER WING OF SPHENOID

MEDIAL- LATERAL PTERYGOID PLATE ANTERIOR - LATERAL POST.SIDE PTERYGOID MAXILLARY PLATE INFRATEMPORAL FOSSA: FORAMINA

FORAMINA MAXILLARY ARTERY 1. AND BRANCHES - V3; ACCESSORY OF V2 (MAXILLARY MENINGEAL DIVISION OF V) PASS ARTERY; THROUGH 2. FORAMEN PTERYGOMAXILLARY SPINOSUM - FISSURE AND NERVOUS SPINOSUS 4. PTERYGO- 3. MANDIBULAR MAXILLARY FORAMEN - FISSURE – INFERIOR LEADS ALVEOLAR NERVE, TO ARTERY, VEIN PTERYGO- PALATINE FOSSA MANDIBLE (= JAW BONE) - PARTS & LANDMARKS MANDIBULAR NOTCH CONDYLE NECK CORONOID PROCESS

MANDIBLE- RAMUS JAW BONE BODY PARTS AND LANDMARKS OUTER VIEW

INNER VIEW LINGULA INFRATEMPORAL FOSSA, MAXILLARY ARTERY

MAXILLARY External and Meningeal Nasal Superficial Middle Ear Arteries Cavity Temporal ARTERY Artery

Infra- orbital

Muscles of Mastication

Mandible, palate, External Carotid Submandibular Artery region COMPLEX, CLINICALLY IMPORTANT AREA - source of blood supply to nasal cavity, calvarium, oral cavity, middle ear; location of muscles of mastication INFRATEMPORAL FOSSA MAXILLARY ARTERY

CUT ZYGOMATIC ARCH + RAMUS OF MANDIBLE

DISSECTION OF MAX. ARTERY- SAW CANNOT EFFECTIVELY LIGATE* THROUGH ZYGOMATIC ARCH, MAXILLARY ARTERY - bleeding (ex. CORONOID PROCESS AND RAMUS OF nosebleed = epistaxis) treated by MANIDBLE cauterization of branches INFRATEMPORAL FOSSA

NOSE

BRANCHES OF CONTENTS MAXILLARY ARTERY 1) MEDIAL & LATERAL LAT. PTERYGOID PTERYGOID MUSCLES M. 2) BRANCHES OF V3 from MED. FORAMEN OVALE PTERYGOID M. 3) MAXILLARY BRANCHES ARTERY & OF V3 PTERYGOID VENOUS PLEXUS

mandible MAXILLARY ARTERY

TABLE OF BRANCHES

MAXILLARY ARTERY *

* - 8- MIDDLE MENINGEAL ARTERY A. COURSE OF MAXILLARY ARTERY - three parts 2) PART 2- SUPERF. TO OR WITHIN LATERAL PTERYGOID

ORIENT

N O 1) PART 1- S POST. AND E MED. TO 3) PART 3 - IN NECK OF PTERYGO- MANDIBLE PALATINE FOSSA THROUGH FORAMINA LATERAL THROUGH PTERYGOID FORAMINA MUSCLE MAXILLARY ARTERY- FIRST PART THROUGH FORAMINA NOSE 1. DEEP AURICULAR - EXT. ACC. orbit AUD. MEATUS - OUTER EAR, MEN. MID TYMPANIC MEMBRANE ANT. MEN. TYMP. 2. ANTERIOR TYMPANIC - TO MIDDLE EAR 3. MIDDLE MENINGEAL - FOR. SPINOSUM TO MID. CRAN FOSSA, CALVARIUM 4. ACCESSORY MENINGEAL - DEEP FOR. OVALE TO MID. CRAN AUR. FOSSA, CALVARIUM 5. INF. ALVEOLAR - MANDIB. INF FOR. - LOWER TEETH - branch - ALV MENTAL ART TO CHIN DAMAGE MIDDLE MENINGEAL, [ACCESSORY MENINGEAL ARTERIES] -

1) fracture near Skull Fracture 2) Tear Middle Meningeal Near Artery Pterion 3) Blood 'peels' dura from bone Tear 4) Lens shaped (biconvex) Middle mass on CT Meningeal 5) mass can Artery displace brain

Uncal 6) Herniation - herniation i. Uncal herniation- push Temporal lobe (uncus) through tentorial notch ii. Tonsillar herniation - Tonsillar herniation push Cerebellum (tonsil) through Clinical - bleeding is arterial – can be profuse and rapid; - ex, car accident – patient lucid at first - can be fatal within hours if herniation occurs MAXILLARY ARTERY- SECOND PART - MOSTLY MUSCLES

orbit PTERYG. DEEP TEMP.

1. DEEP TEMPORAL A. - TEMPORALIS 2. PTERYGOID A. - MED. AND LAT. PTERYGOID MUSCLES 3. MASSETERIC A. - BUCC. MASSETER 4. BUCCAL A. - TO MASS. WITH BUCCAL BR. V3

NOSE MAXILLARY ARTERY- THIRD PART THROUGH FORAMINA orbit 1. POST. SUP. ALVEOLAR - INFRAORB. POST SUP ALV. FOR TO POST MAX TEETH 2. DESCENDING PALATINE - GREATER AND LESSER PAL. FOR. - TO PALATE 3. ARTERY OF - PTERYGOID CANAL- PHARYNX AND AUD. TUBE POST. SUP. 4. SPHENOPALATINE A. - ALV. - NASAL CAVITY 5. INFRAORBITAL A. - INFRAORB. FORAMEN- FACE - branch - ANT. SUP. ALVEOLAR NOSE A. - ANT. MAX. TEETH MAXILLARY ARTERY THIRD PART - BISECT HEAD TO SEE DEEP STRUCTURES

dissection 3) ARTERY OF of bisected PTERYGOID head CANAL - PTERYGOID CANAL - UPPER PHARYNX AND NOSE AUDITORY TUBE

2) DESCENDING 4) SPHENO- PALATINE - GR. PALATINE A. - & LESS PAL. SPHENOPAL. FOR. - HARD FORAMEN AND SOFT NASAL CAVITY PALATE & PALATE IV. PTERYGOID VENOUS PLEXUS NOSE

1) Branches of Maxillary artery have accompanying PTERYGOID veins. VENOUS PLEXUS 2) Drain to Pterygoid Venous Plexus (Superficial to 3) ANASTOMOSE WITH CAVERNOUS SINUS AND FACIAL VEIN ANASTOMOSE WITH CAVERNOUS SINUS Clinical Note: Pterygoid* venous plexus has anastomoses with veins that FACIAL VEIN FACIAL drain to Cavernous Sinus; VEIN Infections can spread from teeth, nasal cavity, palate, etc. to brain (similar to anastomses of Facial Vein). PTERYGOID VENOUS PLEXUS V. TEMPORO-MANDIBULAR JOINT (TMJ) HEAD MANDIBULAR NOTCH CONDYLE NECK CORONOID PROCESS

MANDIBLE- RAMUS JAW BONE BODY PARTS AND LANDMARKS OUTER VIEW

INNER VIEW LINGULA MANDIBULAR FORAMEN V. TEMPORO-MANDIBULAR JOINT (TMJ)

SYNOVIAL JOINT BETWEEN HEAD OF MANDIBLE (CONDYLE) AND MANDIBULAR FOSSA OF TEMPORAL BONE

HEAD OF MANDIBLE *NOTE: ARTICULAR (CONDYLE) TUBERCLE ANTERIOR TO JOINT ** TEMPORO-MANDIBULAR JOINT (TMJ) A. CAPSULE - SURROUNDS JOINT - TIGHTLY ATTACHED TO MANDIBLE, LOOSELY TO TEMPORAL BONE C. LIGAMENTS 1) Temporo-mandibular (Lateral) Ligament - lateral Temporo- thickening of capsule - mandibular Prevents movement posteriorly ligament and inferiorly inner surface 2) Sphenomandibular ligament - spine of to lingula of mandible; function Spheno- unclear. mandibular Ligament 3) Stylomandibular ligament - Styloid process of temporal Stylo- bone to posterior border of mandibular mandible; function unclear. Ligament B. ARTICULAR DISC OF TMJ TMJ DISC TIGHTLY ATTACHED TO MANDIBLE; ARTICULAR DISC- CARTILAGINOUS; DIVIDES JOINT INTO TWO COMPARTMENTS UPPER TEMPORAL BONE DISC COMPARTMENT- SLIDING MOVEMENT, DISC MOVES WITH MANDIBLE, CAN LOCK

EXT AUD MEATUS

LOWER MANDIBLE COMPARTMENT- HINGE MOVEMENT D. MOVEMENTS OF MANDIBLE - 'LOCKED' JAW OPEN CLOSE 1. DEPRESSION/ ELEVATION - OPEN/CLOSE MOUTH - FIRST HINGE IN LOWER 1ST HINGE LOWER COMPARTMENT COMPARTMENT THEN SLIDE IN THEN SLIDE UPPER UPPER COMPARTMENT COMPARTMENT

2. PROTRUDE/ RETRUDE 3. LATERAL

MOVEMENT - BOTH DISC CAN GET STUCK *NOTE: ARTICULAR SLIDE UPPER AND JAW 'LOCKED' TUBERCLE OPEN (HELD OPEN BY ANTERIOR TO JOINT COMPARTMENT ARTICULAR TUBERCLE ** VI. MUSCLES OF MASTICATION - ALL INN BRANCHIOMOTOR V3 - ELEVATE = CLOSE; DEPRESS = OPEN MOUTH

PTERYGOID MUSCLES - O - Lateral Pterygoid Plate LAT. PTERYGOID - I - Neck, Articular Disc A - Depress, Protrude Pull Disc MASSETER - I Forward Ramus, A - Elevate ARTICULAR DISC TMJ

CORONOID PROCESS NECK

TEMPORALIS - I, Coronoid process A - Elevate, Retrude MED. PTERYGOID - I - Ramus, A - Elevate TEMPORALIS IS EXCEPTIONALLY LARGE IN CARNIVORES CAT SKULL OF DOMESTIC CAT

DOG

TEMPORAL FOSSA

CATS AND DOGS HAVE LARGE TEMPORALIS MUSCLES AND SMALL CRANIAL CAVITIES, SMALL BRAINS MUSCLES OF MASTICATION

LATERAL PTERYGOID - ATTACHES TO ARTICULAR DISC OF TMJ ARTICULAR ARTICULAR TUBERCLE DISC

horizontal muscle fibers ARTICULAR DISC LAT PTERYG

PULLS DISC ANTERIORLY WHEN OPEN MOUTH * TMJ JAW LOCK - mandible stuck in partial depression

OPEN MOUTH = ARTICULAR DISC depress mandible ARTICULAR TUBERCLE FIRST HINGE LATERAL LOWER PTERYGOID COMPART MENT JAW LOCK -* DISC STUCK ON ARTICULAR THEN TUBERCLE SLIDE UPPER COMPART MENT LATERAL MOVEMENTS OF JAW - occur in chewing

STRONG PULL PULL TO Lateral movements TO SAME OPPOSITE SIDE 1) Lateral and SIDE Medial Pterygoid (inside mandible) pull toward opposite side 2) Temporals and Masseter (outside mandible) pull toward same side

TRIGEMINAL NERVE DAMAGE (LMN) - Jaw deviates** TOWARD paralyzed side (patient opens mouth); unopposed action of of intact side) JAW JERK REFLEX = STRETCH REFLEX OF MUSCLES OF MASTICATION - sensory and motor in V3

STRETCH REFLEX IN STRETCH REFLEX IN BICEPS MUSCLES OF MASTICATION STRETCH SENSE TAP DOWN ON CHIN MUSCLES THAT ORGAN = CLOSE MOUTH Muscle (ELEVATE Spindle afferent MANDIBLE) TEMPORALIS

TAP ON TENDON

MASSETER MEDIAL PTERYGOID VII. PAROTID REGION

- BETWEEN MASTOID SUPERFICIAL PROCESS & RAMUS TEMPORAL ARTERY AND AURICULO- MANDIBLE TEMPORAL NERVE PAROTID GLAND - CAPSULE -FROM INVESTING LAYER PAROTID - ATTACHED TO DUCT ZYGOMATIC ARCH AND TEMPORAL BONE (TYMPANIC PART); VERY 90 DEGREE TURN TOUGH

PAROTID DUCT- ENTERS MOUTH, PIERCES BUCCINATOR OPPOSITE 2ND MANDIBULAR MOLAR TOOTH; MAKES 90 DEGREE TURN - ACTS AS PASSIVE VALVE, LETS YOU BLOW UP BALLOONS DEVELOPMENT OF PAROTID

OUTPOCKETINGS OF MOUTH 7 WEEKS 1) BUDS FROM ECTODERM OF PRIMITIVE MOUTH 2) EXTEND TO FORM CORDS - DEVELOP LUMENS – FORM DUCTS 3) DUCTS JOIN

Note: can have Accessory Parotid Glands if ducts join incompletely; no clinical consequence ORIENT - HORIZONTAL SECTION THROUGH PAROTID GLAND PAROTID REGION - DEEP STRUCTURES DEEP- POST NOSE BELLY DIGASTRIC, INSIDE STYLOID CAROTID OF MOUTH AURICULO- PROCESS, SHEATH TEMPORAL CAROTID STYLOID NERVE (V3) SHEATH PROCESS EXT CAROTID WITHIN PAROTID- POST BELLY DIGASTRIC RETRO 1) VII, MANDIBULAR VEIN 2) RETROMANDIB- VII ULAR VEIN, 3) EXT CAROTID A., 4) AURICULO- TEMPORAL N. SKIN INNERV. OF PAROTID - VISCERAL MOTOR NOTE: MUMPS: VIRAL INFECTION OF PAROTID; (PARASYMP) SWELLING PAINFUL DUE TO TIGHTNESS CAPSULE; OF IX REFERRED PAIN TO EAR - COMPRESSION OF AURICULO-* (GLOSSPHARYNG. N) TEMPORAL NERVE (ALSO PAROTID TUMOR)