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Dr. Sami Zaqout Faculty of Medicine IUG Auricle External Ear

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Dr. Sami Zaqout Faculty of Medicine IUG Auricle External Ear Dr. Sami Zaqout Faculty of Medicine IUG Auricle External Ear External auditory meatus Middle Ear Auditory ossicles The Ear (Tympanic Cavity) Bony labyrinth Internal Ear (Labyrinth) Membranous labyrinth Dr. Sami Zaqout Faculty of Medicine IUG External Ear Auricle External auditory meatus – Outer third is elastic cartilage. • Hairs • Sebaceous glands • Ceruminous glands – Inner two thirds is bone. Dr. Sami Zaqout Faculty of Medicine IUG External Ear • The sensory nerve supply of the lining skin is derived from the – Auriculotemporal nerve branch of mandibular nerve. – Auricular branch of the vagus nerve. • The lymph drainage is to the – Superficial parotid lymph nodes – Mastoid lymph nodes – Superficial cervical lymph nodes. Dr. Sami Zaqout Faculty of Medicine IUG Temporal lobe of Roof Tegmen tympani the brain Thin plate of Floor Internal jugular vein bone Canal for the tensor Openings into tympani muscle two canals Auditory tube Anterior wall Middle Ear Thin plate of Internal carotid (Tympanic Cavity) bone artery Aditus to the mastoid antrum Posterior wall Pyramid Stapedius muscle Tympanic Fenestra vestibuli Lateral wall membrane Medial wall Promontory Fenestra cochleae Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout Faculty of Medicine IUG Tympanic Membrane Examination • Otoscopic examination of the tympanic membrane is facilitated by first straightening the external auditory meatus by gently pulling the auricle: – Upward and backward in the adult. – Straight backward or backward and downward in the infant. Dr. Sami Zaqout Faculty of Medicine IUG Tympanic Membrane Examination • Normally, the tympanic membrane is pearly gray and concave. • The adult the external meatus is about 2.5 cm long and is narrowest about 5 mm from the tympanic membrane. • The tympanic membrane is extremely sensitive to pain and is innervated on its outer surface by the auriculotemporal nerve and the auricular branch of the vagus. Dr. Sami Zaqout Faculty of Medicine IUG Tympanic membrane Dr. Sami Zaqout Faculty of Medicine IUG Head Neck Malleus Long process Anterior process Lateral process Body Auditory Incus Long process Ossicles Short process Head Neck Stapes Two limbs Base Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout Faculty of Medicine IUG Movements of the Auditory Ossicles Dr. Sami Zaqout Faculty of Medicine IUG Auditory Tube • Connects the anterior wall of the tympanic cavity to the nasal pharynx. Posterior third is bony. Anterior two thirds is cartilaginous. • It serves to equalize air pressures in the tympanic cavity and the nasal pharynx. Dr. Sami Zaqout Faculty of Medicine IUG Mastoid Antrum • The mastoid antrum lies behind the middle ear in the petrous part of the temporal bone. • It communicates with the middle ear by the aditus. Dr. Sami Zaqout Faculty of Medicine IUG Anterior wall Middle ear Sigmoid venous sinus Posterior wall Cerebellum Suprameatal Lateral wall triangle Posterior Antrum Mastoid Mastoid Medial wall semicircular canal Temporal lobe of Superior wall the brain Inferior wall Mastoid air cells Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout Faculty of Medicine IUG Intrapetrous Part of the Facial Nerve Facial nerve in the temporal bone Chorda tympani Dr. Sami Zaqout Faculty of Medicine IUG Intrapetrous Part of the Facial Nerve The greater petrosal nerve Nerve to the stapedius Chorda tympani – Taste fibers from the mucous membrane covering the anterior two thirds of the tongue – Preganglionic parasympathetic secretomotor fibers that reach the submandibular ganglion and are there relayed to the submandibular and sublingual salivary glands. Dr. Sami Zaqout Faculty of Medicine IUG Tympanic Nerve Dr. Sami Zaqout Faculty of Medicine IUG Infections and Otitis Media • Pathogenic organisms can gain entrance to the middle ear by ascending through the auditory tube from the nasal part of the pharynx. • Acute infection of the middle ear (otitis media) produces bulging and redness of the tympanic membrane. Dr. Sami Zaqout Faculty of Medicine IUG Complications of Otitis Media Acute mastoiditis Meningitis and a cerebral abscess Facial nerve palsy Labyrinthitis with vertigo Thrombosis in the sigmoid sinus Dr. Sami Zaqout Faculty of Medicine IUG Vestibule Bony Semicircular labyrinth canals Cochlea Internal Ear (Labyrinth) Utricle and saccule Membranous Semicircular labyrinth ducts Duct of the cochlea Dr. Sami Zaqout Faculty of Medicine IUG The vestibule Dr. Sami Zaqout Faculty of Medicine IUG Semicircular canals • The superior canal is vertical and placed at right angles to the long axis of the petrous bone. • The posterior canal is also vertical but is placed parallel with the long axis of the petrous bone. • The lateral canal is set in a horizontal position Dr. Sami Zaqout Faculty of Medicine IUG Cochlea Dr. Sami Zaqout Faculty of Medicine IUG Utricle and saccule • Located on the walls of the utricle and saccule are specialized sensory receptors, which are sensitive to the orientation of the head to gravity or other acceleration forces. Dr. Sami Zaqout Faculty of Medicine IUG Semicircular ducts • Whenever a movement of the head accelerates or decelerates, the endolymph in the semicircular ducts changes its speed of movement relative to that of the walls of the semicircular ducts. • This change is detected in the sensory receptors in the ampullae of the semicircular ducts. Dr. Sami Zaqout Faculty of Medicine IUG Duct of the cochlea • The highly specialized epithelium that lies on the basilar membrane forms the spiral organ of Corti and contains the sensory receptors for hearing. Dr. Sami Zaqout Faculty of Medicine IUG Vestibulocochlear Nerve • Vestibular nerve: – The utricle – The saccule – The ampullae of the semicircular ducts. • Cochlear nerve: – Spiral organ of Corti Dr. Sami Zaqout Faculty of Medicine IUG Vestibulocochlear Nerve Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout Faculty of Medicine IUG Digastric fossa Symphysis Base menti Alveolar part External surface Mental foramen Genioglossus M Body Mental spines Geniohyoid M Medial surface Angle Submandibular The fossa Mandible Mylohyoid line Sublingual fossa Lateral surface Masseter M Pair of rami Mandibular Inferior alveolar foramen N + V Medial surface Condyloid Coronoid Lingula Sphenomandibular process process ligament Temporalis M Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout Faculty of Medicine IUG Temporomandibular Joint - Articulation • Articulation occurs between: – The articular tubercle and the anterior portion of the mandibular fossa of the temporal bone above – The head (condyloid process) of the mandible below. • The articular surfaces are covered with fibrocartilage. • The articular disc divides the joint into upper and lower cavities. Dr. Sami Zaqout Faculty of Medicine IUG Temporomandibular Joint – Capsule • The capsule surrounds the joint and is attached above to the articular tubercle and the margins of the mandibular fossa and below to the neck of the mandible. Dr. Sami Zaqout Faculty of Medicine IUG Temporomandibular Joint – Ligaments Dr. Sami Zaqout Faculty of Medicine IUG Temporomandibular Joint - Synovial Membrane + Nerve Supply • Synovial Membrane • Lines the capsule in the upper and lower cavities of the joint. • Nerve Supply • Auriculotemporal and masseteric branches of the mandibular nerve Dr. Sami Zaqout Faculty of Medicine IUG Temporomandibular Joint - Movements Dr. Sami Zaqout Faculty of Medicine IUG Muscles of mastication Dr. Sami Zaqout Faculty of Medicine IUG Masseter muscle Dr. Sami Zaqout Faculty of Medicine IUG Medial pterygoid muscle Dr. Sami Zaqout Faculty of Medicine IUG Lateral pterygoid muscle Dr. Sami Zaqout Faculty of Medicine IUG Temporalis muscle. Dr. Sami Zaqout Faculty of Medicine IUG Relations of the Temporomandibular Joint Anteriorly Posteriorly Laterally Medially Tympanic plate of The parotid gland Maxillary artery Mandibular notch the external and vein auditory meatus Fascia Masseteric nerve Auriculotemporal and artery Glenoid process of nerve the parotid gland Skin Dr. Sami Zaqout Faculty of Medicine IUG Dislocation of the Temporomandibular Joint • Dislocation sometimes occurs when the mandible is depressed. • In this movement, the head of the mandible and the articular disc both move forward until they reach the summit of the articular tubercle. Dr. Sami Zaqout Faculty of Medicine IUG Dislocation of the Temporomandibular Joint • In this position, the joint is unstable, and a minor blow on the chin or a sudden contraction of the lateral pterygoid muscles, as in yawning, may be sufficient to pull the disc forward beyond the summit. • In bilateral cases the mouth is fixed in an open position, and both heads of the mandible lie in front of the articular tubercles. Dr. Sami Zaqout Faculty of Medicine IUG Dislocation of the Temporomandibular Joint • Reduction of the dislocation is easily achieved by pressing the gloved thumbs downward on the lower molar teeth and pushing the jaw backward. • The downward pressure overcomes the tension of the temporalis and masseter muscles, and the backward pressure overcomes the spasm of the lateral pterygoid muscles. Dr. Sami Zaqout Faculty of Medicine IUG Dr. Sami Zaqout Faculty of Medicine IUG .
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