Anatomical Spaces Of The Head And Neck I&II

Question 1

What are the 2 classes of bony spaces in the head?

Answer 1

Extracranial and intracranial

Question 2

What are the 3 extracranial bony spaces of the head?

Answer 2

Temporal fossa, infratemporal fossa, pterygopalatine fossa

Question 3

Where is the temporal fossa?

Answer 3

A shallow depression on the side of the skull

Question 4

What are the boundaries of the temporal fossa?

Answer 4

Superior and posteriorly: superior temporal line
Inferiorly: zygomatic arch
Anteriorly: frontal process of zygomatic and zygomatic process of frontal bone
Medially: frontal, parietal, temporal, sphenoid
Laterally: temporal fascia

Question 5

Where does the pterion sit?

Answer 5

In the temporal fossa

Question 6

Muscles of the temporal fossa

Answer 6

Origin of the temporalis

Question 7

Blood vessels of the temporal fossa

Answer 7

Supplies by superficial temporal artery, a terminal branch of the external carotid artery

Question 8

Nerves of the temporal fossa

Answer 8

Mandibular nerve CNV3, anterior and posterior branches of deep temporal nerve, auriculotemporal nerve, zygomaticotemporal nerve, temporal branches of facial nerve

Question 9

What is the location of the infratemporal fossa?

Answer 9

Lies below the middle cranial fossa, medial and deep to the zygomatic arch, behind the maxilla.
A deeper continuation of the temporal fossa.

Question 10

Boundaries of the infratemporal fossa

Answer 10

Superiorly: infratemporal surface of greater wing of sphenoid
Inferiorly: alveolar border of maxilla (or nothing)
Medially: lateral pterygoid plate
No lateral border.

Question 11

Muscles of the infratemporal fossa

Answer 11

Lower part of temporalis, lower parts of medial and lateral pterygoids

Question 12

Nerves of the infratemporal fossa

Answer 12

Mandibular nerve CNV3 and most of its branches: auriculotemporal, buccal, lingual, inferior alveolar nerve
Optic ganglion

Question 13

Arteries of the infratemporal fossa

Answer 13

Maxillary artery, including middle meningeal artery
Superficial temporal artery (branch of ECA)

Question 14

Veins of the infratemporal fossa

Answer 14

Pterygoid venous plexus

Question 15

Direct communications of the pterygoid venous plexus

Answer 15

Cavernous sinus
Superior ophthalmic vein

Question 16

What does venostasis around the pterygoid venous plexus cause?

Answer 16

Creates a lack of movement around the oral region. Produces the yawning reflex. Triggered to produce movement of the jaw.

Question 17

Openings of the infratemporal fossa

Answer 17

Foramen spinous, foramen ovale, alveolar canal, inferior orbital fissure, ptergymaxillary fissure

Question 18

How do pathologies evolve in the infratemporal fossa?

Answer 18

It is a potential anatomical space. Pathologies can evolve without detection, so when they become symptomatic they are likely to be advanced.

Question 19

Describe a mandibular nerve block

Answer 19

Anaesthetic injected to the nerve as it enters the infratemporal - affects the inferior alveolar, lingual, buccal and auriculotemporal nerves

Question 20

Describe an inferior alveolar nerve block

Answer 20

During dental treatment, anaesthetic is injected around the mandibular foramen on the medial side of the of the mandible. All the mandibular teeth are anaesthetic to the medial side. Skin and mucous membrane of lower lip also anaesthetised (supplied by mental branch)

Question 21

Where is the location of the pterygopalatine fossa?

Answer 21

Anatomical space created at the interval between the Neurocranium and viscerocranium. Inverted pyramid shape. Behind and below the ocular orbit. Found between bones on the lateral aspect of the skull immediately posterior to the maxilla.

Question 22

Why is the pterygopalatine fossa a weakness of the face?

Answer 22

Because the embryology of the cranium and facial skeleton are different, so can come apart with enough energy. Can also be a major route of spread of infection and metastases.

Question 23

Boundaries of the pterygopalatine fossa

Answer 23

Anteriorly: posterior surface of maxilla
Posteriorly: pterygoid process
Medially: perpendicular plate of palatine bone
Laterally: pterygomaxillary fissure

Question 24

Communications of the pterygopalatine fossa

Answer 24

With infratemporal fossa via the pterygomaxillary fissure
With middle cranial fossa via foramen rotundum
With nasal cavity via the sphenopalatine foramen
With orbital cavity via the inferior orbital fissure
With the palatine bone via greater palatine canal
With nasopharynx via the pharyngeal and pterygoid canals

Question 25

What’s are the contents of the cranial vault (the intracranial space)

Answer 25

Brain, associated nerves, vasculature, cerebrospinal fluid, meninges

Question 26

What does the tentorium cerebelli divide the cranial vault into?

Answer 26

Supratentorial compartment (divided by falx cerebri into left and right supratentorial space) Infratentorial compartment (smaller)

Question 27

How does the investing layer of fascia continue into the head region?

Answer 27

Continues into the head region to envelope the mandible, muscles and viscera to form the deep fascia compartments of the head.

Question 28

What are the 4 general classes of spaces in relation to soft tissues of the head?

Answer 28

Mandible and below; cheek and lateral face; mid face; pharyngeal and cervical areas

Question 29

What spaces are found in the mandible and below?

Answer 29

Buccal vestibule, mandible, mental space, Submental space, sublingual space, submandibular space

Question 30

What spaces are found in the cheek and lateral face?

Answer 30

Buccal vestibule of the maxilla, buccal space, sub-masseteric space, temporal space, parotid space

Question 31

What spaces are in the midface?

Answer 31

Palate, base of upper lip, canine spaces (infra orbital spaces) and peri orbital spaces. Relates to the danger triangle of the face.

Question 32

What spaces are in the pharyngeal and cervical areas?

Answer 32

Pterygomandibular space, parapharyngeal space, cervical spaces (retropharyngeal and danger).

Question 33

Why is the hyoid important?

Answer 33

Can limit spread of infection of neck

Question 34

What is Ludwig’s angina?

Answer 34

Life-threatening cellulitis of the soft tissue involving the floor of the mouth and neck. Involves the sublingual, submandibular and Submental spaces. Rapidly progressive infection leading to potential airway obstruction. Mainly caused by infection to the lower second and third molars.

Question 35

Difference between primary and secondary spaces

Answer 35

If an infection directly spreads into a space = primary space An infection spreads via another space = secondary space

Question 36

What are the primary maxillary spaces?

Answer 36

Canine space, buccal space, infratemporal space

Question 37

What are the primary mandibular spaces?

Answer 37

Submental, submandibular, sublingual, buccal, sub-masseteric spaces.