B5-101 TMJ, Oral Cavity, and Pharynx Flashcards
the muscles of mastication develop from the mesoderm of the […] pouch
first pharyngeal
the muscles of mastication are innervated by
V3 (trigeminal CN)
root of mandibular nerve
supra and infrahyoid muscles depress the mandible by
- fixing hyoid in place (infrahyoid)
- bringing mandible inferiorly to the fixed hyoid (suprahyoid)
elevators of mastication
3
- masseter
- temporalis
- medial and lateral pterygoid
elevates mandible, closing jaws, more horizontal fibers, some retraction
temporalis
elevates mandible, closing jaws, superficial fibers make limited contribution to protusion of mandible
masseter
- acting bilaterally protracts mandible and depresses chin, acting unilaterally
- alternate unilateral contractions produce large chewing movements
lateral pyerygoid
- acts synergistically with the masseter to elevate
- contributes to protrusion
- alternate unilateraly activity to produce grinding movements
medial pterygoid
depressor innervated by facial and mandibual nerves
digastric (suprahyoid)
depressor innervated by facial nerve (CN VII)
stylohyoid (suprahyoid)
depressor innervated by mandibular nerve (CN V3)
mylohyoid (suprahyoid)
depressor innervated by nerve to geniohyoid (C1-C2)
geniohyoid (suprahyoid)
depressor innervated by ansa cervacalis from cervical plexus (C1-C3)
3
omohyoid
sternohyoid
sternothyroid
all infrahyoid
depressor innervated by C1 via hypoglossal
thyrohyoid (suprahyoid)
depressor innervated by cervical branch of the facial nerve (CN VII)
platysma
depresses mandible against resistance when infrahyoid muscles fix or depress bone
suprahyoids
fixes/depresses hyoid bone
infrahyoids
depresses mandible against resistance
platysma
seals the anterior oral cavity so food does not escape
orbicularis oris
keeps food from falling out between distal tooth rows and cheeks
buccinator
Bell’s palsy may impact what muscle
buccinator
translations of the TMJ happens in which compartment?
superior
hinging and pivoting of the TMJ happen in which compartment?
inferior
the lateral ligament and postglenoid tubercle of the TMJ act to prevent
posterior dislocation
dislocation of the jaw is almost alway
direction
anterior
flexion is
elevation or depression
elevation
extension is
elevation or depresion
depression
bony surfaces of the TMJ
4
- glenoid fossa
- articular tubercle
- postglenoid tubercle
- head of mandible
prevents posterior movement/dislocation of jaw
lateral ligament
the inner joint of the TMJ is separated into a superior and inferior cavity by a
fibrinocartilaginous disk
two accessory ligaments that maintain and limit ROM of the mandible
sphenomandibular
stylomandibular
innervation of TMJ
4
- mandibular (V3)
- massenteric
- deep temporal
- auriculotemporal
nerve that surgeons need to be especially careful of when in the TMJ
auriculotemporal
provides parotid glands and skin sensation over ear
the superior head of the lateral pterygoid inserts into […]
allowing for sliding forward on to the […]
articular disc
atricular tubercle
in the full gape phase of mastrication, the mandible slides forward onto […]
articular tubercle
crepitus determined by provider
degenerative joint disease
prior jaw locking
clicking with opening/closing or protrusion
limited opening
intra-articular joint disorder
2 nerves through which the trigeminal supplies dentation
maxillary nerve
mandibular nerve
arises from the mandibular nerve, travels through mandibular foramen, to innervate lower jaw
inferior alveolar nerve (CN V3)
arises from maxiallary nerve to innervate upper jaw
superior alveolar nerves (V2)
posterior, middle, anterior
innervates left and right vestibular gingiva in the palate
4
- anterior superior alveolar
- infraorbital
- middle superior alveolar
- posterior superior alveolar
from CN V2, mesial to distal
innervates left and right vestibular gingiva in floor of mouth
2
mental branch
buccal branch
from CN V3, mesial to distal
innervates right and left tooth pulp, periodontal ligament, alveolar processes in palate
3
- anterior superior alveolar
- middle superior alveolar
- posterior superior alveolar
from CN V2, mesial to distal
innervates right and left tooth pulp, periodontal ligament, alveolar processes in floor of mouth
2
incisive branch of inferior alveolar
dental branch of inferior alveolar
from CN V3, mesial to distal
innervates superior lingual gingiva in palate of mouth
nasopalatine
greater palatine
from CN V2, mesial to distal
innervates floor of mouth and inferior lingual gingiva
lingual
from CN V3
the pharyngotympanic tube opens into
nasopharynx
what structure lies between the palatoglossal and palatopharyngeal arches?
palatine tonsils
describe the 3 stages of deglutition
differentiate involuntary/voluntary
stage 1: voluntary; bolus pushed against palate and into oropharynx by tongue and soft palate
stage 2: involuntary; soft palate quickly seals off nasopharynx, pharynx widens and shortens to receive bolus
stage 3: involuntary; sequential contraction of pharyngeal constrictor muscles creates peristalsis, forcing bolus into esophagus
innervates parotid gland
glossopharyngeal (CN IX)
innervates sublingual and submandibular glands
facial nerve (CN VII)
runs lateral and inferior to submandibular duct
lingual nerve
of importance when calcus needs to be incised
which salivary glands have long ducts in which calculi can get stuck?
2
parotid
submandibular
when extracting a calculi from the submandibular duct, what nerve is the surgeon concerned about?
lingual (CN V3)
salivary glands lining roof of mouth
palatine glands
can become cancerous
what nerve runs through the parotid gland?
facial
provides motor for facial expression
branches of what nerve are of importance when excising a parotid tumor?
facial
provide motor for facial expression
primarily innervates hard palate
great palatine nerve
primarily innervates soft palate
lesser palatine nerves
levator veli palatine is innervated by
vagus (CN X)
tensor veli patalini is innervated by
trigeminal (V3)
tenses palate to make it taunt laterally
tensor veli palatini
elevates the tense palatine platform
levator veli palatini
the anterior (body) aspect of the tongue is divided from the posterior (root) aspect of the tongue at the
terminal sulcus
tonsils at posterior aspect of tongue
lingual tonsils
space between epiglottis and tongue
valleculae epiglottica
important for intubation
important to identify for intubation
valleculae epiglottica
space between epiglottis and tongue
provides sensation to the anterior 2/3 of tongue
lingual nerve
special sense taste to tongue is provided to the anterior 2/3 of the tongu by what branch of the facial nerve?
chorda tympani
provides general and special sense taste to posterior 1/3 of tongue
glossopharygeal
all of the motor innervation of the tongu is supplied by
hypoglossal (CN IX)
important muscle to protrusion of tongue
genioglossus
if you have damage to one side of the hypoglossal, the tongue will protrude to
the injured side
pull tongue up and posteriorly during swallowing
2
palatoglossal
styloglossal
- if the hyoid is fixed, this muscle will pull hyoid back and down
- or can make hyoid ascend if tongue is fixed
hyoglossus
intrinsic muscles of tongue
3
- superior longitudinal
- transverse and vertical
- inferior longitudinal
firing when you make a clover with tongue
extrinsic muscles of tongue
3
- styloglossus
- hyoglossus
- genioglossus
- depresses central part of tongue
- posterior part pulls tongue anterior for protrusion
- most anterior retracts apex of tongue
- unilateral contraction deviates tongue to contralateral side
genioglossus
- depresses tongue, pulling its sides anteriorly
- helps retrude tongue
hyoglossus
retrudes tongue and curls sides, working with genioglossus to form central trough during swallowing
styloglossus
- elevates posterior tongue
- depresses soft palate
- acts to constrict isthmus of fauces
palatoglossus
located on either side of frenulum and provides opening of submandibular duct
sublingual caruncle
mucosal tissue that attaches tongue to floor of mouth
frenulum
anterior tongue tie
frenulum
posterior tongue tie
frenulum breve posterior
low birth weight
breast feeding issue
don’t latch well
tongue tie
procedure to free up tongue for better latching
frenotomy
afferent limb of swallowing reflex
glossopharyngeal
efferent limb of swallowing reflex
vagus
from palatoglossal arch to valleculae epiglottica and tip of uvula to superior epiglottis is the
fauces
food first drops in the […] to push the epiglottis over the oral airway
fauces
due to proximity, osteoarthritis of the vertebral column can effect
swallowing
speech
swollen palatine tonsils can push up the […] and effect airway
soft palate
the pharyngotympanic tube and ridge of levator veli palatini are located in the
nasopharynx
the anterior attachment for the superior pharyngeal constrictor is the […]
and joins the buccinator
pterygomandibular raphe
runs from pharyngeal raphe, anteriorly to attach on hyoid
middle pharyngeal constrictor
attachment point for inferior pharyngeal constrictor
thyroid and cricoid catrilage of pharynx
lower part of inferior pharyngeal constrictor
cricopharyngeas
which pharyngeal muscle is innervated by CN IX?
glossopharyngeal
stylopharyngeus
other than stylopharyngeus, all other muscles of the pharynx are innervated by
vagus (CN X)
muscles that pull down on eustachian tube to open ears
3
salpingopharyngeus
levator veli palatini
tensor velin palatini
constrict walls of pharynx during swallowing
3
superior pharyngeal constrictor
middle pharyngeal constrictor
inferior pharyngeal constrictor
elevate (shorten and widen) pharynx and larynx during swallowing and speaking
3
palatopharyngeus
salpingopharyngeus
stylopharyngeus
only muscles that glossopharyngeal innervates
stylopharyngeus
produce contractions to move food bolus up or down pharynx (gag/swallow reflex)
2
vagus (CN X)
glossopharyngeal (CN IX)
what nerve should a surgeon be cautious of in a tonsillectomy?
glossopharyngeal
lose sensation and taste on one side of tongue
can pull the mandible laterally when working in isolation
lateral pterygoid
when accompanied by its attachment to the articular disc of the TMJ, helps the mandibular condyle translate onto the articular tubercle
lateral pterygoid
nerve responsible for sensation to lower mandibular dentition
inferior alveolar
supplies motor to muscles of tongue
hypoglossal
branch of V3 that provides sensation to anterior 2/3 of tongue
lingual
will innervate the nasal septum
nasopalatine nerve
innervates sensation to the maxillary molors and premolars
posterior superior alveolar
help fix the hyoid inferiorly, permitting active depression of the mandible
3
sternohyoid
thyrohyoid
omohyoid
motor nerve for tongue musculature
hypoglossal
permits protrusion of tongue
genioglossal
supplies motor to muscles of facial expression
facial n
branch of V3 that provides senstation to anterior 2/3 of tongue
lingual
supplies innervation to the bulk of the pharyngeal and laryngeal muscles
vagus
supplies general sensation and taste to posterior 1/3 of tongue
glossopharyngeal
provides sensation to the side of the face anterior to ear
auriculotemporal
provides motor to tongue muscles
hypoglossal
supplies motor to muscles of facial expression
facial
supplies innervation to bulk of the pharyngeal and laryngeal muscles
vagus
provides motor innervation to stylopharyngeus muscle
glossopharyngeal
provides afferent innervation of pharynx and carotid body and sinus
glossopharyngeal
provides taste and general sense to posterior 1/3 of tongue
glossopharyngeal
provides sensation to anterior 2/3 of tongue
lingual
provides sensation to the mandible and motor to the muscles of mastication
mandibular nerve of trigeminal
cartilaginous flap at anterosuperior aspect of the larynx
epiglottis
attaches to ventrum of tongue
lingual frenulum
efferent limb of gag reflex
vagus
afferent limb of gag reflex
glossopharyngeal
supplies sensation to skin and oral mucosa of cheek
buccal nerve
provides visceral sensation from base of tongue
vagus
what would cause facial asymmetry with TMJ?
atrophy of muscles of mastication
why do you get mandibular deviation to the left in TMJ?
trouble with anterior excursion due to degeration, osteophytes, or displacement of articular disc
what is the average normal interincisal distance?
40
what may the crepitus be indicative of in TMJ?
cartilage degeneration
- produce side to side movement when firing unilaterally
- cause protrusion
- cause anterior movement of articular disc
lateral pterygoid
adductors or elevators of jaw
3
medial pterygoid
masseter
temporalis
pulls the articular disc foward and medial in TMJ
lateral pterygoid
superior head
osteoartritic changes you may expect to see on CT of TMJ
osteophytes
flattening of head of mandible
decreased joint space
sclerosis of bone
intra-articular joint disorder is confirmed by what imaging modality?
MRI
degenerative joint disease is confirmed by what imaging modality?
CT
TMJ is associated with what disease?
psoriasis
localized pain at angle of mandible with swelling and severe pain
parotitis
what nerve lies in close proximity to the parotid gland?
facial
enlarged and diffuse hypoechoic structure on US with increased vascularization on color doppler
parotitis
COVID and mumps may cause
parotitis
provides sensation to the posterior 1/3 of tongue
glossopharyngeal
provides sensation to anterior 2/3 of tongue
lingual
provides motor to intrinsic muscles of tongue
hypoglossal
provides sensation to mandible and inferior teeth
inferior alveolar nerve
provide sensation to maxillary molars/premolars, gums, and maxillary sinus
posterior superior alveolar nerve
provides motor to temporalis muscle
deep temporal n.
travels between the heads of the lateral pterygoid to provide sensation to the skin and oral mucosa of the cheek
buccal nerve
central incisors and canine teeth are inervated by
anterior superior alveolar
provides sensation to the hard palate
greater palatine n.
provides sensation to soft palate, uvula, and tonsil
lesser palatine nerve
provides sensation to the nasal septum
nasopalatine nerve
buccinator is innervated by
facial nerve
genioglusses is innervated by
hypoglossal
the stylopharyngeus is innervated by
glossopharyngeal
tensor veli palatini is innervated by
trigeminal
palatopharyngeous is innervated by
vagus