Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

HNNS > HNS32 Parotid And Infratemporal Regions > Flashcards

HNS32 Parotid And Infratemporal Regions Flashcards

1
Q

Temporal fossa and Infratemporal fossa

A

Temporal fossa:

  • narrow fan-shaped space
  • mastication muscles —> Temporalis

Infratemporal fossa
- highway centre —> connect with a lot of space (orbit, nasal, cranial cavity, mediastinum (pericardial infection) etc.)
—> anterior: Inferior orbital fissure —> **Orbit
—> roof: Foramen rotundum, Pterygoid canal —> **Middle cranial fossa (brain)
—> medial: Sphenopalatine foramen —> ***Nasal cavity

  • below zygomatic arch
  • below Temporal fossa
  • interconnect with Temporal fossa on lateral side of head
  • below skull base
  • Temporomandibular joint (TMJ)
  • mastication muscles —> Temporalis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Bony framework and landmarks of Infratemporal fossa

A
  1. Medial: Lateral pterygoid plate, Lateral wall of pharynx, Tensor (CNV3) / Levator veli palatini (Pharyngeal plexus)
    - contains ***Pterygomaxillary fissure —> leads to Pterygopalatine fossa
  2. Lateral: Mandibular ramus (medial surface)
    - contains ***Mandibular foramen
  3. Roof: Infratemporal crest of greater wing of Sphenoid / Temporal bone / Temporal fossa
    - contains **Foramen ovale, **Foramen spinosum, ***Petrotympanic fissure
  4. Anterior: Posterior surface of Maxilla (Maxillary tuberosity) / Maxillary process of Zygomatic bone
    - contains **Alveolar foramina
    - upper part opens as **    Inferior orbital fissure
  5. Posterior: Styloid process of Temporal bone

—> Open to neck posteroinferiorly (infection spread)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

***Foramen ovale, Foramen spinosum, Petrotympanic fissure

A

Foramen ovale (OVALE acronym):

  1. ***Otic ganglion (from CN9)
  2. ***CNV3
  3. Accessory meningeal artery
  4. ***Lesser petrosal nerve
  5. Emissary veins

Foramen spinosum:

  1. ***Middle meningeal artery
  2. Middle meningeal vein
  3. ***Recurrent meningeal branch of CNV3 (every branch of CN5 have meningeal branch)

Petrotympanic fissure:
1. ***Chorda tympani (CN7)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Inferior orbital fissure

A
  1. Zygomatic branch (CNV2)
  2. Infraorbital nerve (CNV2)
  3. Infraorbital A+V (Maxillary)
  4. Ascending fibres from Pterygopalatine ganglion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

***Infratemporal fossa communications

A
  1. Cranial cavity
    - Foramen ovale
    - Foramen spinosum
  2. Orbit
    - Inferior orbital fissure
  3. Pterygopalatine fossa
    - Pterygomaxillary fissure (connect with nasal, oral cavity, orbit)
    - Sphenopalatine foramen
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Attachment of styloid process

A

Ligaments:

  1. Stylohyoid ligament
  2. Stylomandibular ligament
  • **Muscles:
    1. Stylohyoid (CN7)
    2. Styloglossus (CN12)
    4. Stylopharyngeus (CN9)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

***Infratemporal fossa contents

A

Ligament:
1. Sphenomandibular ligament

  • **Muscles of mastication:
    1. Medial pterygoid muscle
    2. Lateral pterygoid muscle
    3. Masseter
    4. Temporalis

Nerve:

  1. ***Mandibular nerve (CNV3)
    - motor + sensory
    - sensory: from Trigeminal ganglion through Foramen ovale
    - motor: motor root bypass medially to Trigeminal ganglion —> enter Foramen ovale —> fuse with sensory —> Mandibular nerve

Blood vessels:

  1. ***Maxillary artery
  2. ***Pterygoid venous plexus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Temporomandibular joint (TMJ)

A
  • Only pair of synovial joint in skull (movable)
  • Opening / closing, Chewing, Side-to-side movement of lower jaw
  • Formed between Mandible head + Mandibular fossa / Articular tubercle
  • Divided completely by articular disc —> upper / lower part
  • 3 Extracapular ligaments of TMJ:
    1. Sphenomandibular ligament (spine of sphenoid to lingula of mandible) (Maxillary artery, inferior alveolar nerve)
    2. Lateral ligament
    3. Stylomandibular ligament (division of infratemporal region / parotid region)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

4 Mastication muscles

A
  1. Medial pterygoid
  2. Lateral pterygoid
  3. Masseter (strongest muscle: elevate jaw / 開合口)
  4. Temporalis

ALL supplied by **Maxillary artery + **CNV3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Medial pterygoid muscle

A
  • Quadrangular
  • 2 heads: Deep + Superficial heads (夾住Lateral pterygoid plate)

Deep head:
- attached to ***medial surface of Lateral pterygoid plate + associated surface of pyramidal surface of Palatine bone

Superficial head:

  • smaller
  • from Maxillary tuberosity + adjacent pyramidal process of Palatine bone

Insertion:
- Medial angle of mandible

Action:
- **Elevate mandible, **Protrusion of lower jaw, ***Move mandible medially

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Lateral pterygoid muscle

A
  • Triangular
  • 2 heads: Upper + Lower heads (Lateral pterygoid plate出面)

Upper head:

  • from roof of Infratemporal fossa
  • lateral to Foramen ovale + Foramen spinosum

Lower head (比Medial pterygoid包住):

  • larger
  • attached to lateral surface of Lateral pterygoid plate
  • between 2 heads of Medial pterygoid muscle

Insertion:
- Condylar process of mandible

Action:
- Major **protruder of lower jaw, assist **side-to-side movement of lower jaw

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Temporalis muscle

A

Origin:

  • bony surface superiorly to inferior temporal line
  • attaching laterally to Temporal fossa

Insertion:
- Coronoid process and along anterior margin of Mandible ramus

Action:

  • Anterior fibres: ***Elevate mandible —> Close jaw
  • Posterior fibres: **Retract mandible (ONLY retractor) + assist **side-to-side movement of mandible
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Masseter

A
  • 2 heads: Superficial + Deep heads

Origin:
- Maxilla and Zygomatic arch

Insertion:
- Lateral surface of Mandible ramus + Coronoid process

Action:
- **Elevation, **Protrusion of mandible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

***Mandibular nerve CNV3

A 
Function:
- Sensory: teeth and gingivae of mandible, ***anterior 2/3 tongue, mucosa of oral cavity floor, lower lip, skin over temple, lower face skin, part of dura mater
- Motor:
—> ***Mastication muscles
—> ***Tensor tympani
—> ***Tensor veli palatini
—> ***Anterior belly of digastric
—> ***Mylohyoid
  1. Trunk branches (origin: Medial side of CNV3)
    —> ***Meningeal nerve
    - enters Foramen spinosum (with middle meningeal artery)
    - sensory to dura mater (in middle cranial fossa)
    —> Nerve to medial pterygoid (branch to tensor tympani, tensor veli palatini)
  2. Anterior branches (***Motor mostly)
    —> Masseteric nerve (laterally over lateral pterygoid muscle through mandibular notch)
    —> Deep temporal nerve (Temporalis)
    —> Nerve to lateral pterygoid
    —> Buccal nerve (最前) (cheek, mucosa, buccal gingiva) (Buccinator: CN7)
  3. Posterior branches (***Sensory mostly)

—> ***Auriculotemporal nerve (包住middle meningeal artery)

  • General sensory: skin over temple, external ear, external acoustic meatus, tympanic membrane, TMJ
  • Visceral motor: carries postsynaptic fibre from **Otic ganglion (presynpatic fibre: **Lesser petrosal nerve from CN9) —> Parotid gland

—> Inferior alveolar nerve

  • Sensory: lower teeth and associated gingivae, mucosa, skin of lower lips, skin of chin
  • Motor: ***Mylohyoid + Anterior belly of digastric
  • Incisive nerve —> ***Mental nerve (exit in mental foramen)

—> ***Lingual nerve

  • General sensory: anterior 2/3 tongue, mucosa of oral cavity floor, lingual gingivae
  • Visceral motor: joined by **Chorda tympani (Taste + Parasympathetic presynaptic fibres from CN7 within middle ear) —> **Submandibular ganglion —> Sublingual gland + Submandibular gland (ALL salivary glands below level of oral fissure)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Chorda tympani

A
  • Branch of CN7
  • Origin: inside temple bone, passes through medial end of petrotympanic fissure
  • Joins Lingual nerve medial to lateral pterygoid muscle
  • Special sensory: taste fibres from anterior 2/3 tongue
  • Visceral motor: Presynaptic parasympathetic fibres —> Submandibular ganglion —> Sublingual gland + Submandibular gland + Blood vessels of tongue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Submandibular ganglion

A
  • Hangs from Lingual nerve at lateral surface of ***Hyoglossus muscle
  • Secondary cell bodies for Presynpatic fibres in Chorda tympani
  • Postsynaptic fibres travel along Lingual nerve to Submandibular gland + Sublingual gland
17
Q

Lesser petrosal nerve

A
  • Branch of Tympanic plexus
  • Carries presynpatic fibres from CN9
  • Passes medially and descend with CNV3 through Foramen ovale
  • Presynpatic fibres —> Otic ganglion (medial side of CNV3) —> Auriculotemporal nerve
18
Q

***Maxillary artery

A
  • Largest branch of External carotid artery
  • Origin: deep substance of parotid gland —> between mandibular neck and sphenomandibular ligament —> Infratemporal fossa —> Pterygomaxillary fissure —> Pterygopalatine fossa
  • nasal cavity, lateral wall + roof of oral cavity, dura mater, infratemporal fossa
  • 1st part: Between neck of mandible and sphenomandibular ligament (Posterior to Lateral Pterygoid)
    —> **Middle meningeal artery
    —> **    Inferior alveolar artery
    —> Deep auricular, Anterior tympanic, Accessory meningeal arteries
- 2nd part: Within Lateral pterygoid muscle
—> Deep temporal branch
—> Masseteric branch
—> Buccal branch
—> Pterygoid branch
  • 3rd part / Terminal branch: Pterygopalatine fossa (Anterior to Lateral Pterygoid)
    —> **Infraorbital artery
    —> **    Sphenopalatine artery
19
Q

Pterygoid venous plexus

A
  • Network of veins between Medial + Lateral pterygoid muscle / between Lateral pterygoid + Temporalis
  • Drains nasal cavity, lateral wall + roof of oral cavity, all teeth, muscles in infratemporal fossa, paranasal sinuses, nasopharynx
    1. Posterior: Short maxillary vein, connects with **Retromandibular vein —> **External jugular vein
    2. Anterior: Deep facial vein, connects with **Facial vein —> **Internal jugular vein
    3. Inferior ophthalmic vein from orbit —> Inferior orbital fissure —> Pterygoid plexus
    4. ***Cavernous sinus: through Inferior ophthalmic vein + Emissary veins (pass through skull)
20
Q

***Clinical relevance of Infratemporal fossa

A
  1. Fracture of pterion (太陽穴)
    - overlies **Middle meningeal vessels (anterior branch)
    —> blow to lateral side of head
    —> **    Epidural haematoma
    —> pressure on cerebral cortex
  2. Pterygoid venous plexus
    - connects to Facial vein through **Inferior ophthalmic and **Deep facial vein
    —> infection in oral cavity and nasal cavity could spread through pterygoid plexus
    —> Emissary veins
    —> Cavernous sinus
    —> **Septic thrombosis
    —> **    Stroke, Meningitis, Encephalitis
    - Danger triangle of face —> Facial vein —> Cavernous sinus —> Cavernous sinus thrombosis —> meningitis, brain abscess
  3. Lingual nerve injury
    - proximal to where Chorda tympani joins —> loss of general sensation (anterior 2/3 tongue, oral mucosa, gingivae)
    - distal to where Chorda tympani joins —> above + loss of saliva from submandibular / sublingual gland + taste from anterior 2/3 tongue
    - enter oral cavity floor in a shallow groove on medial surface of mandible immediately inferior to last molar teeth —> in danger when operating on molar teeth and gingivae
  4. Perineuronal infiltration of Inferior alveolar nerve (posterior branch of CNV3) by LA in dental procedures
    —> needle placed lateral to anterior arch of fauces
    —> advances along medial border around inferior 1/3 of mandible
    —> possible to anaesthetise infraorbital, mental, incisive, buccal nerves
21
Q

***Parotid gland

A
  • Largest salivary gland
  • Inverted pyramid shape: Superior + Superficial + Anteromedial + Posteromedial surface + Tapering blunt apex inferiorly
  • CN7 divides gland into Superficial (larger) + Deep (smaller) part
  • ***Structures traversing parotid gland (入—>出):
    —> ECA
    —> Retromandibular vein
    —> CN7 + branches
  • Parotid fascia: from Deep investing cervical fascia splitting in face
    —> enclose Parotid gland
  • Parotid LN:
    —> lie on / within parotid fascia
    —> within gland
    —> ALL drain into Upper ***Deep cervical LN

Location:
- Below external acoustic meatus
- Between Mandible ramus, SCM, Mastoid process (medial to mandible ramus, anteromedial surface of gland passes forward to reach medial pterygoid muscle)
- Anterior border:
—> anterior border of condyle of mandible to a point at middle of Masseter then to a point 2cm below and behind angle of mandible
- Upper border:
—> curve traced from condyle of mandible across lobule of ear to mastoid process
- Posterior border:
—> line joining posterior ends of anterior and upper border

22
Q

***Facial nerve CN7

A

Emerges from Stylomastoid foramen
—> winds laterally to styloid process
—> dives into posteromedial surface of Parotid gland
—> bifurcate into Upper + Lower divisions

Upper division:

  1. Temporal branch
  2. Zygomatic branch

Lower division:

  1. Buccal branch
  2. Marginal mandibular branch
  3. Cervical branch

ALL branches exit Parotid gland along its anterior border

23
Q

Parotid duct

A
  • 5cm
  • arise from anterior border of gland
  • on Masseter about 1 finger’s width below Zygomatic arch
  • opens into mucosa opposite **2nd upper molar at **Parotid papilla
  • can be palpated on clenched masseter
  • middle 1/3 of a line drawn from lower border of tragus of ear to midpoint of philtrum

HNNS (58 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions