infratemporal fossa Flashcards

1
Q

boundaries of temporal fossa

A
  • superior: superior temporal line
  • inferior: zygomatic arch
  • anterior: zygomatic process of frontal bone and frontal process of zygomatic bone
  • posterior: supramastoid crest
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2
Q

*Boundaries of the infratemporal fossa

A
  • lateral: ramus of the mandible
  • anterior: maxilla
  • medial: lateral pterygoid plate
  • roof: greater wing of sphenoid
  • posterior: open
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3
Q

temporalis muscle

A

origin: temporal fossa, fascia and inbetween 2 temporal lines
insertion: coronoid process (apex, medial surface, anterior border until external oblique line of the mandible)
nerve supply: from deep temporal nerves; 1st branchial arch (from 1st pharyngeal arch V3)
action: elevation (by anterior fibers) and retraction (by posterior fibers) of the mandible

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4
Q

masseter

A

origin: inner surface and lower border of zygomatic arch (superficial–maxillary process; deep–whole length of zygomatic arch)
insertion: outer surface of ramus (superficial–lower part of ramus; deep–lateral surface of rams superior to superficial)
nerve supply: massetric nerve (branch from anterior division of V3 and passes mandibular notch
action: elevation and protraction of mandible

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5
Q

lateral pterygoid

A

origin: upper head–infratemporal surface and greater wing of sphenoid
lower head–lateral surface of lateral pterygoid
plate
Insertion: neck of mandible and articular disc of TMJ
Action: 1. pulls neck of mandible forward with articular disc to depress mandible and open mouth
2. acts with medial pterygoid of same side during movement of chewing (moving mandible to opposite side)
3. acts with medial pterygoid to protrude the mandible

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6
Q

medial pterygoid

A

Origin: superficial head–tuberosity of maxilla
deep head–medial surface of lateral pterygoid plate
Insertion: angle of the mandible (medial surface)
Nerve supply: main trunk of mandibular nerve (V3)
Action: elevates mandible, acting with lateral pterygoid during movement of chewing and protraction

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7
Q

pterygomandibular space

A
  • located b/w medial pterygoid medially and mandibular ramus laterally
  • contains inferior alveolar nerve (IAN) and artery (IAA) and lingual nerve (LN)
  • communicates with parapharyngeal space posteriorly (infection here could be dangerous)
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8
Q

depression of mandible

A
lateral pterygoid
digastric
geniohyoid
mylohyoid
platysma
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9
Q

elevation

A

temporalis
masseter
medial pterygoid

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10
Q

protrusion

A

lateral and medial pterygoids of both sides

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11
Q

retraction

A

posterior fibers of temporalis

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12
Q

lateral chewing movement

A

lateral and medial pterygoids of both sides acting alternately

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13
Q

all muscles of mastication are protractors EXCEPT —-

A

Temporalis

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14
Q

all muscles of mastication are elevators EXCEPT —

A

lateral pterygoid

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15
Q

mandibular nerve

A
  • arises from trigeminal ganglion in the middle cranial fossa
  • immediately receives the motor root of the trigeminal nerve (sensory and motor)
  • leaves cranium through the foramen ovale into the infratemporal fossa
  • contains GSA (general somatic afferent) and SVE (spatial visceral efferent) fibers
  • branches of CN V3 supply the four muscles of mastication but not the buccinator (supplied by facial nerve)
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16
Q

what’s the only muscular branch from posterior division of trigeminal?

A

nerve to mylohyoid

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17
Q

trunk of the mandibular nerve supplies?

A

medial pterygoid, tensor tympani, tensor palatini

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18
Q

anterior division of CN V supplies what muscles?

A

temporalis
lateral pterygoid
masseter

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19
Q

long buccal nerve supplies

A

only sensory division of anterior trigeminal

skin, mucous membrane, gum around buccinator

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20
Q

lingual nerve supplies

A

anterior 2/3 of tongue

general sensory?

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21
Q

what CN joins with lingual nerve and supplies taste, submandibular gang and sublingual gang?

A

CN VII

chorda tympani

22
Q

what nerve goes through the mental foramen

A

inferior alveolar nerve

23
Q

mylohyoid nerve supplies

A

mylohyoid muscle and anterior belly of digastric

24
Q

auriculotemporal nerve supplies

A

auricle, temporal region, TMJ, parotid (sensation)

25
Q

lesser superficial petrosal nerve joins —– to supply parotid gland

A

auriculotemporal (general visceral efferent)

26
Q

CN going through ovale and forms otic ganglion

A

CN IX

27
Q

three groups of branches in infratemporal fossa

A
  1. trunk
  2. anterior branches
  3. posterior branches
28
Q

branches arising from trunk in infratemporal fossa

A
  • Spinous nerve: passes through the spinous foramen and enters the cranium. It is a sensory nerve innervating the dura mater
  • Medial pterygoid nerve: innervates the medial pterygoid muscle, tensor veli paltini, tensor tympani
29
Q

anterior branches in infratemporal fossa

A

buccal nerve (sensory)
masseteric nerve
deep temporal nerve
lateral pterygoid

30
Q

posterior branches in infratemporal fossa

A

auriculotemporal nerve
lingual nerve
inferior alveolar nerve

31
Q

auriculotemporal nerve

A
  • supplies sensory fibers to the auricle and temporal region
  • sends articular (sensory) fibers to TMJ
  • conveys postsynaptic parasympathetic secretomotor fibers from the otic ganglion to parotid gland
32
Q

inferior alveolar nerve

A

enters mandibular foramen and passes thru mandibular canal –> inferior dental plexus–> sends branches to all mandibular teeth on its side

33
Q

terminal branch of inferior alveolar nerve

A

mental nerve

passes through mental foramen

34
Q

lingual nerve

A

sensory to anterior two thirds of tongue, floor of mouth, and lingual gingivae

35
Q

chorda tympani nerve and submandibular ganglion

A
  • branch of CN VII carrying TASTE from anterior two thirds of the tongue
  • joins lingual nerve in infratemporal fossa
  • also carries secretomotor fibers to submandibular and sublingual salivary glands
  • *parasympathetic
36
Q

otic ganglion

A

parasympathetic

  • location: infratemporal fossa, just inferior to foramen ovale
  • presynaptic parasympathetic fibers: derived mainly from the glossopharyngeal nerve (via lesser pet nerve) synapse in the otic ganglion
  • postsynaptic parasympathetic fibers: secretory to parotid gland, pass from the otic ganglion to this gland thru auriculotemporal nerve
37
Q

roots of otic ganglion

A

parasympathetic (functional) root: lesser superficial petrosal nerve
sensory root: auriculotemporal nerve
sympathetic root: postganglionic fibers from the superior cervical ganglion

38
Q

injury to inferior alveolar nerve

A

loss of teeth/lower lip sensation

39
Q

lingual nerve injury

A

after third molar removal

- nerve position is lateral to retromolar pad

40
Q

maxillary artery

A
  • arises posterior to neck of mandible as larger of two terminal branches of external carotid
  • three parts:
    1. mandibular: deep to condyle of mandible
    2. pterygoid: superficial or deep to lateral pterygoid muscle
    3. pterygopalatine: inside infratemporal fossa (extends to pterygopalatine fossa)
41
Q

branches of 1st part of maxillary artery

A

MIADA

  1. Middle meningeal (to dura mater and calvaria)
  2. Inferior alveolar artery (to mandibular gingiva and teeth)
  3. Anterior tympanic artery (to tympanic membrane)
  4. Deep auricular (to external acoustic meatus)
  5. Accessory meningeal artery (to cranial cavity)
42
Q

branches of 2nd part of maxillary artery

A

(muscular branches)

  1. deep temporal artery (to temporal muscle)
  2. pterygoid artery ( to pterygoid muscles)
  3. masseteric artery (to massetor)
  4. buccal artery (to buccinator muscle)
43
Q

branches of 3rd part of maxillary artery

A
  1. posterior superior alveolar artery
  2. infra-orbital artery
  3. greater palatine artery
  4. pharyngeal artery
  5. sphenopalatine artery
  6. artery of the pterygoid canal
    * Collectively, these branches supply the nasal cavity, roof of the oral cavity, and all upper teeth. ALSO contribute to blood supply of sinuses, oropharynx, and floor of orbit
44
Q

middle meningeal artery and extradural hematoma

A
  • first part of maxillary artery (origin: petrous part of internal carotid)
  • ascends between two roots of auriculotemporal nerve to enter cranial cavity through foramen spinosum
  • divides into anterior and posterior
  • anterior ascends opposite the pterion and posterior branch runs posteriorly toward the tentorium cerebelli
  • supplies dura, trigeminal ganglion, and pertosal branch that supplies facial nerve
  • common source of extradural hemorrhage and hematoma and plays a role in development of migrane
45
Q

clinical course of extradural hematoma

A
  • initial loss of consciousness following head trauma
  • temporary recovery of consciousness (lucid interval)
  • renewed decline in mental status (talk and die)
46
Q

epidural hematoma

A
  • traumatic rupture of middle mengingeal artery
  • lucid interval, then loss of consciousness, headache, hemiplegia
  • biconvex, hyperdense lesion located between the brain and calvarium, limited by suture lines
  • manage by surgical drainage
47
Q

subdural hematoma

A
  • rupture of bridging vein
  • increasing headache over days or weeks
  • changes in mental status
  • cresent-shaped homogenous lesion between brain and calvarium, not limited by suture lines
  • manage by surgical drainage
48
Q

subarachnoid hemorrhage

A
  • secondary to rupture of saccular aneurysm
  • trauma
  • sudden, severe headache
  • loss of consciousness
  • extensive area of hyperdense signals around circle of willis
  • manage by medical therapy to reduce vasospasm
  • surgical intervention: clippingor endovascular repair
49
Q

pterygoid venous plexus

A
  • located between temporalis and pterygoid muscles
  • venous plexus equivalent of most of maxillary artery
  • maxillary vein corresponds to first of the artery and pterygoid plexus to second and third part of artery
50
Q

pterygoid plexus may provide alternative path for ______ and ______ in case of internal jugular vein obstruction

A

intracranial venous blood and CSF

51
Q

pterygoid plexus connects ____ with ____ through emissary veins that pass through ______ and with ophthalmic veins through ______

A

facial veins with cavernous sinus (cranial cavity) through emissory veins that pass thru foramen ovale and with ophthalmis veins thru inferior orbital fissure
**dangerous triangle

52
Q

explain transantral approach to pterygopalatine fossa

A
  • approach through maxillary sinus
  • elevate upper lip
  • traverse the anterior wall of maxilla
  • chip away the posterior wall
  • go through anterior wall of pterygopalatine fossa

**ligates the maxillary artery to control the chronic bleeding from the nose (epistaxis–nasal bleeding)