Infratemporal Fossa - Herring Flashcards
The temporal fossa is filled by the _______ and what line does it actually attach to?
temporalis muscle ; inferior temporal line
The _____ ligament of TMJ resists lateral dislocation
lateral
The articular disc of TMJ is a biconcave disc that is thickened _______ and ______
posteriorly and anteriorly
The superior compartment of the TMJ has what kind of movement
Gliding (translation)
The inferior compartment of the TMJ has what kind of movements
Elevation
Depression
4 Movements of TMJ
Gliding
- protrusion
Depression
Elevation
Gliding
- retrusion
What ligament of TMJ provides primary passive support
Sphenomandibular ligament
What is located between articular disc and the posterior osseous structures (aka between TMJ and ear)
Retrodiscal pad (tissue)
Primary neurovascular supply of TMJ
Auriculotemporal nerve
Superficial temporal a. THIS IS MAIN BLOOD SUPPLY OF TMJ
anterior surface of the TMJ is innervated by what 2 things
N. to masseter
Muscular branches of maxillary a.
muscles of mastication are all innervated by CN ______ and all produce movement at ____
CN V3 ; TMJ
Bilateral movement of temporalis muscle –> anterior fibers
Resting tonus
Elevation of mandible
Bilateral movement of temporalis muscle –> posterior fibers
Retraction/retrusion of mandible
Unilateral action of temporalis muscle =
Ipsilateral excursion of mandible
Bilateral movements of masseter muscle
Elevation of mandible
Protrusion (superficial)
Retrusion (deep)
Unilateral movements of masseter muscle
Ipsilateral excursion
Lateral pterygoid muscle (appears almost horizontal) - Bilateral movements - inferior heads
Protrusion & depression
Lateral pterygoid muscle - Bilateral movements - Superior heads
Elevation against resistance
Lateral pterygoid muscle - Unilateral movements
contralateral excursion
Medial pterygoid muscle - Bilateral movements
Elevation of mandible
Protrusion
Medial pterygoid muscle - Unilateral movements
Contralateral excursion
Elevation of Mandible Muscles (3):
Temporalis
Masseter
Medial Pterygoid
Depression of Mandible Muscles
Gravity **mostly **
Lateral pterygoid
- Inferior heads
these 3 are only engaged if against resistance
Suprahyoid mm.
Infrahyoid mm.
Platysma
Protrusion of Mandible Muscles
Masseter
- Superficial fibers
Lateral Pterygoid
Medial Pterygoid
Retrusion of Mandible Muscles
Temporalis
- Posterior fibers
Masseter
- Deep fibers
Digastrics
Geniohyoid
Right Lateral Movements Muscles
Left lateral pterygoid
Left medial pterygoid
Right temporalis
Right masseter
Left Lateral Movements Muscles
Right lateral pterygoid
Right medial pterygoid
Left temporalis
Left masseter
Risks of Temporalis Muscle + Botox
Difficulty chewing
- Especially if combined with masseter muscle botox therapy
Brow ptosis
Upper eyelid ptosis
Diplopia
Risks Pterygoid Muscles + Botox
Injection into vascular structures
Dysphonia (medial pterygoid)
Dysphagia (medial pterygoid)
1st part of Maxillary Artery
deep to neck of mandible
2nd part of Maxillary Artery
lateral pterygoid muscle
3rd part of Maxillary Artery
pterygopalatine fossa
All branches of 1st part – Mandibular portion of maxillary artery go into
_____
bone
All branches of 2nd part – pterygoid portion of maxillary artery supply ______
muscles
All branches of 3rd part pterygopalatine fossa of maxillary artery are located near or within the _____________
pterygopalatine fossa
CN V3 exits the foramen ovale and gives off
Meningeal branch
Nerve to medial pterygoid
Nerve to tensor tympani
As CN V3 exits the foramen ovale, it gives off 3 things and then divides into
Anterior Division (smaller)
Posterior Division (larger)
The anterior division of CN V3 is a _____ root with 1 sensory nerve
motor
The posterior division of CN V3 is a _____ root with 1 motor nerve
sensory
CN V3 motor branches - muscles of mastication =
Deep temporal nerves
Masseteric nerve
N. to lateral pterygoid
N. to medial pterygoid
CN V3 - sensory
TMJ
Anterior ear
Temporal region
CN V3 post-ganglionic parasympathetic fibers (from otic ganglion) hitch a ride to the ____________
parotid gland
CN V3 - Long buccal nerve - Sensory
Skin over cheek
Mucosa of cheek
Buccal surface of mandibular molar gingiva
CN V3 - lingual nerve - sensory
Anterior 2/3rd tongue
Mucosa of floor of mouth
Mandibular lingual gingivae
Pre-ganglionic parasympathetic fibers of the lingual nerve - chorda tympani - hitch a ride and then synapse at the
submandibular ganglion
Pre-ganglionic parasympathetic fibers of the lingual nerve - chorda tympani - synapse at the submandibular ganglion and supply what glands
submandibular & sublingual glands
Taste fibers from the ________ 2/3rds of the tongue hitch a ride (lingual nerve - chorda tympani)
anterior
Once the IAN is in the mandibular canal, what is formed
inferior dental plexus
Sensory from skin &
mucous membranes of lower lip & skin of the chin, vestibular gingiva of mandibular incisors, canine, & premolars (variable)
Mental nerve (terminal branch of IAN)
Sensory innervation from incisors, canine, & 1st premolar (variable)
Incisive nerve (terminal branch of IAN)
What’s anesthetized?
Mandibular teeth
Buccal / vestibular gingiva of the mandibular premolars, canine, & incisors
Inferior alveolar nerve
What’s anesthetized?
Tongue
Lingual gingivae
Lingual nerve
What’s anesthetized?
Buccal gingiva of the mandibular molars
Long buccal nerve block
The otic ganglion pathway
Lesser petrosal nerve of CN IX has what kind of fibers
Preganglionic parasympathetic
The postganglionic parasympathetic fibers of the lesser petrosal nerve synapse on the _________ ganglion and hitch a ride on _______ to innervate the ___________
otic ; CN V3 ; parotid gland
the chorda tympani nerve is a branch of CN VII that branches after the ________ ganglion
geniculate
the chorda tympani nerve is a branch of CN VII that leaves through the petrotympanic fissure and hitches a ride on the ________ nerve
lingual
The chorda tympani nerve has 2 types of fibers, what are they
Preganglionic parasympathetic
Afferent taste fibers
The preganglionic parasympathetic fibers of the chorda tympani nerve synapse at the ____________ ganglion
submandibular
The preganglionic parasympathetic fibers of the chorda tympani nerve synapse at the submandibular ganglion, some fibers leave and immediately enter the __________ gland
submandibular
The preganglionic parasympathetic fibers of the chorda tympani nerve synapse at the submandibular ganglion, some fibers leave and immediately enter the submandibular gland, other postganglionic parasympathetic fibers hitch a ride on the ________ nerve to reach the __________ glands
lingual ; sublingual
the afferent taste fibers of the chorda tympani nerve are involved in what potion of the tongue
anterior 2/3rd tongue
Lingual nerve immediately distal to the foramen ovale has ___________ fibers only
somatic sensory
Lingual nerve immediately distal to the foramen ovale has somatic sensory fibers only and a lesion would present what signs/symptoms
Abnormal pain, temp, & touch sensation from the ipsilateral floor of the mouth, mandibular lingual gingivae, & anterior 2/3rd tongue
Chorda tympani nerve in the middle ear or at / immediately distal to the petrotympanic fissure has what kind of fibers
Preganglionic parasympathetic and taste fibers
Chorda tympani nerve in the middle ear or at / immediately distal to the petrotympanic fissure and a lesion would present what signs/symptoms
Abnormal taste sensations from ipsilateral anterior 2/3rd tongue
LESION: Lingual nerve as it travels between medial pterygoid muscle & the mandible to the 3rd mandibular molar
Somatic sensory, preganglionic
parasympathetic, & taste fibers
Abnormal pain, temp, & touch
sensation from the ipsilateral floor
of the mouth, mandibular lingual
gingivae, & anterior 2/3rd tongue
Abnormal taste sensations from
ipsilateral anterior 2/3rd tongue
(variable) dry mouth due to loss of
innervation to the ipsilateral
submandibular & sublingual glands
LESION: Lingual nerve as it travels along the floor of the mouth
Somatic sensory, POSTganglionic
parasympathetic, & taste fibers
Abnormal pain, temp, & touch
sensation from the ipsilateral floor
of the mouth, mandibular lingual
gingivae, & anterior 2/3rd tongue
Abnormal taste sensations from
ipsilateral anterior 2/3rd tongue
Even less likely to experience dry
mouth due to loss of innervation
only to the ipsilateral sublingual
glands
Posterior Superior Alveolar Nerves CN V2 - originate in
pterygopalatine fossa
Posterior Superior Alveolar Nerves CN V2 - enters the
posterior superior alveolar foramina
Posterior Superior Alveolar Nerves CN V2 - supplies the
posterior maxillary molars
Contents of the infratemporal fossa (8 things)
temporalis muscle
lateral pterygoid muscle
medial pterygoid muscle
maxillary artery
pterygoid venous plexus
CN V3 branches
chorda tympani (CN VII)
Otic ganglion
What is the inferior articulating surface of the TMJ
mandibular condyle/head
What are the 2 superior articulating surfaces of the TMJ
articular tubercle/eminence of temporal bone
mandibular fossa of temporal bone
The retrodiscal pad (tissue) is extremely well vascularized and innervated by CN _____
V3
Risks of Masseter Muscle + Botox
Asymmetrical smile
- Injection too medial or shallow
Dry mouth
- Injection too lateral / anatomical variation
Paradoxical masseter bulging
- Poor diffusion
3 arteries from the 1st part of the maxillary artery (called the mandibular portion)
Middle Meningeal A
Accessory Middle Meningeal A
Inferior Alveolar A
MMA ______ into the foramen spinosum
ascends
Inferior alveolar artery ________ into the mandibular foramen
descends
Long buccal nerve does NOT innervate the _______ muscle
buccinator
The inferior dental plexus is responsible for sensory from
mandibular teeth
