Infratemporal Fossa, Maxillary Artery, Muscles of Mastication and V3 Flashcards
What is the only trigeminal division that carries both motor and sensory?
V3 mandibular branch
What are the CN that are general visceral efferents and parasympathetics? How do these travel to the head?
3,7,9,10 and they travel by jumping onto 5 to get to their target
What makes up the temporal region?
the temporal and infratemporal areas
Where do you find the infratemporal fossa?
deep to the mandible and inferior to zygomatic arch
What is the anterior boundary of the infratemporal fossa?
What is the medial boundary of the infratemporal fossa?
What is the lateral boundary of the infratemporal fossa?
What is the posterior boundary of the infratemporal fossa?
maxillary bone
lateral pterygoid plate
ramus
parts of temporal bone
What is the infratermporal fossa continuous with?
the temporal fossa
What is the inferior border of the infratemporal fossa?
there isnt one, it is actually open but the medial pterygoid muscle holds it in place
What do you call the point between the body and the ramus of the mandible?
the angle of the mandible
What the space between the mastoid process and styloid process? What passes through this?
the styloidmastoid foramen
CN 7
Once CN7 passes through the styloidmastoid foramen, what kind of fibers does it mainly carry? What does it give off here?
motor
5 terminal branches of facial expression (temporal, zygomatic, buccal, mandibular, cervical)
What is the fissure between the pterygoid plate and the maxilla? Why is this significant?
the pterygomaxillary fissure
this is how things get into and out of the Pterygopalatine fossa
What artery runs from the infratemporal fossa through the pterygomaxillary fissure and through the pterygopalantine fossa?
the terminal branch of the maxillary artery called the pterygopalatine portion or 3rd portion
So the foramen ovale and the foramen spinosum are wildly important, because one of the foramen has something neat coming out of the cranium and one has something neat going into the cranium….what are they?
coming out of the foramen ovale is the V3 (mandibular) nerve
going into the foramen spinosum is the middle meningeal artery
Once the mandibular nerve (v3) comes out of the foramen ovale, where does it go?
into the infratemporal fossa :)
What are the lateral and medial pterygoid plate a part of?
the sphenoid bone
where is the mandibular fossa?
underneath the zygomatic process where it meats the condylar process
What are four bony structures found on the mandible?
condylar process (articulation w/ temporal bone) mandibular notch (below condylar process) mandibular foramen (place for anesthesia) coronoid process (crown next to mandibular foramen)
What is the TMJ?
temporomandibular joint
What do you find in the mandibular foramen and why is this significant?
you find the blood vessels and nerves to the mandible i.e. nerve supply to lower teeth (important for anesthesia)
How many joint cavities does the TMJ have and what are they?
2 cavities
superior joint cavity, a disc and inferior joint cavity
Explain the composition of the TMJ?
superior joint cavity, a disc, inferior joint cavity surrounded by strong ligamentous capsule. With a muscle that attaches from the condyle (of the mandible) to the disc.
What is the muscle called that connects the condyle (of mandible) to the disc of the TMJ?
the lateral pterygoid muscle (a muscle of mastication)
What does the lateral pterygoid muscle do?
it pulls both the condyle (of mandible) and the disc of the TMJ anteriorly
What happens when you open your jaw to your mandibular joint?
the mandibular condyle will move forward anteriorly on the mandibular fossa and then ride over the articular tubercle
What happens if you open your jaw too wide (i.e extreme protraction)?
you will move your condyle too far anteriorly and roll of the articular tubercle and thus into the space where your strong muscles of mastication are which will cause uniform contraction and prevent the return of the condyle to its previous location. To fix this you must use muscle relaxants and shove it back into place.
How do you open your jaw fully?
extreme protraction
Slight elevation and depression of your jaw happens as a (blank) movement.
hinge movements
How do you create grinding motions (side to side)?
elevation, depression, protraction and retraction
T or F
Can you protract on one side and retract on the other at the TMJ?
yes!
What are the 2 ligaments of TMJ that get taught as the jaw pulls forward and what do they do?
the sphenomandibular ligament
stylomandibular ligament
limit excess opening of the mandible
What is the main protractor of the mandible and how does it do this?
the lateral ptergyoid muscle It has two heads one pulls the condyle towards the ptergyoid plate and the other head yanks on the articular disc to open the jaw
So what do the two heads of the lateral ptergyoid muscle attach to?
One head-> condyle
second head-> articular disc
What connects the temporal bone to the mandible?
the joint capsule (fibrous CT)
Where do you find the synovial membrane within the joint capsule of the TMJ?
non-weight bearing surfaces
Where do you find hyaline cartilage in the TMJ?
articular surfaces
Betweeen the articular disc and the mandibular fossa (temporal bone) of the TMJ, what kinds of movements do you get here?
gliding movements
Between the articular disc and the hyaline cartilage of the condylar process of the TMJ, what kinds of movements do you get here?
hinge movements
Is the TMJ a stiff joint or does it have a large range of motion?
What does this mean?
large range of motion
very susceptible to dislocation
If you pass in anterior to the articular tubercle, what do you have?
jaw dislocation
What three general classifications of things do you find in the infratemporal fossa?
muscles of mastication
branches of mandibular nerve
branches of maxillary artery
What kinds of fibers do we need for muscles of mastication?
branchiomotor (SVE)
Describe the fibers found on CN V
it is a sensory nerve except for V3 which is also branchiomotor
Muscles of mastication all stem from (blank) and what gives motor innervation to them?
first branchial arch
CN 5 V3 (only division that carries motor in addition to sensory)
What is the most superifical muscle of mastication right underneath the skin?
masseter
What is a powerful elevator of the mandible (closes the jaw) and what plane is is the origin and insertion in? What does this mean about its movments?
the masseter
both in the same sagittal plane
its gonna kick ass at going up and down but sort of suck at going side to side.
What is the origin the masseter?
What is the insertion of the masseter?
zygomatic arch
ramus and angle of mandible
What do the anterior fibers of the temporalis muscle do?
How are the fibers oriented?
they contribute to elevation of the mandible and jaw closing
vertically oriented
What do the posterior fibers of the temporalis muscle do?
How are the fibers oriented?
contribute to retraction of the mandible and jaw closing horizontally oriented (good at grinding)
The temporalis muscle and massater muscle are both innervated by what and do what?
V3 of CN5
they are muscles of mastication
which pterygoid muscle parallels the orientation of the masseter?
the medial pterygoid muscle
What is the muscle that has horizontal fibers and goes from the lateral border of the maxilla to the teeth? What kind of muscle is it? What innervates it?
buccinator
facial expression muscle
CN 7
What do you find going through the buccinator and where does it come from?
the parotid duct (entering right by the second upper molar) from the parotid gland :)
When it comes to protraction, what muscle is the big protractor?
lateral pterygoid
How many muscles does it take to do rotational (i.e grinding) movements?
at least 3 muscles alternating sides
Which of the following muscles elevate:
masseter, temporalis, lat pterygoid, med, pteryoid?
masseter, temporalis, med. pterygoid
Which of the following muscles depress:
masseter, temporalis, lat pterygoid, med, pteryoid?
lat. pterygoid
Which of the following muscles protract:
masseter, temporalis, lat pterygoid, med, pteryoid?
masseter, lat pterygoid, med pterygoid
Which of the following muscles retract:
masseter, temporalis, lat pterygoid, med, pteryoid?
temporalis
Which of the following muscles rotate:
masseter, temporalis, lat pterygoid, med. pterygoid?
temporalis, lat pterygoid, med. pterygoid
What do you find coursing between the bellies of the pterygoid muscles?
inferior alveolar nerve and lingual nerve
What are the four branches of the maxillary artery?
middle meningeal inferior alveolar muscular branches sphenopalatine (I Must Seduce Max)
What are the 6 branches of the 3rd trigeminal nerve (mandibular) that comes out of the foramen ovale and enter the infratemporal fossa?
buccal nerve (sensory) lingual nerve auriculotemporal nerve inferior alveolar nerve mylohyoid nerve motor branches to muscles of mastication BLAIM Me
What does the maxillary artery come off of? What comes of the maxillary artery and enters the foramen spinosum?
the external carotid
middle meningeal artery
What nerve pops out of the foramen ovale and splits around the middle menningeal artery?
auriculotemporal nerve
The external carotid comes up and ends in two terminal branches, what are they?
superficial temporal and the maxillary artery (goes deep into the infratemporal fossa)
What artery passes into the pterygomaxillary fissure?
the maxillary artery
What 2 branches of the maxillary artery travel underneath the temporalis muscle?
anterior and posterior deep temporal arteries (muscular branches)
What branch of the maxillary artery travels down and innervates the teeth of the mandible?
inferior alveolar artery
What branch of the maxillary artery enters the foramen spinosum?
middle meningeal artery
so once the maxillary artery enters the pterygopalantine fissure it no longer is in the infratemporal fossa but has now entered the (blank)
pterygomaxillary fossa
What does the middle meningeal make between the dura and the inside of the calveria (skull)?
depressions/grooves
What artery supplies the dura and can be easily torn following head trauma to the region of the temporal bone?
middle meningeal artery (cuz skull is softer in this area and more susceptible to fracture)
Motor innervation is from the buccal branch of the (blank). Sensory innervation is supplied by the buccal branch (one of the muscular branches) of the (blank).
facial nerve (cranial nerve VII)
mandibular part of the trigeminal (cranial nerve V)
What stuff within or near the infratemporal fossa needs somatosensory innervation? What gives this?
teeth tongue general sense oral cavity skin anterior to ear CN 5
What is the ganglion of the trigeminal nerve?
trigeminal ganglion
Distal to the trigeminal ganglion, where does V3 go? What about V2 and V1?
goes through foramen ovale
goes through cavernous sinus
What are the little tiny branches that come off of CN 5 V3 before it makes its main divisioN?
MMTT meningeal medial pterygoid (motor branch) tensor veli palatini tensor tympani
What two division does CN5 V3 turn into?
the posterior and anterior division
What are the branches of the anterior division of CN 5 V3?
BLMAP (mostly motor with one sensory) buccal (sensory branch) lateral pterygoid masseter anterior and posterior deep temporals
What are the branches of the posterior division of CN 5 V3?
ALI (mostly sensory with one motor)
Auriculotemporal
Lingual
Inferior alveolar
What is the mylohyoid branch?
it comes off the inferior alveolar and is motor
Where does the mental nerve come from?
it is a continuation of the inferior alveolar nerve
do the motor fibers and sensory fibers of CN 5 have the same nucleus?
no
What sensory innervation is coming back on CN 5?
general sense for discriminative touch, pain, proprioceptions, temperature
What nucleus will discriminitve touch go to?
What nucleus will proprioception go to?
Where will pain and temp go? Then where do all these fibers go?
chief sensory
mesencephalic
spinal 5
to the brainstem then to the pons
If a CN 5 fiber needs to go to spinal 5 nucleus which way from the trigeminal nucleus will it go?
down
What is weird about the proprioceptive fibers of of the trigeminal nerve?
they dont enter chief sensory, instead its ganglion is in the mesencephalic nucleus. (reflexes)
Which branch of the trigeminal nerve is the only branch with motor fibers?
the mandibular (V3)
2 pt disc, vibrational sense etc. synpases in what nucleus?
chief sensory nucleus
All components of the trigeminal nerve have their ganglion in the trigeminal ganglion except for which fibers?
fibers conveying proprioception (instead their ganglion is in mesencephalic)
The corneal reflex is the involuntary blinking of the eyelids – stimulated by tactile, thermal or painful stimulation of the cornea.
In the corneal reflex, the (blank) nerve acts as the afferent limb – detecting the stimuli. The facial nerve is the efferent limb, causing contration of the the orbicularis oculi muscle.
If the corneal reflex is absent, it is a sign of damage to which nerves?
opthalmic (5 V1)
either opthalmic (5 V1) or fascial nerve
Pain and temp from face, head and ant. 2/3 of tongue which have info from all three divisions of the trigeminal nerve but synapse at what nucleus?
descend down the spinal tract of 5 to the spinal nucleus of V
Does the chief sensory nucleus take info on pain?
Noooo
If you have a trigeminal division with branchiomotor and general sense, then what division is it?
mandibular division (v3)
All the glands of the head are innervated by (blank) except for the parotid gland. What CN innervates the parotid gland?
CN 7
CN 9
How do we get parasympathetics for the parotid coming in on 9 and the fibers of 7 to all the other glands?
by jumping on CN 5
Parasympathetics to the head leave the brainstem with cranial nerves (blank X 4). And how do these get to the head? What kind of nucleus will each of these nerves have?
III, VII, IX, X
X not for the head*
Hitchhike on CN V
general visceral efferent
Where is CN 3 located? CN7? CN 9?
midbrain
pons
medulla
What is attached to the lingual nerve and submandibular gland?
Why do you need this?
the submandibular ganglion
because it is parasympathetic and need to synapse close to their target :)
What kind of fibers does the lingual nerve carry?
somatosensory
What is the chordi tympani?
Where will it go?
it is a branch off of 7 inside the middle ear cavity that carries SVA for taste. It exits the petrotympanic fissure ad then jumps on the back of the lingual nerve synapses in submandibular ganglion and gives fibers to sublingual and submandibular gland
So if we really think about it, where does taste come from?
form the chordi tympani which will hit up the lingual nerve for a ride to the tongue
Where does the chorda tympani come from?
CN VII
the lingual nerve carries preganglionics from the chorda tympanni and post ganglionics after the (blank)
submandibular gland
Does the chorda tympani come off of CN 7 before or after the stylomastoid foramen? What is its position relative to the malleus and incus?
before
over the malleus under the incus
Where does cranial nerve 7 enter the brainstem?
at the point of entry there is a nucleus for branchiomotor (motor VII) and visceromotor (salivation) , but there is no nucleus for (blank).
pons
taste
Where do taste fibers and visceral afferent info go from CN 10, 9 ,7?
down to the medulla in the nucleus solitarius
What do you need parasympathetics to the head for?
for glands (they are secretormotor) and for pupillary constriction
What does chief sensory turn into as it goes down?
What does chief sensory turn into as it goes up?
spinal 5
mesencephalic
Bells palsy is an upper motor neuron problem or lower?
lower
Orbicularis oculi muscle is innervated by (balnk) (i.e the muscle that closes the eye). However the muscle that opens the eye is innervated by (blank).
CN 7
CN 3
There is collateral flow between the external and internal carotid in the face. T or F?
T
What nerve arches over the top of the tympanic membrane and heads to the tongue?
chordi tympani
(blank) is a canal in the petrous part of the temporal bone of the skull that carries nerves from inside the skull towards the middle and inner ear, namely cranial nerve VII and cranial nerve VIII.
internal auditory meatus
What goes through the pterygoid canal?
greater petrosal nerve and deep petrosal nerve carrying sympathetics
What fibers off of CN 7 go through the pertrotympanic fissure?
chorda tympani
How do you get the preganglionic parasympathetics into the parotid gland?
via the lesser petrosal nerve
The parotid gland is innervated by preganglionic parasympathetics from CN (blank) to the otic ganglion.
9
Describe the path of the lesser petrosal nerve
it is a tiny branch off CN 9 that exits the foramen ovale along side the mandibular division of CN 5, that synapses at the otic ganglion.
What fibers are on the lesser petrosal nerve?
only preganglionic parasympathetics
where does the petrosal nerve synapse and what happens after this point?
synapses in the otic ganglion, gives off fibers that jump on the auriculotemporal nerve and travel around the middle meningeal artery to innervate the parotid gland
What kind of fibers does the auriculotemporal nerve carry?
primarily sensory (to skin of ear, parotid gland, fasci) but it also carries postganglionic fibers that are secretomotor to the parotid gland
What is the nucleus for the lesser petrosal nerve?
the inferior salivatory nucleus of CN 9
What CN does the superior salivatory nucleus supply?
CN 7
What do salivatory nucleus (secretomotor nucleus) sit next?
motor nuclei
A tiny little nucleus called the inferior salivatory sits next to the (blank) column in the medulla and sends preganglionic axons out with cranial nerve IX. These ultimately synapse in a parasympathetic ganglion and reach the parotid gland. Very similar to the superior slaivatory nucleus associated with VII.
branchiomotor
So we have preganglionic fibers from the inferior salivatory nucleus, where do they go from here?
What other CN nerves exit here?
they exit the skull through the jugular foramen, CN 9 gives off tympanic nerve which goes through the tympanic canaliculus into the middle ear cavity and through the tympanic plexus to enter the petrosal hiatus to rreenter the skull to become the lesser petrosal nerve (on top of petrous portion of temporal bone) and the heads out the foramen ovale jumps into the otic ganglion and supplies the parotid gland.
Cn 9,10, 11
What is one of the main roles of CN 9?
to provide sensory to the middle ear cavity
What supplies the skin on the lateral side of the face just anteior to the ear and wraps around the middle meningeal artery and hooks around the mandible?
the auriculotemporal nerve
Where does the auriculotemporal nerve come from?
posterior division of V3
