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MBBS II HNNS > L32 - Infratemporal Fossa & Parotid Gland > Flashcards

L32 - Infratemporal Fossa & Parotid Gland Flashcards

1
Q

Location of temporal fossa?

A

Narrow fan shaped space: interconnect spaces on lateral side of the head

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2
Q

Location of infratemporal fossa? (medial, anterior, posterior, boundaries)

A

Inferior of temporal fossa, under zygomatic arch, Between side wall of pharynx and mandibular ramus

medial to temporomandibular joint and muscles of mastication

Anterior = posterior surface of maxilla

Posterior = opens to neck

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3
Q

Describe the roof of the infratemporal fossa? List 3 major foramen/ fissures?

A

Infratemporal surface of greater wing of sphenoid and temporal bone,

Opens to temporal fossa lateral to the infratemporal crest

Contains the foramen ovale, foramen spinosum and petrotympnic fissure

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4
Q

Content bound by the foramen ovale? ‘OVALE’

A 
Otic ganglion
V3
Accessory meningeal artery 
Lesser petrosal nerve 
Emissary veins
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5
Q

Content bound by foramen spinosum?

A

Middle meningeal A/V

meningeal branch of mandibular nerve

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6
Q

Content that passes through petrotympnic fissure?

A

Chorda tympani of facial nerve

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7
Q

Describe the anterior wall of the infratemporal fossa + a major fissure on it?

A

Anterior wall

  • Posterior surface of the maxilla, maxillary tuberosity
  • Contains alveolar foramina
  • Upper part opens as the inferior orbital fissure
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8
Q

Content of the inferior orbital fissure on the upper part of the anterior wall of infratemporal fossa?

A

Zygomatic branch of maxillary nerve

Infraorbital nerves

Pterygopalatine ganglia

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9
Q

Describe the medial wall of the infratemporal fossa + one major fissure on it?

A

Formed by:

  • Lateral pterygoid plate (superiorly)
  • Lateral wall of pharynx
  • Tensor and levator veli palatini

Contains pterygomaxillary fissure

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10
Q

Describe the lateral wall of the infratemporal fossa + one major foramen?

A

Formed by medial surface/ inside of the mandibular ramus

Contains mandibular foramen

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11
Q

List the foramen/ fissures that connect infratemporal fossa with cranial cavity, orbit and pterygopalatine fossa?

A

To cranial cavity: Roof: F. ovale and F. spinosum

To orbit: upper Anterior wall: Inferior orbital fissure

To Pterygopalatine fossa: Medial wall: Pterygomaxillary fissure

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12
Q

List the 6 content of the infratemporal fossa? ML MS MP

A

Medial pterygoid muscle
Lateral pterygoid muscle

Maxillary artery
Sphenomandibular ligament

Mandibular nerve
Pterygoid venous plexus

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13
Q

Range of movement of the TMJ?

A

Temporomandibular joint

Opening and closing mouth, chewing

+ side to-side movement of lower jaw

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14
Q

Describe the joint in TMJ?

A

Formed between head of mandible + Mandibular fossa/ articular tubercule

Double joint: Upper and lower joint cavities divided by articular disc

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15
Q

How is the TMJ stabilized? (SLS)

A

Via 3 Extracapsular ligaments

  • Sphenomandibular ligament (spine of sphenoid bone&raquo_space; lingula of mandible)
  • Lateral ligament
  • Stylomandibular ligament
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16
Q

What regions does the stylomandibular ligament separate?

A

Separate parotid and infratemporal region

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17
Q

Origin, insertion and action of the medial pterygoid muscle (one content of the infratemporal fossa)?

A

Origin = 2 heads: Deep head (from Lateral pterygoid plate) + Superficial head (from maxillary tuberosity and pyramid of palatine)

Insertion: Medial Angle of Mandibular ramus (roughened lower area for attachment)

Action: Elevate, protrude and move mandible medially

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18
Q

Origin, insertion and action of Lateral pterygoid muscle?

A

Origin: Triangular with 2 heads: Upper (roof of infratemporal fossa, lateral to 2 foramen) and lower (lateral pterygoid plate, between 2 heads of medial pterygoid)

(buccal nerve passes through gap between 2 heads)

Insertion: condylar process of mandible

Action: Major protruder, side to side movement of lower jaw

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19
Q

What is lateral to the infratemporal fossa?

A

Muscles of mastication

TMJ

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20
Q

List the muscles of mastication and their innervation?

A

innervated by mandibular nerve (+maxillary nerve)

  • Temporalis (superior)
  • Masseter (lateral)
  • Medial pterygoid (content of infratemporal fossa)
  • Lateral pterygoid (content of infratemporal fossa)
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21
Q

List the muscles for protrusion of lower jaw?

A

Lateral pterygoid + medial pterygoid

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22
Q

List the muscles for retraction of lower jaw?

A

Temporalis (posterior fibers) + masseter + geniohyoid + diagastric

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23
Q

List the muscles for elevation of lower jaw?

A

Medial pterygoid muscle
+ masseter
+ Temporalis

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24
Q

List the muscles for depression of lower jaw?

A

Diagastric + geniohyoid + mylohyoid

assisted by gravity

25
Q

Origin, insertion and action of temporalis muscle?

A
  • Origin: bony surface superior to the inferior temporal line, lateral to temporal fascia
  • Insertion: the coronoid process and anterior margin of ramus of mandible

-Actions:
anterior fibres elevate mandible and close jaw

posterior fibres retract mandible, assist side-to-side movement

26
Q

Origin, insertion and action of Masseter?

A

Two heads: superficial and deep heads

  • Origin: maxilla and zygomatic arch
  • Insertion: lateral surface of ramus/angle of mandible and coronoid process
  • Actions: elevation and protraction of mandible
27
Q

Define the origin and tract of the motor and sensory division of mandibular nerve reaching infratemporal fossa?

A

Split into anterior, posterior and trunk branches

Sensory: originates from trigeminal ganglion, drops through foramen ovale

Motor: passes medially to the trigeminal ganglion to enter foramen ovale, fuses together to become mandibular nerve

28
Q

List the trunk branches of the mandibular nerve in the infratemporal fossa?

A

1 -Meningeal nerve enters foramen spinosum (with middle meningeal artery); sensory to dura mater in the middle cranial fossa

2 -Nerve to medial pterygoid supplies medial pterygoid, branches to nerves to tensor tympani and tensor veli palatini

29
Q

List the 4 anterior branches of the mandibular nerve in the infratemporal fossa?

A

3 motor, 1 sensory

  • Masseteric nerve: motor, to masseter
  • Deep temporal nerves: motor, to temporalis (upwards into temporal fossa)
  • Nerve to lateral pterygoid: motor, to lateral pterygoid
  • Buccal nerve: sensory, to cheek (skin, mucosa, buccal gingivae)
30
Q

List the 3 posterior branches of the mandibular nerve in the infratemporal fossa?

A

Auriculotemporal nerve

Inferior alveolar nerve

Lingual nerve

31
Q

Structures supplied by Auriculotemporal nerve

A
  • sensory, to skin over temple, external ear, external acoustic meatus, tympanic membrane, TMJ
  • carries postsynaptic parasympathetic secretomotor fibers of glossopharygeal nerve IX from otic ganglion to parotid gland
  • two roots route around/envelop the middle meningeal artery
32
Q

Structures supplied by Inferior alveolar nerve

A
  • mostly sensory, to all lower teeth and much of associated gingivae, mucosa and skin of lower lip, skin of chin
  • gives a motor branch to mylohyoid (for mylohyoid and ant. belly of digastric)
  • terminates as incisive and mental nerve
33
Q

Structures supplied by Lingual nerve

A
  • sensory, to anterior 2/3 of the tongue, mucosa of oral cavity floor, lingual gingivae
  • joined by chorda tympani (branch of facial nerve VII), provides special sensation (taste) to the anterior 2/3 part of the tongue
  • pre/postsynaptic parasympathetic fibres to all salivary glands below the level of oral fissure
34
Q

List the nerves that exist in the lower region of the infratemporal fossa? (upper region = mandibular nerve and branches)

A

Chorda tympani
Submandibular ganglion
Lesser petrosal nerve

35
Q

Function and tract of chorda tympani passing through infratemporal fossa?

A
  • Branch of facial nerve VII&raquo_space; inside temple bone&raquo_space; petrotympnic fissure&raquo_space; lingual nerve
  • Special sensory fibers for taste sensation from the anterior 2/3 of tongue
  • Presynaptic parasympathetic fibers to submandibular ganglion&raquo_space; two salivary glands + blood vessels of the tongue
36
Q

Function and tract of submandibular ganglion in the infratemporal fossa?

A
  • Connected to lingual nerve
  • Carries secondary cell bodies for presynaptic fibres in chorda tympani
  • Postsynaptic fibres travel along lingual nerve to sublingual and submandibular glands
37
Q

Function and tract of lesser petrosal nerve in infratemporal fossa?

A
  • Branch of tympanic plexus, carries presynaptic fibers from glossophayngealnerve IX
  • Passes medially and descends with mandibular nerve through foramen ovale
  • Presynaptic fibers synapse in otic ganglion
  • Postsynaptic fibers join the auriculotemporal nerve
38
Q

Origin and supply of Maxillary artery in the infratemporal fossa?

A

External carotid artery

Supplies nasal cavity, lateral wall + roof of oral cavity, all teeth, dura mater, infratemporal fossa…etc

39
Q

Divide the maxillary artery into 3 parts regarding their location?

A

first part: between the neck of the mandible and sphenomandibular ligament

second part: related to lateral pterygoid muscle

third part: in the pterygopalatine fossa

40
Q

Branches from 1st part of maxillary artery?

A
  • middle meningeal artery
  • inferior alveolar artery
  • deep auricular, anterior tympanic and accessory meningeal arteries
41
Q

Branches from 2nd part of maxillary artery?

A

-gives origin to deep temporal, masseteric, buccal, and pterygoid branches

42
Q

Branches from 3rd part of maxillary artery?

A
  • greater (descending) palatine artery
  • posterior superior alveolar artery
  • pharyngeal artery
  • infraorbital artery
  • artery of the pterygoid canal
  • sphenopalatine artery
43
Q

List the 6 structures supplied by the pterygoid plexus

A 
nasal cavity, 
roof and lateral wall of oral cavity, 
all teeth, 
muscles in infratemporal fossa, 
paranasal sinuses 
nasopharynx
44
Q

How does the pterygoid plexus connect with the cavernous sinus?

A

inferior ophthalmic vein, emissary veins that pass through the skull through the foramen Vesalii, foramen ovale, and foramen lacerum

45
Q

List some anterior venous connections the pterygoid plexus makes?

A
  • Inferior ophthalmic vein (from the orbit drains through inferior orbital fissure into the plexus)
  • deep facial vein, connects with the facial vein
46
Q

List some posterior venous connections the pterygoid plexus makes?

A

short maxillary vein, connects with the retromandibular vein

47
Q

How can oral or nasal infections spread intracranially and cause septic thrombosis?

A

Danger triangle of face&raquo_space; facial vein&raquo_space; pterygoid plexus&raquo_space; cavernous sinus

septic thrombosis (may leads to stroke, meningitis, or encephalitis)

48
Q

Which structures are damaged in the fracture of pterion?

A

Pterion in temporal fossa overlie anterior branches of the middle meningeal vessels

> > rupture causes haematoma, lethal if untreated

49
Q

Clinical sequalae if the lingual nerve is injured Proximal to where chorda tympani joins?

A

loss of general sensation at anterior 2/3 of the tongue, oral mucosa, gingivae

50
Q

Clinical sequalae if the lingual nerve is injured distal to where chorda tympani joins?

A

loss of general sensation at anterior 2/3 of the tongue, oral mucosa, gingivae

+

loss of secretion from the salivary glands below the oral fissure

+

Loss of taste from the anterior 2/3 of the tongue

51
Q

Describe the course of the lingual nerve in the oral cavity?

A

Enters oral cavity floor in a shallow groove on medial surface of mandible

immediately inferior to the last molar tooth

52
Q

Where is general anesthesia inject to anesthetize inferior alveolar nerve, infraorbital, mental, incisive or buccal nerves?

A

lateral to the anterior arch of the fauces (palatoglossalarch) in the oral cavity

53
Q

Location of parotid gland?

A

below the external acoustic meatus

Wedged between the ramus of the mandible, the sternocleidomastoidmuscle and the mastoid process

Parotid fascia = continuation of neck fascia

54
Q

Which nerve divides the parotid gland into 2 parts?

A

Divided into two parts by facial nerve: superficial and deep parts

55
Q

List the 3 structures that traverse the parotid gland, from deep to superficial?

A

deep to superficial

  • External carotid artery
  • Retromandibular vein
  • Facial nerve and its branches
56
Q

Describe the tract of facial nerve after it bifurcates at the parotid gland?

A

-The upper division: temporal and zygomatic branches

-The lower division:
buccal, marginal mandibular, and cervical branches

57
Q

Describe the tract of the facial nerve before it enters the parotid gland?

A

emerges from the stylomastoid foramen,

winds laterally to the styloid process

dives into the posteromedial surface of the parotid gland

58
Q

Where does the parotid duct open into the oral cavity?

A

arises from the anterior border (On masseter about one finger’s breadth below the zygomatic arch)

-Opens into the mucosa opposite the second upper molar teeth at the parotid papilla

MBBS II HNNS (57 decks)

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