Lecture 6 - Infratemporal and Pterygopalatine fossae

Question 1

Why do we need to know this region?

Answer 1

• Posterior epistaxis (posterior nasal bleeding) - artery comes form this area
• Nerve blocks - greater palatine, posterior superior alveolar nerve block
• headache symptoms
• temperomandibular joint disorder

Question 2

Temperomandibular joint

• what are the 3 ligaments
• what type of joint?

Answer 2

• between condular part of mandible and mandibula fossa of temporal bone
• has got a capsule
• need 3 ligaments to stabalise it - lateral ligament, spehnomandibular ligament and stylomantibular ligamnet
• atypical syndovial joint - disc in middle divides it into two parts , and instead of having hyaline on articular surface it has fibrocartilage

Question 3

Which muscles are in charge of elevation, depression, retraction, protrusion - COULD SHOW THIS IMAGE IN EXAM - what muscle are in charge of elevating the mandible (or tmj) ect.

Answer 3

Protrusion - lateral pterygoid, medial pterygoid

Retraction - termporalis, masseter, geniohyoid, digastric

Elevation - temporalis, masseter, medial pterygoid

Depression - gravity, digastric, geniohyoid, mylohyoid

Question 4

Muscles of mastication

Answer 4

temporalis muscle - temporal region to mandible

Masseter muscle - lower margin of maxilla down to mandible

Question 5

Pterygoid muscles

Answer 5

• lies deep to mandible
• have 2 groups of these - medial and lateral pterygoid muscles - have attatchment to TMJ joint
• upper and lower head of lateral pterygoid
• superficial and deep head of medial pterygoid

-V3 innovates these nerves

Question 6

Contents of infra temporal Fossa

Answer 6

latereal and medial pterygoid muscles

spehnomandibular ligament
middle menangial artery - supplies menangies (extradural hemorage)
inferior alveolar artery - sometiems dentists damage this
-these two are branches of the maxillary artery

Nerves - V3 - divides into anterior and posterior bundles

• anterior - dont need to know
• Posterior bundle - lingual nerve (sensaiton of floor) , ineferior alveolar nerves, mental nerves, auriculotermporal nerve - very important
• lingual nerve meets chorda tympani here (goes to tongue anterior 1/3) and lesser petrosal meets aurgiotemporal nerve (goes to parotid)
• also have branches of 12, 9.
• pterygoid plexus sits in this region as well - infection here can go back to cranium
• also has autic ganglion (seperate to pyterygopalatine ganglion)

Question 7

Path of chorda tympani

Path of lesser petrosal nerve

Answer 7

runs within middle ear, and is eventually joins lingual nerve (give taste to anterior 1/3 of tongue)

Lesser petrosal nerve - runs with aurigotemporal nerve important because parasympathetic and sympatehtic in head nad neck are differnet to throax and abdomnen
-paratoid gland gets its parasympathetic through lesser petrosal branch form v3 (running with aurigotemproal nerve)

Question 8

Contents of pyterygopalatine fossa

Answer 8

Foreamne rotundum comes into here - V2 enters

• ptyergopalatine ganglion - hay fever ganglion (runny nose, eyes ect.) - can destroy this ganglion - patient symptoms resolve
• greater petrosal contributes to this ganglion

Inferior orbital fissure 
-inferior optahlamic vien
-ifraorbital vien, artery
zygomatic branch of maxillary nerve
pterygopalate ganglia + branches 

spehnopalatine foramen
Maxiallary artery - sphenopalatine arter

Question 9

Spehnopalatine foreamen

Answer 9

branch of maxillary arteyry sphenopalatine artery runs through this and goes to nasal canal

• opening - causes posterior nasal bleeding
• send this to a major hospital as cannot control this bleeding - can kil patient

Question 10

Pterygopalatine ganglia

Answer 10

Sympathetics around internal cartoid artery come here - can send info

• can see - facial nerves - sending parasympathetic fibers going in
• greater petrsoal nerve - some parasympathetic - hay fever symptoms