Module 8 - Infratemporal Fossa Flashcards by Dailen Terry

What is important about the sympathetic innervation of the head and neck?

arises from cervical ganglia (inferior, middle, [mostly] superior)
no preganglionic cell bodies in cervical region
preganglionic axons from upper thoracic synapses in cervical ganglia

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What is the pathway of the middle ear nerve of the internal carotid nerve (sympathetics)?

pregang symp > nucleus > internal carotid nerve > courses with internal carotid artery > tympanic plexus

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What is the pathway for the deep petrosal nerve of the internal carotid nerve(sympathetic)?

pregang symp > nucleus > internal carotid nerve > courses with internal carotid artery > deep petrosal n > V2 br

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What is the pathway for the cavernous sinus branch of the internal carotid n (sympathetic)?

pregang symp > nucleus > internal carotid nerve > courses with internal carotid artery > cavernous sinus > CNs: III, IV, VI, V1, V2

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What CNs sympathetics exit the skull directly from the superior cervical ganglia?

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Where do the communicating branches of sympathetic innervation go and what CNs do they communicate with?

along external carotid artery
communicate with: V2, V3, VII, IX, X, XII

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What is the infra temporal fossa?

irregular space inferior and eep to zygomatic arch and mandible and posterior to maxilla

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What is the lateral boundary of the infratemporal fossa?

ramus of mandible

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What is the medial boundary of the infratemporal fossa?

lateral pterygoid plate

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What is the anterior boundary of the infratemporal fossa?

posterior maxilla

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What is the posterior boundary of the infratemporal fossa?

mastoid and styloid processes

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What is the superior boundary of the infratemporal fossa?

greater wing of sphenoid

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What is the inferior boundary of the infratemporal fossa?

mandibular attachment of medial pterygoig

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What are the contents of the infratemporal fossa?

inferior part of temporals
lateral (sup + inf) and medial (deep + superficial) ptergygoid muscles
maxillary artery and its branches

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What are the muscles of mastication?

masseter
temporalis
lateral pterygoid
medial pterygoid

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What are the OIANs of the masseter?

origin: zygomatic arch

insert: angle of mandible and lateral aspect of ramus

action: elevation, protraction and retraction (deep fibers) of mandible

nerve: mandibular nerve CN V3

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What are the OIANs of the temporalis muscle?

origin: temporal fossa

insert: coronoid process and anterior border of the ramus of mandible

action: elevation and retraction of the mandible

nerve: mandibular nerve CN V3

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What are the OIANs of the lateral pterygoid muscle?

origin: infratemporal surface of sphenoid and lateral surface of the lateral pterygoid plate

insert: neck of the mandible and TMJ disc

action: depress mandible, protracts and acts with ipsilateral medial pterygoid to rotate mandible to produce the side to side movement of chewing

nerve: mandibular nerve CN V3

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What are the OIANs of the medial pterygoid muscle?

origin: medial surface of lateral pterygoid plate and adjacent maxilla

insert: medial aspect of angle of mandible

action: elevation of mandible and acts with ipsilateral lateral pterygoid to rotate th maxilla to produce side to side movement during chewing

nerve: mandibular nerve CN V3

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What nerves are found in the infratemporal fossa?

mandibular CN V3
- auriculotemporal
- inferior alveolar
- lingual
- chorda tympani

otic ganglion

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What is the importance of the pterygoid plexus in the spread of infection to the cranial cavity?

due to communication with cavernous sinus, infection of superficial face may spread to cavernous sinus, causing cavernous sinus thrombosis

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What are the components of the temporomandibular joint (TMJ)?

temporal = mandibular fossa of temporal bone
mandibular = head of mandible
fibrocartilage articular cartilage
articular tubercle

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What are the ligaments of the TMJ?

lateral ligament
stylomandibular ligament
joint capsule
sphenomandibular ligament

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What are the attachments of the lateral ligament of the TMJ?

condyle process > zygomatic arch

What are the attachments of the stylomandibular ligament of the TMJ?

styloid process > angle of mandible

What are the attachments of the sphenomandibular ligament?

sphenoid bone > ramus of mandible

What are the nerves that innervate the TMJ?

sensory: branches of V3 - auricularotemporal nerve - deep temporal nerve - masseteric nerve (articular branches) 1st branchial arch derivative innervated by CN V3

What are the movements of the TMJ?

- elevation (closing mouth) - depression (opening mouth) - protrusion - retrusion - lateral

What are the muscles that control the elevation (closing) of TMJ?

- temporalis - masseter - medial pterygoid

What muscles control depression (opening) of the TMJ?

- lateral pterygoid - suprahyoid muscles - infrahyoid muscles - mainly gravity

What are the muscles that control protrusion of the TMJ?

- lateral pterygoid - messier - medial pterygoid

What are the muscles that control retrusion of the TMJ?

- temporalis - masseter

What are the muscles that control the lateral movement of the TMJ?

- same side temporalis - opposite side pterygoids - opposite side masseter mandible to left: - L temporalis - R masseter - R pterygoid

Why does TMJ dislocation happen?

mandibular head slides out of TMJ past the articular tubercle - happens in yawning, taking large bites, excessive contraction of lateral pterygoids

What are the consequences of aging on the mandible?

- loss of teeth and alveolar process is resorbed - mental nerve more exposed due to mental and mandibular foramina being more superior on body of mandible - body of mandible may fracture

What is the primary sympathetic effect on the pupils?

- dilate: slower effect

What is the primary sympathetic effect on the skin?

- contracts arrector pilli muscle (goosebumps) - vasoconstriction - sweating

What is the primary sympathetic effect on the glands of the head?

- no direct effect, but vasoconstriction has some indirect effect to reduce secretion

What is the parasympathetic effect on the eyes?

- pupil: constricts; fast effect - ciliary body: lens accommodation

What is the parasympathetic effect on the skin?

no effect

What is the parasympathetic effect on the glands of the head?

- lacrimal: promotes secretion; tears - salivary: promotes secretion; spit - small mucous glands: promotes secretion; mucous i.e. snot

What are the dorsal cervical rami nerves of the cervical plexus?

- suboccipital - greater occipital - 3rd occipital

What are the spinal level and function of the suboccipital nerve?

- C1 - sensory, post gang sympathetic (gray ramus) innervation to semispinalis capitis and suboccipital muscles

What is the spinal level and function of the greater occipital nerve?

- medial branch C2 - sensory and postgang symp (gray ramus) innervation of skin overlying back of the head

What is the spinal level and function of the 3rd occipital nerve?

- median branch C3 - sensory and postgang symp (gray ramus) innervation of skin overlying suboccipital triangle

What are the ventral rami cutaneous nerves of the cervical plexus?

- lesser occipital - great auricular - transverse cervical - supraclavicular

What is the spinal level and function of the lesser occipital nerve?

- C2 - sensory and postgang symp (gray ramus) innervation of the skin overlying the posterior- lateral aspect of the head and upper neck

What is the spinal level and function of the great auricular nerve?

- C2,3 - sensory and postganglionic symp (gray rami communicans) innervation of the skin overlying the upper sternocleidomastoid, lower parotid region and ear

What is the spinal level and function of the transverse cervical nerve?

- C2,3 - sensory and postganglionic symp (gray rami communicans) innevervation of the skin overlying the lower sternocleidomastoid and anterior neck

What is the spinal level and function of the supraclavicular nerve?

- C3,4 - sensory and postgang symp (gray rami communicans) innervation of the skin overlying the lower half of the posterior triangle of the neck

What are the muscular branch nerves of the ventral rami of the cervical plexus?

- nerve to geniohyoid - nerve to thyrohyoid - ansa cervicalis - phrenic nerve

What is the spinal level and function of the nerve to geniohyoid?

- C1 via CN XII - sensory, postganglionic symp (gray ramus), and motor innervation of the geniohyoid muscle

What is the spinal level and function of the nerve to thyrohyoid?

- C1 via CN XII - sensory, postanglionic symp (gray ramus, and motor innervation of the thyrohyoid

What is the spinal level and function of the superior root of ansa cervicalis?

- C1 - sensory, postgang symp (gray ramus), and motor innervation of the superior belly of the omohyoid

What is the spinal level and function of the inferior root of ansa cervicalis?

- C2,3 - sensory, postgang symp (gray rami communicans), and motor innervation of the sternohyoid, sternothyroid, and inferior belly of the omohyoid muscles

What is the spinal level and function of the phrenic nerve?

- C3,4,5 - sensory, postganglionic symp (gray rami communicans), and motor innervation of the diaphragm

What are the strictly sensory nerves of the cervical plexus?

- greater occipital - lesser occipital - great auricular - 3rd occipital - transverse cervical - supraclavicular

What are the sensory and motor nerves of the cervical plexus?

- suboccipital - nerve to geniohyoid - nerve to thyrohyoid - ansa cervicalis (S+I omohyoid, sternohyoid, sternothyroid) - phrenic nerve