week 7 Flashcards
1
Q
what are the 2 main parts of the mandible
A
- body
- ramus
2
Q
what is a symphysis
A
secondary cartilaginous joint
3
Q
what is the mental symphysis
A
In a foetus there is a fibrous joint / material between the 2 halves but these 2 halves then unite by a bony union by the time of birth
not a true symphysis
4
Q
what is the mental protuberance
A
forward projection of the chin
5
Q
what is found in the middle of the mental protuberance
A
mental tubercle
6
Q
what passes through the mental foramen
A
the mental nerve emerges from bone here as well as mental blood vessels
7
Q
what is the mental nerve a continuation of
A
inferior alveolar nerve
8
Q
where can the mental foramen be found on the mandible
A
just below the premolars
9
Q
what is the oblique line
A
where the buccinator muscle attaches to the mandible
10
Q
what is the base of the mandible
A
the underside of the mandible
11
Q
where can you see the digastric fossa
A
when looking at the mandible from underneath
12
Q
what attaches to the digastric fossa
A
the digastric muscles (right and left)
13
Q
what is the alveolar process of the mandible
A
the part of the bone that bears the teeth
the roots go down into the alveolar process
14
Q
what happens to the alveolar bone if you lose your teeth
A
the alveolar process atrophies / disappears
If you lose the teeth, the alveolar process disappears and you are left with the body without the alveolar process
15
Q
what is the problem with losing the alveolar process
A
it means that the mental foramen comes to be very high up on the remaining body
If the mandible is very atrophic, (ie if the person lost their teeth a long time ago) you can get patients with the mental foramen sitting on the top part of the body of the mandible so in a patient with dentures the denture might sit on the mental foramen / nerve and this can be a cause of pain
16
Q
what is the mylohyoid line
A
found on the medial surface
This is for the attachment of the mylohyoid muscle
17
Q
what do the mylohyoid muscles do
A
The 2 mylohyoid muscles meet in the midline and they are a bit like a hammock supporting the structures in the oral cavity such as the tongue
18
Q
why is the mylohyoid line important
A
This line is separating the tissues of the floor of the mouth from the submandibular region
19
Q
what is the problem with an abscess bursting above or below the mylohyoid line
A
above: infected material comes into the tissues in the floor of the mouth
below: infected material is released into submandibular region
if it is a really bad infected it can start to track back and drop down through the tissue planes and into the thorax (if this happens it doesn’t matter if it is coming from the floor of the mouth or the submandibular region as they both lead back into the tissues lateral to the pharynx and the infected material can pass down into the thorax)
This is called Vincent’s Angina
20
Q
why is the mylohyoid line important in the making of dentures
A
if you are making dentures for the lower jaw, the denture has to stop short of the mylohyoid muscle
otherwise when you are speaking or eating, the contraction of the mylohyoid will lift the denture
and in the same way the denture has to miss the oblique line on the external surface otherwise it will be interfering with the buccinator muscle
21
Q
what is the smooth area behind and below the mylohyoid line called
A
the area where the submandibular gland lies
called the submandibular fossa
22
Q
what is the smooth area above the mylohyoid line
A
the area where the sublingual salivary gland lies
called the sublingual fossa
23
Q
what are the little bumps in the midline of the internal surface of the mandible called
A
mental spines / genial tubercles
24
Q
what attaches to the upper mental spines
A
genioglossus muscle
25
what does the genioglossus muscle do
the muscle that sticks your tongue out
26
what attaches to the lower mental spine
geniohyoid muscle
27
what does the geniohyoid muscle do
pulls the hyoid bone forward when you are swallowing
28
what groove is found near the mylohyoid line
mylohyoid groove
29
what nerve travels in the mylohyoid groove
nerve to mylohyoid
30
where does the nerve to mylohyoid come from
branch off the inferior alveolar nerve
31
where does the tendon of the temporalis muscle attach
attaches around the coronoid process
| also comes quite far down the anterior border of the ramus
32
what is the coronoid process
projection of the mandible
33
what is the condylar process
projection of the mandible
| consists of the head and neck
34
what does the inferior alveolar nerve pass into
mandibular foramen
35
what is the mandibular canal
it is found within the mandible and carries the IAN inside the bone
36
what is the problem with the lingula during and IAN block
if the lingula is big the needle can hit the lingula rather than advancing forward so the LA is deposited to the wrong area
37
why is there a rough surface at the inner aspect of the ramus at the angle of the mandible
where the attachment of the medial pterygoid muscle is
38
what is the mandibular notch
The mandibular notch is the notch between the coronoid process and the condylar process
The nerve and vessels to the masseter that are coming from the mandibular nerve comes out and heads laterally and pass through this notch
39
what is the pterygoid fovea
found at the front of the neck of the mandible (a little depression)
This pterygoid fovea is part of the attachment for the lateral pterygoid muscle
40
what is the pterygoid hamulus
the little projection at the back of the mouth at the lower end of the medial pterygoid plate
41
where is the start of the origin of the pterygomandibular raphe
pterygoid hamulus
42
what is the pterygomandibular raphe
this is a fibrous band between the pterygoid hamulus and the mandible
43
what are the 3 muscles that the pharynx is partly surrounded by
3 constrictor muscles
○ Superior
○ Middle
○ Inferior
44
what are the constrictor muscles made from
skeletal
45
what sort of control is the constrictor muscles under
strong reflex control
46
what do the constrictor muscles do
When you swallow the constrictors sort of grasp the bolus and help to move it down through the pharynx
47
what does the superior constrictor muscle attach to
a little bony projection from the base of the skull found a little bit in front of the foramen magnum called the pharyngeal tubercle
48
what is found at the back of the pharynx where these muscles pass
pharyngeal raphe
49
what muscle is attached to the side of the hyoid bone
middle constrictor muscle
50
what is found between the thyroid and cricoid cartilage
fibrous band
51
what muscle does the thyroid and cricoid cartilage and fibrous band give rise to
inferior constrictor muscle
52
what muscle is attached to the styloid process
stylopharngeus muscle
53
where does the stylopharyngeus muscle go
comes down from styloid process
blends with wall of pharynx
passes between superior and middle constrictor muscle
54
where does the pharynx tend to be open
towards the front
The constrictor muscles are coming from their different origins and going around the sides of the pharynx and meeting each other at the back
55
what nerve supplies the mucosa of the oral phayrnx and nasal pharynx
glossopharyngeal nerve
56
what nerve supplies the stylopharyngeus muscle and constrictor muscles
- vagus nerve supplies constrictor muscles
| - glossopharyngeal nerve supplies stylopharyngeus
57
what is the first part of swallowing
voluntary
chewing and moving the bolus
58
how does the styloglossus help with swallowing
helps move the bolus back
59
when the 2 tendons that wind around the pterygoid hamulus join together what is this called
palatal aponeurosis
the 2 tendons spread out and form a flattened sheet that forms the skeleton of the soft palate
60
what muscle runs from the pterygoid hamulus to the base of the skull
tensor veli palatini muscle
61
what is the tensor veli palatini quite close to at the base of the skull
close to where the auditory tube is
62
what happens when the tensor veli palatini muscle contracts
the tendons are pulled so the soft palate becomes tense
63
what nerve supplies the tensor veli palatini muscle
mandibular nerve (CN5)
64
what pharyngeal arch is the tensor veli palatine muscle fromed from
first pharyngeal arch of the emrbyo
65
what does the auditory tube allow for
allows air into the middle ear
66
what muscle is found coming down from the base of the skull behind the auditory tube to attach to the upper aspect of the palatal aponeurosis
levator veli palatini muscle
67
what is the function of the levator veli palatini muscle
pulls the palate up
68
what nerve supplies the levator veli palatini
vagus nerve
69
what muscle runs from the tongue up to the palatal aponeurosis
palatoglossus muscle
70
what nerve supplies the palatoglossus muscle
vagus nerve
71
what muscle attaches to the palatal aponeurosis and blends with the wall of the pharynx
the palatopharyngeus muscle
72
what nerve supplies the palatopharyngeus muscle
vagus nerve
73
what is the uvulua
found at the back end of the soft palate
| the little piece that hangs down
74
what is the function of the uvulua
improves the seal of the soft palate when swallowing fluids
75
what muscle runs in the soft palate immediately on the upper surface of the palatal aponeurosis on either side of the midline
uvular musles
76
what is the space between the palatoglossal folds called
isthmus of the fauces
77
where is the maxillary tuberosity found
an elevation of the posterior part maxilla is the maxillary tuberosity
This is just behind the upper third molar
78
what is the articular disc
Disc of fibrous material inside the TMJ and it fuses with the back part of the capsule
79
how many compartments does the TMJ have
The joint has 2 compartments - an upper and a lower part
80
what nerve comes out of the lateral pterygoid muscle
buccal nerve
81
what is the buccal nerve
A long nerve which is a branch of the mandibular nerve that is sensory to the cheek / mucosa at the back of the cheek
This nerve also gives branches to the gums / buccal gingivae
82
what artery comes out of the lateral pterygoid muscle close to the buccal nerve
maxillary artery
sometimes it runs deep to the lateral pterygoid muscle
83
what is the maxillary artery a branch of
external carotid artery
84
what other artery comes off the external carotid artery
superficial temporal artery
85
what artery comes off the maxillary artery
inferior alveolar artery
86
what gland does the external carotid artery run through
parotid salivary gland
87
roughly where does the external carotid artery brach
Just as this artery reaches the area of the TMJ, just around the upper part of the parotid gland this artery splits into 2 terminal branches
88
what does the maxillary artery supply
Runs forward to supply the tissues in the infratemporal fossa and gives off branches to the upper and lower jaws
89
where does the inferior alveolar artery run
The inferior alveolar artery runs into the mandible along with the inferior alveolar nerve
There would be a vein inside the jaw as well accompanying the artery and nerve
90
what is found amongst the fat underneath the ramus of the mandible
pterygoid venous plexus
lots of veins
91
what do you call the area that is deep to the ramus
infratemporal fossa
92
how many heads does the lateral pterygoid muscle
2 heads
- superior
- inferior
93
where does the superior head of the lateral pterygoid muscle come from
base of the skull
94
what direction does the fibres of the superior head of the lateral pterygoid muscle run
Its fibres run backwards and downwards
95
where does the superior head of the lateral pterygoid muscle attach to
As they run back the fleshy fibres gives way to tendon and the tendon attaches to the capsule of the TMJ
96
where does the inferior head of the lateral pterygoid muscle come from
lateral side of the lateral pterygoid plate
97
what nerve and artery are superficial to the inferior head of the lateral pterygoid muscle
The buccal nerve and the maxillary artery is superficial to this muscle
98
what direction does the fibres of the inferior head of the lateral pterygoid muscle run
Fibres are running backwards and slightly upwards as they go
99
where does the inferior head of the lateral pterygoid muscle attach to
becomes tendonous just before they reach the capsule of the TMJ
100
as well as the capsule, where else do the 2 heads of the lateral pterygoid muscles attach to
pterygoid fovea on the mandible
101
what happens when the lateral pterygoid muscle contracts
When the lateral pterygoid contracts it pulls on the neck of the mandible and pulls on the capsule of the TMJ and the disc inside
so the whole of the head of the mandible slides out of its fossa to the eminence in front
So you open your mouth and the head of the mandible slides forward / protrudes the mandible due to the contraction of the lateral pterygoid
protracts the mandible
102
what are the 2 heads of the medial pterygoid muscle
- superficial head
| - deep head
103
where does the inferior alveolar nerve run
runs deep to the lateral pterygoid muscle
runs downwards and forwards and into the mandible
Found fairly close to the maxillary artery as it is going to run in the same path as the inferior alveolar artery
104
where does the inferior alveolar nerve enter
mandibular foramen
goes into the mandibular canal
105
just before the inferior alveolar nerve enters the mandibular foramen it gives off a branch, what is it called
nerve to mylohyoid
106
what does the nerve to mylohyoid supply
mylohyoid muscle
anterior belly of the digastric muscle
107
what nerve is found in front of the inferior alveolar nerve
lingual nerve
108
where does the lingual nerve come form and go
Comes out from undercover of the lateral pterygoid muscle
it makes it's way down to the area of the mandible near the 3rd lower molar nerve
109
where does the medial pterygoid muscle attach to the mandible
at the angle of the mandible
110
where does the tendon of the superficial head of the medial pterygoid muscle attach
maxillary tuberosity
111
where do the fibres of the deep head of the medial perygoid muscle attach
medial side of the lateral pterygoid plate
112
what direction do the fibres of the medial pterygoid muscle run
Fibres are running downwards and backwards and also coming out towards us
113
If the 2 medial pterygoid muscles contract together (right and left) what would they do?
○ Muscle fibres are coming downwards to the angle of the mandible
○ So if these muscles contract they are going to elevate the mandible
○ 2 muscles contracting together would also pull the mandible forwards
○ So the medial pterygoid muscle can elevate and protract the mandible
114
what happens if only the left medial pterygoid muscle contracts
If the left side contracts it will pull on the deep side of the angle of the mandible, it will pull the mandible towards the opposite side
Will pull it medially so the mandible swings to the opposite side that is contracting
115
what movements of the mandible can hte medial ptergoid muscle cause
An elevator, protractor and moves mandible to other side when it contracts
116
does the medial pterygoid muscle have to turn a corner in order to be attached to the medial side of the lateral pterygoid plate
no
The lateral pterygoid plate is not sitting straight but actually sits at an angle
this allows the medial pterygoid muscle to attach to the medial side of the lateral pterygoid plate and slide out that way rather than having to turn a corner
117
is the pterygomandibular space an anatomy term
no
more clinic
118
what is the pterygomandibular space
This is the area between the ramus of the mandible and the medial pterygoid muscle and below the lateral pterygoid space
119
what is the significance of the pterygomandibular space
This is the space where the LA is going to be given
120
what is behind the area of the pterygomandibular space
Parotid gland is just behind this area - don’t want LA to go there
121
where does the main trunk of the mandibular nerve come frm
foramen ovale in the sphenoid bone in the base of the skull
122
what is the first branch to come off the main trunk of the mandibular nerve
nerve to the medial pterygoid muscle
123
what 2 divisions does the mandibular nerve split into
○ Anterior division
| ○ Posterior division
124
where does the anterior division run initially
At the start the anterior division runs very high up in the infratemporal fossa near the base of the skull
This happens deep to the lateral pterygoid muscle
125
what is the first branch of the anterior division of mandibular nerve
nerve to the masseter muscle
126
where does the nerve to the massester muscle run
Runs laterally and into the mandibular notch between the head and the neck on one side and the coronoid process and enters the deep aspect of the masseter
127
what is the second branch of the anterior division of mandibular nerve
the deep temporal nerves
128
where do the the deep temporal nerves run
they run into the deep aspects of the temporalis muscle
Approach from the medial side
129
what is the branch after the deep temporal nerves
nerves to lateral pterygoid muscle
130
after the nerve to the lateral pterygoid muscle, where does the anterior division go
start to distribute itself to the skin of the cheek and the mucosa inside the cheek and the branches to the gums on the buccal sides of the teeth
becomes the buccal nerve
131
where does the buccal nerve come out between
2 heads of the lateral pterygoid muscle
132
what muscles does the anterior division supply
masseter
temporalis
lateral pterygoid muscle
133
does the anterior divison supply sensation
the last part (buccal nerve) is sensory to the cheek, skin of mucosa and gums
134
When does the anterior division stop becoming the anterior division and become the buccal nerve?
Not very clear in the books
Changes when it comes through the heads of the lateral pterygoid to come out to be the sensory nerve
Could argue when the last motor nerve comes off it is then the buccal nerve
Doesn’t actually matter
The buccal nerve is the continuation of the anterior division of the mandibular nerve once the motor nerves have come off
135
what is the most anterior branch of the posterior division
lingual nerve
136
what does the lingual nerve supply
Lingual nerve is a purely sensory nerve
Provides sensation to
§ the mucosa of the anterior two thirds of the tongue of its own side,
§ the floor of the mouth of its own side and
§ The lingual gingiva on its own side
137
where does the lingual nerve pass
Passes close to the bone on the inner aspect of the area where the 3rd molar tooth is sitting, close to the internal aspect of the mandible
Extractions of lower 3rd molar can put this nerve at risk
138
what nerve is next to the lingual nerve
inferior alveolar nerve
139
where does the inferior alveolar nerve travel
Enters mandibular foramen
Runs forward in the bone within the mandibular canal
Continues below the area where the roots of the molar teeth are
140
what nerve does the inferior alveolar nerve give off
mental nerve
141
where does the mental nerve come out
round about the area of the premolars the mental nerve comes out through the mental foramen
142
what does the mental nerve supply
Supplies the skin on the chin and the skin of the lip and the mucosa
143
what is the nerve that is a continuation of the inferior alveolar nerve called
incisive nerve
144
what does the incisive branch supply
Carrying on in the bone round to the area of the canines and incisors is the continuation of the inferior alveolar nerve which is often called the incisive branch of the nerve
145
before the inferior alveolar nerve enters the mandible what does it give off
gives off the little branch called nerve to the mylohyoid
146
what does the nerve to the mylohyoid supply
anterior belly of the digastric muscle
| mylohyoid muscle
147
what nerve supplies the posterior belly of the digastric muscle
facial nerve
148
what is the only motor branch in the posterior division
nerve to mylohyoid
149
what artery runs up beside the mandibular branch
middle meningeal artery
150
what artery does the middle meningeal artery come from
maxillary artery
151
how does the middle meningeal artery pass into the cranial cavity
passes through the foramen spinosum
152
coming from the mandibular division, what branch forms a little loop of nervous tissue around the middle meningeal artery
auriculotemporal nerve
153
what does the auriculotemporal nerve supply
Supplies sensation to the TMJ and carries on up to supply sensation to the skin anterior to the ear
154
what does the posterior division of the mandibular nerve give off
Lingual nerve
IAN
Auriculotemporal nerve
(nerve to mylohyoid)
155
what nerve joins the lingual nerve
a branch of the facial nerve called the chorda tympanii
156
how is sensory information about taste conveyed
Sensory fibres leaving taste buds and travel from the tongue in the lingual nerve
These fibres then come off and run in the chorda tympanii nerve, join the facial nerve and then go to the brain stem via the facial nerve
157
where does the chorda tympanii run
Branches off from the facial nerve close to the middle ear
Called the chorda tympani because it runs across the inside of the upper part of the ear drum (tympanic membrane)
158
what does the chorda tympanii carry
Carries fibres concerned with taste from the anterior 2/3s of the tongue
(special sensation)
159
what sort of sensation is supplied by the lingual nerve
general sensation
160
what sort of supply does the submandibular gland and sublingual gland receive
these have a parasympathetic supply
161
what nerve carries the pre-ganglionic fibres for the parasympathetic supply for salivary glands
facial nerve
162
what makes the submandibular and sublingual salivary glands secrete
Chorda tympani also carry the pre-ganglionic parasympathetic fibres that make the sublingual and submandibular salivary gland secrete
163
What lies between the head of the mandibular and the mandibular fossa
There is an articular disc
| Fibrous dense tissue
164
what passes through the incisive foramen
Nasopalatine nerve
| Branch of maxillary nerve
165
what does the nasopalatine nerve supply
Supplies hard palate
166
what passes through the greater palatine foramen
greater palatine nerve
| branch of maxillary nerve
167
what does the greater palatine nerve supply
Posterior 2/3s of hard palate on its side
168
what is found just behind the greater palatine foramen
1/2/3 little holes
The lesser palatine nerve comes through these
They have their own little bony canals
169
whatt does the lesser palatine nerve supply
They supply the soft palate (sensory)
170
why do you want to avoid LA in the area of the soft palate
can affect swallowing mechanism
171
if you see a distinct groove in the bone of the hard palate what would be running in this groove
Greater palatine artery
172
where does the masseter muscle attach
lower borders of zygomatic arch and deep surface
lateral surface of the ramus of the mandible / most of the outer surface of the ramus of the mandible
173
what direction do the fibres of the masseter run
Fibres run downwards and slightly backwards (superficial)
| Deeper down there are more vertical fibres
174
what action is produced when the 2 masster muscles contract together
§ It elevates - pulls the mandible up
§ But because the superficial fibres run slight backwards there is another movement as well - it will pull the mandible slightly forward as well so helps with protrusion of the mandible as well
Elevator and protractor
175
what is the nerve supply of the masseter muscle
nerve to masseter
branch of mandibular dividion
comes through the mandibular notch to reach masseter muscle
176
where does the masseter attach
lower border of zygoma
177
what attaches to the inferior temporal line
Temporalis muscle attaches to this line
| Runs from temporal fossa
178
what is the temporalis muscle covered by
dense fascia
179
where does the fascia over the temporalis muscle attach
this runs as far as the superior temporal line and to the upper edge of the zygomatic arch
180
where does the tendon of the temporalis muscle attach
Tendon attaches along edge of coronoid process, along anterior border of ramus almost to the lower 3rd molar tooth
181
what direction do the fibres of the temporalis run
Anterior - vertically to coronoid process, anterior border, almost 3rd molar
Posterior - deep to zygomatic arch then attach to coronoid process
182
what does the temporalis muscle do
• Elevation of mandible
• Retraction / retrude mandible
Only muscle that pulls the mandible back
183
what nerve supplies the temporalis muscle
mandibular division - deep temporal nerves
184
what is the buccinator muscle
Muscle of facial expression used when eating
185
what is a raphe
Fibrous tissue between 2 muscles
186
where do the upper fibres of the buccinator come from
come from side of maxilla
| Above the vestibule of the mouth
187
where do the lower fibres of the buccinator come from
coming from the mandible
To do with the oblique line
This is where these fibres arise from
188
what way are the fibres of the buccinator arranged
• There is a criss crossing arrangement
Upper middle fibres run up and then pass into lower lip and blend with orbicularis oris
Lower middle fibres run down and then pass into upper lip and blend
189
what is the modiolus
At angle of mandible the cheek is thicker and this is called the modiolus
190
how does the parotid duct enter the oral cavity
has to pierce the buccinator to get into the oral cavity
Arrangement of muscle fibres around it
Comes into mouth beside crown of second upper molar
