10.4.2006 Infratemportal Fossa & Temporomandibular Joint
Terms
undefined, object
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- The IF is _____ to the zygomatic arch & ___ to the proximal ramus (of mandible).
-
medial
medial - The temporalis muscle arises from ____. It attaches to ______.
- temporal fossa; coalesces & forms tendon deep to zyg. arch); coronoid process
-
BORDERS of IF:
Anterior:
Posterior:
Inferior: -
maxilla bone
mastoid & styloid processes (parts of temporal bone)
alveolar process of maxillary -
BORDERS of IF:
Lateral:
Medial:
Superior: -
ramus of mandible
lateral pterygoid plate
great. wing of sphenoid & infratemporal crest - The IF communicates with the orbit via ______.
- INFERIOR orbital fissure
- The IF communicates with the pterygopalatine fossa medially via ______.
- pterygomaxillary fissure
- The foramen ovale & spinosum are located in what bone?
- greater wing of sphenoid
-
What does the IF contain 1º?
muscles of mastication (which ones?)
____ venous plexus -
mastication-temporalis & pterygoid muscles
pterygoid -
What does the IF contain 1º?
portion of _____
_____ artery -
parotid gland (glenoid process)
Maxillary-main artery of IF -
What does the IF contain 1º?
____ nerve
____ ligament -
mandibular nerve
sphenomandibular ligament - The mastication muscles attach to ____, ____, & ____.
-
lat. & med. pterygoid plates
infratemporal crest
pyramidal process of palatine bone - The lateral & medial pterygoid plates are part of the _____ bone.
- sphenoid
- The infratemporal crest is the _____, lateral edge of the _____ bone.
-
inferior;
sphenoid - The ______ is the angle of the mandible
- gonion
- The mylohyoid muscle attaches to ________.
- the mylohyoid line (in mandible)
- The LINGULA is a bony structure at the level of ____ that leads into _____.
-
mandibular foramen;
mandibular canal - Why is the mandibular canal significant (especially to dentists)?
- Takes inf. alveolar nerve (from mand. n) into mandible to supply inf. jaw--anesthesia bathes inf. alv. branch (lower teeth)
- The angle of the mandible in adults is usually ___-___º. Is it different w/age?
-
115-120º
older adults & infants have increased angle - The temporalis attaches to the _____.
- coronoid process & anterior aspect of mandible
- The masseter attaches to _______.
- lateral surface of ramus & angle of mandible
- The pterygoid muscles are found _____ to the mandible.
- deep
- The _______ pterygoid has 2 heads.
- lateral & medial
- The SUPERIOR head of the lat. pterygoid harises from ____ & inserts into _____.
-
arises: infratemporal crest
attaches: disc b/tw TMJ - The INFERIOR head of the lat. pterygoid arises from ____ & inserts into _____.
-
arises: lateral pterygoid plate
attaches: fovea of neck of mandible - The medial pterygoid runs about the same angle as what muscle?
- masseter (externally)
- The medial pterygoid's deep head arises from ____.
- pterygoid plate; pyramidal process
- The medial pterygoid's superficial head arises from ____.
- tubercle of the maxilla
- The medial pterygoids heads come together & insert into _____.
- angle of the mandible (like the masseter)
- Which muscle arises from the medial pterygoid plate?
- NONE!!! Both lateral & medial arise from lateral plate (lateral surface & medial surface, respectively)
- The temporalis is the 1º ___ & ____ of the jaw, so it ____ the mouth & ___ the jaw.
-
ELEVATOR & RETRACTOR;
closes mouth & retracts jaw (brings it back) - The masseter is for ___, ____, & _____ the jaw.
-
elevating
clenching (grasping after elevates)
protruding - When the masseter protrudes the jaw, what fibers are used?
- superficial fibers that come off the EXTERNAL surface of the zygomatic arch
- The medial pterygoid assists in ____ of the jaw (mandible).
- elevation
- The lateral pterygoid is the 1º_____ of the mandible.
- protruder
- The ____ closes the jaw (as in chewing), while the ___ closes it (as in biting).
-
temporalis-chewing
masseter-biting - Depression & elevation of the mandible is carried b/tw __-__º.
- 40-60º
- ____ is the nerve of mastication.
- V3
- If V3 is injured, what will happen to the jaw?
- swing toward injured side (ipsilateral deviation of chin via pterygoid muscles)
- If V3 is injured what will likely visably atrophy?
- temporal fossa (due to lack of innervation of the masseter)
- The ____ is the 1º artery of the IF.
- maxillary;
- The maxillary a. runs ___ to the neck of mandible & ___ to sphenomandibular ligament.
-
DEEP;
Lateral to Ligament - The maxillary artery is divided into 3 parts. What are the 1st part's branches?
- deep auricular; anterior tympanic; middle meningeal; accessory meningeal; inferior alveolar
- The maxillary artery is divided into 3 parts. What are the 2nd part's branches?
- masseteric; anterior deep temporal; posterior deep temporal; pterygoid; buccal
- The maxillary artery is divided into 3 parts. What are the 3rd part's branches?
- post. sup alveolar; infraorbital; desc palatine; art. of p-goid canal; pharyngal br.; sphenopalatine
- The ___ part of the maxillary supplies muscles, EXCEPT for what artery?
- buccal (b/c buccinator is not a mastication muscle)
- The ____ artery pierces the external auditory meatus.
- deep auricular-1st part of maxillary artery
- The ___ artery travels into the mandible & helps supply the lower jaw.
- inferior alveolar-1st part of maxillary artery
- The ____ artery travels through the foramen spinosum.
- middle meningeal-1st part of maxillary artery
- The ____ artery travels up the internal aspect of the tympanic membrane/cavity.
- anterior tympanic-1st part of maxillary artery
- The ___ artery travels through the foramen ovale & helps supply CNV & related meninges.
- accessory meningeal-1st part of maxillary artery
- The ___ artery helps supply the hard & soft palate (& adjacent areas).
- descending palatine-3rd part of maxillary artery
- The ___ artery is a terminal branch of maxillary artery. It leaves via IO foramen.
- infraorbital-3rd part of maxillary artery
- The ____ artery is the main blood supply of nasal cavity & a terminal branch of max. artery
- sphenopalatine-3rd part of maxillary artery
- The ____ artery penetrates small foramina on post. maxilla to supply upper jaw/teeth.
- posterior superior alveolar-3rd part of maxillary artery
- For a ptx. w/chronic epistaxis (nosebleeds), what can be done?
- ligate maxillary artery (or even ECA) to prohibit blood flow through sphenopalatine
- The ____ venous plexus surrounds the maxillary arterial branches.
- pterygoid
- The pterygoid venous plexus consists of which 2 main veins?
- maxillary & deep facial veins
- How does the deep facial vein allow infection to come from external to internal?
- communiation (via inferior opthalmic vein) superiorly w/cavernous sinus
- The ____ nerve is the main nerve of the infratemporal fossa.
- mandibular (V3)
- V3 carries what kinds of fibers (G, S, V, A, E..)?
- GSA & SVE
- The anterior division of V3 (mandibular) is 1º ____, except for what branch?
-
MOTOR,
except for BUCCAL branch (sensory) - The posterior division of V3 (mandibular) is 1º ____, except for what branch?
-
SENSORY,
except for NERVE 2 MYLOHYOID (innervates m-hyoid & ant. belly of digast) - The trunk of V3 sends the nerve to ____ (tensors) & ____ (meningeal branch)
-
medial pterygoid;
nervus spinosus - The mandibular nerve descends thru ___ & divides inferior & posterior.
- foramen ovale
- After V3 goes through foramen ovale, what branches does it divide into?
- auriculotemporal n, inferior alveolar n, lingual n.
- The ____ nerve ascends to external auditory meatus, ___ to the super. temporal a.
- auriculotemporal
- The auriculotemporal nerve has a loop proximally, which lets ____ go through.
- middle meningeal artery
- The middle meningeal artery travels through which foramen?
- spinosum
- The ____ nerve gives off the mental nerve.
- inferior alveolar
- The _____ branches of V3 are branches to the temporalis.
- anterior & posterior deep temporal nerves
- The auriculotemporal nerve provides sensory innervation to _______.
- anterior-lateral part of face (in front of ear)
- The auriculotemporal has some ___ (GSA..)fibers that hitchhiked on it from _____.
- GVE fibers from CN9
- The GVE fibers that hitchhiked on the auriculotemporal n. will fall off on _____.
- parotid gland
- The parotid gland gets secretory innervation from ______.
- CN 9
- The buccal branch of V3 (aka 'long buccal'; NOT buccal of CN7) supplies ____.
- skin overlying cheek & mucousa lining adjacent area of oral cavity
- The chorda tympani travels through the ____.
- middle ear (but doesn't have much to do with the tympanic cavity)
- The chorda tympani is a recurrent branch of the ____.
- facial nerve
- The chorda tympani branches off CN7 just before CN7 exits the _____.
- stylomastoid foramen
- The chorda tympani leaves the cranium via the _____ fossa & enters the _____.
-
petrotympanic fissure
Infratemporal fossa - Once in the infratemporal fossa, the chorda tympani becomes associated with ____.
- the lingual nerve
- Hitchhiking fibers of the chorda tympani are taking & bringing what?
-
taking: motor fibers into oral cavity
bringhing: sensory fibers back from oral cavity - The motor fibers hitchhiking on chorda tympani are bringing ____ fibers from __.
- PREGANGLIONIC PARASYMPATHETIC from CN 7.
- The pregang. PS fibers from CN7 that hitchhike on chorda tympani synapse on ___ & postgang. have what action?
-
synapse-submandibular ganglion
action-make submandibular & sublingual salivate - Fibers in the chorda tympani traveling back to CN 7/brain stem are fibers of _____.
- taste for the anterior 2/3 of tongue
- Sensation for the anterior 2/3 of the tongue is by ___. What is this a branch of?
-
lingual nerve
branch of CN 5, particularly V3 - The otic ganglion are ____ (symp or PS). It's ____ to V3 as V3 enters the IF.
-
PARASYMPATHETIC;
medial to V3 - The preganglionic PS fibers from ___ run into the otic ganglion & synapse.
- CN IX
- The postganglionic fibers of otic ganglion travel with __ n. to be deposited onto ___.
-
auriculotemporal;
parotid gland---salivation - CN 7 carries out salivation via _______ (which gland?).
- submandibular & sublingual
- CN 9 carries out salivation via ________ (which gland?).
- parotid
- What are the 2 synovial joints of the head?
- TMJ, b/tw ear ossicles in middle ear
- The TMJ is a modified ____ joint b/c it has both ____ & ____.
-
hinge joint;
hinging & gliding - The gliding of the TMJ helps with ____ of the mandible.
- protrusion
- While most synovial joints are lined with fibrocartilage, the TMJ is lined with ______.
- hyaline cartilage
- The ____ fossa is the cranial accepting cavity for the TMJ.
- mandibular
- The _____ is the partial origin for the sphenomandibular ligament.
- spine of sphenoid
- The _____ & _____ frorm the bony anterior border of the mandibular fossa.
- articular tubercle (lateral protrusion) & articular eminence (horizontal portion)
- What's ironic about the articular tubarcle?
- it doesn't articulate with anything
- The _____ is the site of attachment for the lateral ligament of the TMJ.
- articular tubercle (helps stabilize lateral surface of articulation)
- The stylomandibular ligament is a thickening of _____. Where does it arise & attach?
-
parotid fascia
arises: styloid process; attaches: gonion (angle) - The TMJ is closely related to the _______. What's the clinical significance?
-
external auditory meatus
if hit hard, you can fracture ant. wall of external auditory canal - The _____ is the ligament on the medial surface of the TMJ
- sphenomandibular
- The sphenomandibular ligament is a remnant of ____.
- Meckel's cartilage
- The sphenomandibular ligament arises from ____ & inserts onto _____.
-
arises: spine of sphenoid, next to petrytympanic fissure)
inserts: lingula of mandible - The sphenomandibular ligament is good to pierce when anesthitizing b/c ____.
- it helps localize anasthesia around inferior alveolar n. & not spread to other branches of V3
- ______ pierces the sphenomandibular ligament.
- Nerve to mylohyoid
- Dislocation of the TMJ is usually _____ to the articular tubercle. How?
- Head of condyle will jump over articular eminence
- Posterior dislocation of the TMJ is prevented by _____.
- tempanic plate (however, you can drive through this boundry & into external ear) & styloid process
- Medial dislocation of the TMJ is prevented by _____.
- spine of sphenoid
- The TMJ disc is made of _____.
- dense connective tissue
- The 2 joint compartments of the TMJ are ______ & ______.
- suprameniscal & inframeniscal compartments
- The suprameniscal compartment of the TMJ helps with ____ (45-60%) & _______.
- protrusion & retraction
- The inframeniscal compartment of the TMJ helps with ____ & _____.
- elevation & depression
- The ______ is basically the superior head of the lateral pterygoid muscle.
- sphenomeniscus
- The attachment of the sphenomeniscus is into the ____.
- disc of TMJ
- What is the purpose of th esphenomeniscus muscle?
- it pulls the disc forward to prevent bones of TMJ from rubbing against eachother
- An injury to the TMJ of boxers is ______.
- force from below driving head of mandible into middle cranial fossa
- The TMJ is innervated by what nerve(s)?
-
masseteric
auriculotemporal
great auricular - The blood supply to the TMJ is via which arteries?
- superficial temporal, deep auricular, anterior tympanic, ascending pharyngeal