Sistem Neurovaskular

Kraniofasial
Puspita Hajardhini

Oral Biology Department

Faculty of Dentistry Universitas Muhammadiyah Semarang
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 12 pasang saraf kranial

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 Basis Cranii

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Foramen pada Internal Basis Cranii

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Foramen pada
Eksternal Basis Cranii

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 N. Trigeminal (N.V)

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N. Trigeminal (N.V)
• Tonjolan nervus di cranium, berupa sensory root→ ganglion trigeminal (ganglion
semilunar atau gasserian), terletak anterior dari bagian petrosa tulang temporal.
• Anterior dari ganglion trigeminal→muncul percabangan sensorik menjadi 3
nervu/divisi →masing-masing nervus keluar dari cranium melalui 3 fissura/foramen
berbeda di tulang sphenoid.
• Percabangan N.V :
• Divisi Ophthalmic →melewati fissura orbitalis superior (berhubungan dengan orbita)
• Divisi Maxillary →melewati foramen rotundum (berhubungan dengan fossa
pterygopalatina)
• Divisi Mandibular →melewati foramen ovale (berhubungan dengan fossa
infratemporal)
N. Trigeminal (N.V)

• Setiap divisi membawa neuron primer untuk :

• Nyeri dan suhu (the cell body of the primary neuron is
located in the trigeminal ganglion)
• Sentuhan (the cell body of the primary neuron is located in
the trigeminal ganglion)
• Proprioception (the cell body of the primary neuron is located
in the mesencephalic nucleus of V)
• Bersifat Parasimpatis →untuk distribusi serabut saraf ke seluruh
leher-kepala

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N. Ophtalmicus (N.V1)

• Sensory root
• Saraf aferen →konjungtiva, kornea, bola mata, orbita, dahi, sinus ethmoidalis dan
sinus frontalis, durameter, kavum nasi, hidung.
• Berjalan ke anterior pada dinding lateral sinus cavernosus→superior dari N. III dan
N.IV, inferior dari N.maksilaris (N.V1)
• Sebelum memasuki orbita, melalui fissura orbita superior bercabang menjadi :
• N. Lacrimal
• N. Frontal
• N. Nasociliary

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• Percabangan N. opthalmicus

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 N. Maksilaris (N.V2)

• Berjalan di sepanjang dinding lateral sinus cavernosus

• Melewati fossa cranial media kedalam fossa pterygopalatine melalui
foramen rotundum tulang sphenoid.
• Dalam fossa pterygopalatine bercabang menjadi 4 : N. zygomatikus,
N. alveolaris superior anterior, media dan posterior, N. palatina
mayor dan minor, N. nasopalatina.
• N. infraorbitalis dianggap keberlanjutan dari N. maksilaris (N.V2).
• N. meningeal → cabang dalam fossa kranial media yang
mempersarafi meninges.

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• Ganglion pterygopalatine berada inferior dari
N. maksilaris dalam fossa pterygopalatine.
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Ada 2 percabangan ganglionik
yang menghubungkan
N.maksilaris (N. V2) terhadap
ganglion pterygopalatina
• Serabut sensoris tanpa
sinaps –melewati ganglion
pterygopalatine
• Serabut parasimpatis
bersinaps– serabut autonom
postganglion terhadap
kelenjar lakrimal. Sinaps
antara serabut preganglionic
dan serabut postganglionic.

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Persarafan gigi dan gingiva maksila

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N. Mandibularis (N.V3)

• Bersifat sensoris dan motoris

• Dibentuk sensory root (besar) dan motor root (kecil)—yang
bergabung setelah melewati foramen ovale untuk
memasuki fossa infratemporalis
• Muncul percabangan meningeal dan pterygoid medialis
sebelum terbagi ke dalam divisi anterior dan posterior

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• Divisi Anterior : lebih kecil,
dominan motor, dengan 1
cabang sensoris (N. bukalis) :
N. masseteric, N. deep
temporalis anterior dan
posterior, N. lateral pterygoid,
N. bukalis
• Divisi Posterior : lebih besar,
dominan sensoris, dengan 1
percabangan motor (N.
mylohyoid) : N.
auriculotemporal, N. lingualis,
N. alveolar inferior, N.
Mylohyoid
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Persarafan gigi dan gingiva mandibula

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N. Fasialis (N.VII)

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• Saraf aferen dan eferen
• Keluar dari otak, lalu masuk ke meatus akustikus internus di
bagian petrosa tulang temporal.
• Dalam tulang temporal, bercabang saraf eferen → N. petrosal
mayor dan chorda tympani (keduanya parasimpatis)
• Batang saraf fasialis keluar dari cranium melalui foramen
stylomastoid tulang temporal
• Lalu bercabang menjadi N. auricular posterior, N. digastricus
posterior (percabangan ke posterior belly otot digastricus), N.
stylohyoid (mempersarafi otot stylohyoid)→serabut eferen

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• The facial nerve then passes into
the parotid salivary gland and
divides the gland into superficial
and deep lobes.
• The trunk of the facial nerve
itself divides into numerous
branches to supply the muscles
of facial expression but does
not innervate the parotid salivary
gland itself

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Percabangan ke otot-otot ekspresi wajah
• These branches to the muscles of facial expression include: the temporal, zygomatic,
buccal, (marginal) mandibular, and cervical branches.
• The temporal branches supply the muscles anterior to the ear, frontal belly of
the epicranial muscle, superior part of the orbicularis oculi muscle, and corrugator
supercilii muscle.
• The zygomatic branches supply the inferior part of the orbicularis oculi muscle and
zygomatic major and minor muscles.
• The buccal branches supply the muscles of the upper lip and nose and buccinator,
risorius, and orbicularis oris muscles.
• The (marginal) mandibular branch supplies the muscles of the lower lip and mentalis
muscle. The mandibular branch should not be confused with the mandibular nerve
or V3.
• The cervical branch runs inferior to the mandible to supply the platysma muscle.

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Vaskularisasi
Kraniofasial

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• The origins from the heart of the common carotid and subclavian
arteries that supply the head and neck are different for the right
and left sides of the body.
• For the left side of the body, the common carotid and
subclavian arteries arise directly from the aorta.
• For the right side of the body, the common carotid and
subclavian arteries are both branches from the brachiocephalic
artery. The brachiocephalic artery is a direct branch of the aorta.
Arteri karotis interna

• The internal carotid artery is a division that travels superiorly in a slightly

lateral position in relationship to the external carotid artery after leaving the
common carotid artery.
• This artery is covered by the large SCM muscle on each side of the neck.
• The internal carotid artery has no branches located in the neck but continues
adjacent to the internal jugular vein within the carotid sheath to the skull
base, where it enters the cranium.
• The internal carotid artery supplies intracranial structures and is the source of
the ophthalmic artery, which supplies the eye, orbit, and lacrimal gland

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Arteri karotis eksterna

• As with the internal carotid artery, the external carotid artery begins at the
superior border of the thyroid cartilage, at the termination of the common
carotid artery and the carotid sheath.
• The external carotid artery travels superiorly in a more medial position
in relationship to the internal carotid artery after arising from the
common carotid artery.
• The external carotid artery supplies the extracranial tissue of the head
and neck, including the oral cavity.
• The external carotid artery has four sets of branches grouped according to
their location to the main artery: the anterior, medial, posterior, and terminal
branches

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Percabangan Arteri karotis eksterna
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Percabangan Arteri Maksilaris
 Cabang Pars Mandibularis (Percabangan pertama)

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 Cabang Pars Pterygoidea (Percabangan kedua)

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 Cabang Pars Pterygopalatina (Percabangan ketiga)

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Cabang Pars Pterygopalatina (Percabangan ketiga)
 Sistem Vena

• The internal jugular vein drains the brain as well as most of

the other structures of the head and neck (Table 6-3),
whereas the exter- nal jugular vein drains only a small part
of the extracranial structures. However, the two veins have
many anastomoses. The beginnings of both veins are
discussed initially and, later, their route to the heart is
discussed.

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Sistem Vena
Vena Jugularis Interna
Vena Jugularis Eksterna
 Vena Fasialis

• The facial vein drains into the internal jugular vein.

• The facial vein begins near the medial canthus of the eye with the junction of
two veins from the frontal region, the supratrochlear vein and supraorbital
vein.
• The supraorbital vein also anastomoses with the ophthalmic veins. The
ophthalmic veins drain the orbit. This anastomosis provides a direct
communication with the cavernous sinus.
• The facial vein receives branches from the same areas of the face that are
supplied by the facial artery.
• The facial vein anastomoses with the deep veins such as the pterygoid
plexus of veins in the infratemporal fossa and with the large retromandibular
vein before joining the internal jugular vein at the level of the hyoid bone

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Vena Profunda
Kepala
Percabangan Vena Fasialis

• superior labial vein drains the upper lip area;

• inferior labial vein drains the lower lip area.
• submental vein drains the mental region including the chin as well as the
submandibular region.
• dorsal lingual veins that drain the dorsal surface of the tongue,
• deep lingual vein drains the ventral surface of the tongue
• sublingual vein that drains the floor of the mouth.
• they also may drain indirectly into the facial vein or directly into the internal jugular
vein.
• The lingual veins are important clinically as they are capable of rapid and direct
topical drug absorption.

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Vena retromandibularis

• The retromandibular vein will form the external jugular vein from a part of its route. The
retromandibular vein is formed from the merger of the superficial temporal vein and maxillary
vein.
• The retromandibular vein emerges from the parotid salivary gland and courses inferiorly. This
vein and its beginning venules drain areas similar to those supplied by the superficial
temporal and maxillary arteries.
• Inferior to the parotid salivary gland, the retromandibular vein usually divides into two parts
• The anterior division joins the facial vein, and the posterior division continues its inferior
course on the surface of the SCM muscle.
• After being joined by the posterior auricular vein, which drains the lateral scalp posterior to
the ear, the posterior division of the retromandibular veins becomes the external jugular vein

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Vena temporal superfisialis

• The superficial temporal vein drains the lateral scalp and is superficially located in skin
covering the temporal region and can sometimes be noted on a patient during an
extraoral examination.
• The superficial temporal vein goes on to drain into and form the retromandibular vein,
along with the deeper maxillary vein.

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Vena maksilaris

• The maxillary vein is deeper than the superficial

temporal vein and begins within the
infratemporal fossa by collecting blood from
the pterygoid plexus of veins while
accompanying the maxillary artery.
• Through the pterygoid plexus of veins, the
maxillary vein receives the middle meningeal,
posterior superior alveolar, inferior alveolar
veins, as well as other veins such as those from
the nasal cavity and palate, which are served by
the maxillary artery.
• After receiving these veins, the maxillary vein
merges with the super- ficial temporal vein to
drain into and form the retromandibular vein.

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Pterygoid Plexus of Veins

• The pterygoid plexus of veins is a collection of small anastomosing vessels

surrounded by the lateral pterygoid muscle and surrounding the second part (or
pterygoid part) of the maxillary artery on each side of the face within the
infratemporal fossa.
• This vascular plexus anastomoses with both the facial and retromandibular veins.
• The pterygoid plexus of veins drains the veins from the deep parts of the face and
then drains into the maxillary vein.
• The middle meningeal vein also drains the blood from both the dura mater of the
meninges (not the arachnoid or pia mater) and the bones of the cranial vault into the
pterygoid plexus of veins.
• Some parts of the pterygoid plexus of veins are located near the maxillary
tuberosity, reflecting the drainage of both the maxillary and mandibular dental
arches into the vascular plexus.

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Vena alveolaris superior posterior

• The pterygoid plexus of veins also

drains the posterior superior
alveolar vein, which is formed by
the merging of its dental and
alveolar branches.
• The dental branches of the posterior
superior alveolar vein drain the pulp
of the maxillary teeth by way of each
tooth’s apical foramen. The alveolar
branches of the posterior alveolar
vein drain the periodontium and
gingiva of the maxillary teeth.

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Vena alveolaris inferior

• The inferior alveolar vein forms from the

merging of its dental branches, alveolar
branches, and mental branches in the
mandible, where they also drain into the
pterygoid plexus of veins.
• The dental branches of the inferior alveolar
vein drain the pulp of the mandibular
teeth by way of each tooth’s apical
foramen. The alveolar branches of the
inferior alveolar vein drain the
periodontium and gingiva of the
mandibular teeth.
• The mental branches of the inferior alveolar
vein enter the mental foramen after draining
the mental regions with the chin on the outer
surface of the mandible, where they
anastomose with branches of the facial vein.

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Terima kasih